How is the procedure performed?
The operation is performed under a combination of general and regional anaesthesia. The fracture is exposed, the bone fragments realigned and then fixed with a plate and screws or other device. The fixation may occasionally be supplemented with bone grafting using “off the shelf” bone substitutes.
Benefits
Surgery allows the displaced bone fragments to be realigned and fixed in a way that restores and maintains the shape of the bone. This is turn allows an earlier and better recovery of function.
Risks
Medical complications
Chest infection, Deep vein thrombosis, Pulmonary embolism, Myocardial infection are possible after surgery.
Surgical complications
Infection: This can occur after any operation where metal devices are implanted in the body. Several measures are employed to minimize the risk of infection including administration of antibiotics prior to the operation, an antiseptic technique and the use of a clean air theatre.
Nerve or vascular injury: This is possible but rare.
Bleeding : Bleeding may occur during or after surgery. A blood transfusion is rarely required. In very rare instances a blood vessel may be damaged as a consequence of injury or surgery.
Numbness below the scar: The nerves that run to the skin below the scar may be injured during the operation leading to a numb patch below the scar. This diminishes in size over time and does not lead to functional problems.
Fixation failure: If the bone is weak due to osteoporosis, the plate and screws may not hold well and the fixation may fail.
Malunion: Sometimes the bone may heal with an altered shape. In some instances the shoulder may continue to function well despite a malunion but if function is affected then further surgery may be considered.
Nonunion: Occasionally the fracture may fail to heal. This may require further surgery.
Stiffness: This is uncommon following injury and surgery. In most instances it will resolve as you start moving the arm with the aid of physiotherapy.
Implant related symptoms: Metal implants may occasionally irritate the skin, the soft tissues or sometimes lead to aching in cold weather. Some patients may find it uncomfortable to carry shoulder bags or backpacks owing to the straps rubbing on the scar. If these symptoms are troublesome, removal of the plate and screws may be considered, but this is usually deferred until at least 12 months after surgery.
Aftercare
Following the procedure the surgical wound is covered with a shower-proof dressing. The dressing should be left undisturbed as far as possible for 14 days. If the dressing is removed for any reason they should be replaced with similar dressing or waterproof plaster. Prior to discharge from hospital a physiotherapist will provide instructions about looking after the shoulder. You will be advised to protect the shoulder by wearing a sling for 4 weeks and intermittently performing movements of the shoulder within certain limits. After 4 weeks you may stop wearing the sling and will be allowed to move the shoulder actively through a greater range. You may resume driving at 2 weeks. Strengthening exercises are started after 12 weeks. Vigorous use of the arm or lifting heavy objects should be avoided for at least 3 months. Outpatient physiotherapy will be arranged and may need to be continued for 6-12 months. For further information on rehab click here.
Follow-up
An outpatient appointment will be arranged for you to be seen 2 weeks after the procedure. Follow-up is required for at least 6-12 months after surgery or until a satisfactory recovery is achieved. X-rays will be performed at intervals to monitor fracture healing.
