In elderly patients, these type of fractures are usually due to a fall. In younger patients, high energy injuries are more common. Patients present with severe pain and bruising around the shoulder joint, unable to move the shoulder.
In the casualty department the patient will receive pain medication and will have X-rays taken as well as a CT-scan if the fracture is displaced.
If the fracture is undisplaced, it will be treated conservatively in a sling for six weeks. Regular X-rays will be taken to make sure it did not displace after a couple of days. This can happen due to muscle contraction.
If the fracture is displaced it will need surgery. The type of surgery depends on the age of the patient and the bonestock available for fixation.
The types of surgery is an open reduction and internal fixation with a plate and screws or a fracture prosthesis (a type of shoulder replacement.)
In the older patient, a fracture prosthesis would be more likely due to the quality of the bone, which is usually very soft and screws would tear out.
Physiotherapy will be indicated after surgery as these type of injuries to the shoulder very often results in a stiff joint which takes time to loosen up.