A Case of Bilateral Severe Proximal Humeral Fracture Treated Operatively and Conservatively

Introduction We present a case of active 54-year-old male who, over a period of one year, sustained severe fractures of his shoulder joints bilaterally. The first trauma was treated operatively but the intervention was unsuccessful. Intensive rehabilitation was performed which led to unexpectedly good functional results. Few months later the patient suffered same type of injury contralaterally. Only the rehabilitation protocol was repeated and this led to even better results. Materials and Methods We used the Neer classification to determine the type of fracture. The right shoulder was treated operatively with a PHILOS plate implanted. The left shoulder joint was treated only conservatively. To evaluate the condition of the shoulder joints after the treatment we used the DASH Score. To evaluate the pain in the shoulder joints we used the VAS system. To evaluate the change of quality of life we used the SF-36 questionnaire (provided by RAND Healthcare). There were two evaluations done: one 40 days after treatment for both shoulder joints and another one: 18 months for the right shoulder and 6 months for the left shoulder Results The DASH Score result for right shoulder was 60.83 pts. on the 40 ^th day and 10 pts., 18 months later. For the left shoulder it was 56.66 pts. on the 40 ^th day and 7,5 pts. on the 6 ^th month. The results based on the Visual Analogue Scale were as follows: 5 pts. for right shoulder and 4 pts. for the left shoulder on the 40 ^th day. Several months later the patient reported 1pt. for both shoulder joints. Conlusions Often when operative treatment has to be postponed or is impossible, conservative treatment can give very good results if carried out strictly.