Surgical Management of Proximal Humerus Fractures in Patients With Common Injury-Specific Comorbidities

When evaluating a humeral neck fracture for surgical intervention, it is prudent to evaluate the patient for the common injury-specific comorbidities of alcoholism and osteoporosis, as the presence of either of these conditions, require additional considerations to prevent complications. This case presents a 63-year-old female who presented for evaluation after multiple falls. She was discharged from an outside facility one week prior with a left (nondominant extremity) humeral neck fracture. Her condition was complicated by alcohol use disorder with recent heavy alcohol use. On hospital stay day one, orthopedic surgery performed an initial assessment and deemed her fracture to be nonoperative due to medical comorbidities. On hospital stay day three, the patient requested a second opinion from orthopedic surgery due to continued increased pain and concern for the long-term function of her left upper extremity. The second opinion found that the fracture would be best managed by surgical intervention now that she had been medically optimized since admission. On hospital stay day five, she was taken to the operating room for planned percutaneous intramedullary nail placement with closed reduction of the fracture. Intraoperatively, the percutaneous procedure had to be converted to an open procedure due to the difficult nature of her osteoporotic bone in terms of performing a closed reduction. This case discusses the various methods for surgical management and guidelines for optimizing patients with the fracture-specific common comorbidities of alcohol use disorder and osteoporosis. The novelty of this case includes the rarity of a patient with both the major predisposing factors to proximal humerus fractures and includes a literature review of the latest recommendations for surgical management.