Dr. Zuckerman makes some excellent points in the presentation he gave at the Current Solutions Shoulder and Elbow Course held in Tampa, Florida this January. Many of you call it the Frankle Meeting. One of the many things I like is his lecture style. He tells you what he is going to say, says it, and then tells what he said. It is an old trick performed brilliantly by a not-so-old rhetorician.
He makes the point of treating the person with the fracture, not just the fracture. This is something we are all aware of but it came to life today when I saw an 83 year old woman who had fallen three days previously and sustained a humeral surgical neck fracture with a mildly displaced (posterior) greater tuberosity fracture. We talked about treatment options and she just wanted a sling since “I didn’t use that arm very much overhead before.”
Interestingly, Zuckerman states that he uses open reduction and internal fixation more commonly than he did a decade ago, as our understanding of medial calcar importance and bone grafting techniques has improved, along with the increased sophistication and efficacy of internal fixation devices.
I was struck by his comments in regard to using an arthroplasty to treat an acute fracture. He feels comminution and poor bone quality remain indications in his practice but the risk of avascular necrosis alone is insufficient for him to insert a prosthesis. He makes the point that AVN in the shoulder is better tolerated than AVN of the hip.
View his presentation on G9MD.com. Wise words from an expert. Look under meetings, Current Solutions in Shoulder and Elbow 2011.