CONFRONTING FRAGILITY: MANAGEMENT OF PROXIMAL HUMERUS FRACTURES IN OLDER ADULTS, A CASE REPORT.

Introduction: Proximal humerus fractures are frequently observed in older patients with osteoporosis following lowenergy impacts, such as falls from the same level. Extra-articular two-part surgical neck fractures are unifocal humeral fractures with displaced metaphysis. Case Report: This paper aims to follow the case of a 71-year-old patient, who presented to the Emergency Department of the hospital, experiencing high levels of pain regarding the right shoulder along with a limitation of mobility in the right upper limb. These symptoms manifested following a same-level fall. A combination of pathological antecedents may have led to increased bone fragility, making such a fall result in a severe fracture. Some of the risk factors associated with our patient included the chronic administration of antidepressants, type 2 diabetes, female gender, and also glaucoma which could have heightened the probability of a fall by significantly narrowing the field of view. After a clinical examination that revealed a shorter right upper limb, a discontinuity of the bone margin, bone crepitus, and deformation of the limb, contrasted by a radiological examination, the definitive diagnosis of a displaced humeral surgical neck fracture was assessed. Due to its unstable nature, the decision for surgical treatment was promptly made. The patient underwent an Open Reduction and Internal Fixation procedure, chosen for its advantages in facilitating a quicker return to normal daily activities and reducing the required time in plaster. Because of the medial displacement of the humeral diaphysis and the risk of axillary nerve injury associated with lateral access, the deltopectoral approach was selected. An angular stable plate, secured with locking-head screws, additional calcar screws, and two bicortical screws for enhanced stability, was utilized. The surgery proceeded without further complications, resulting in a rapid improvement in the patient's medical status. Discussions : Falls serve as markers of immobility, and health impairment in older persons, reducing function through injury. According to the Downton fall scale, our patient obtained a score of 4, indicating a high risk of falling. This implies that careful consideration and caution may be necessary in the long-term treatment of this patient. Conclusions: The prevention of falls must include a wide range of ages and health states within the older population, addressing the diverse causes of falls without compromising quality of life and independence. A low-energy fall can be disabling, particularly in association with older age or risk factors that decrease bone density or reduce the awareness of the environment. [ABSTRACT FROM AUTHOR]