Transcription:
Proximal Humerus Fractures

Joey Wahler (Host): Proximal humerus fractures or bone breaks that can affect patients young and old alike. So what are they and how are they treated? This is Doc Talk. Brought to you by Montefiore St. Luke's Cornwall. Thanks for joining us. I am Joey Waller, our guest, Dr. Wasik Ashraf. He's an orthopedic surgeon and medical director of sports medicine for Montefiore St. Luke's Cornwall, Dr. Ashraf, thanks for being with us here today.

Dr. Wasik Ashraf: Thank you for having me.

Joey Wahler (Host): So this particular type of fracture, what is it exactly?

Dr. Wasik Ashraf: So the proximal humerus fracture is a type of fracture that happens in the upper arm, in the shoulder. And it really results from overuse or trauma or a fall.

Joey Wahler (Host): And as mentioned, it can affect younger and older people let's start with younger. What would be typical ways that this would be suffered in the first place?

Dr. Wasik Ashraf: So a lot of our young athletes now, they sub-specialize in a certain type of sports and this is commonly seen in baseball anything throwing mechanics. And so if you overthrow you gate type of shoulder fracture called little leaguer shoulders. And which, if we throw through all the pain, you can actually have a break in the growth plate of the proximal humerus or the upper arm. And that's something that we see in our younger patients that are just overdoing it and playing the same sport all year around. And it's a very common and prevalent injury that we're seeing more and more these days.

Joey Wahler (Host): I know for instance, Mets pitcher, Jacob DeGrom recently suffered an injury to a bone in his shoulder. I don't believe this type of break specifically, but I remember people being kind of taken a back doctor because they were like, boy, even those of us that follow baseball are not used to hearing about a pitcher suffering shoulder damage to a bone. It's usually more muscle related, right?

Guest: Yeah, you're absolutely right. We hear more ligaments and tendons that are most related, but one thing with our younger patients, especially ones that are still growing their growth plate actually is the weakest parts. As opposed to say an adult where the bone is already fused that growth plates fuse. They tend to injure more ligaments, but our younger patients, adolescents are the most at risk for this overuse injury in the upper arm.

Joey Wahler (Host): So now let's talk about older folks. How do they typically get this?

Dr. Wasik Ashraf: So most of my seasoned patients, you know, patients that are having humorous fractures tends to be from a fall. And as we all season, as we all get a little older, our bone tends to get weaker and we call that osteopenia, the bone is weak or osteoporosis, which is the bone is very soft. And one of the signs of osteoporosis is after a small fall, having a break in the bone. And the proximal humerus or ball near the shoulder is a very common place people can break. And so most of my injuries that I see over the proximal humerus in my elderly patients are. Trauma a small fall or it's a small hit on the side of the shoulder that causes a pretty big fracture.

Joey Wahler (Host): And so how, if at all, does treatment in terms of options differ between younger and older people that are effected?

Dr. Wasik Ashraf: Our Younger patients, very seldom need surgery for this type of a fracture. Usually the younger patients, the pitchers, the throwers really. Education about what is causing this, the overuse, the over-training getting the parents and the trainers involved and really kind of shutting them down from throwing and then slowly easing them back into a pitching program. We'll take care of this. So very seldom do our younger patients need surgery. Involved with counseling than anything else. Our elderly patients, it's really multifactorial where if surgery is warranted or not, if there are a variety of their lefty how bad is the fracture? Is there a chance that this could heal on its own with therapy? But more and more surgeries being done for these humorous fractures for our elderly patients.

Joey Wahler (Host): And So if that surgery is needed, what does that involve?

Dr. Wasik Ashraf: So there's a few ways we can attempt at putting the pieces back together for a proximal humerus fracture. Surgically, we can try to put plate and screws. To hold the pieces together and allowing them to heal. But as we talked about earlier, this is usually in patients with soft bone. So the screws really don't have good purchase or can really grab onto the bone piece as well. So plating and screws really don't work as well. There's a thing called a half a shoulder replacement called a hemiarthroplasty, which is something that we used to do more because we really had no other options.

Nowadays, most of the proximal humerus fractures that needs surgery get a surgery. That's called a reverse shoulder replacement where we put the ball on the side of the socket and the socket on side of the ball. And we make the deltoid muscle, the muscle on the side of the arm, do the work and they've had really excellent result.

Joey Wahler (Host): And is that something that's newer, that procedure?

Dr. Wasik Ashraf: It is, it's something that it has really, in the last 10 to 12 years really evolved. We use it for significant arthritis, for rotator cuff tears that cannot be repaired, as well as proximal humerus fractures, where we're trying to gain motion, decrease pain, and increase functionality.

Joey Wahler (Host): How tricky can it be as an orthopedic surgeon dealing with older patients, they have brittle bones in certain cases that is. Often contribute to bringing this particular type of fracture about. Plus, you know, they're often perhaps more adverse to surgery because they are just trying to enjoy their latter stages of life and may be more reluctant than younger people. How do you deal with that as a doctor, that whole scenario?

Dr. Wasik Ashraf: So it's a joint decision with the patient, the family, and really understanding what they're trying to get back to. If I have a patient that has a proximal humerus fracture, and they are really not super active. You know, their sport of choice or what they like to do is more sedentary. Then surgery may not be the answer. We don't treat x-rays, we treat patients and what they're trying to get back to, I have my more elderly patients that are still playing golf three times a week that are playing pickleball and the idea for me is to get them back to that stage. And so if they understand that's what they want to get back to, I can reliably tell them that doing a reverse shoulder replacement has a higher chance to get them back to what they were doing before, but it really depends person to person, patient to patient, fracture to fracture.

Joey Wahler (Host): Interesting. You just mentioned pickleball doc because more and more people are playing that all the time. And just a, whether it be this particular injury or in general, are you seeing more pickleball injuries since it's becoming so much more prevalent?

Dr. Wasik Ashraf: No, I have seen more rotator cuff injuries, more rotator cuff tendonitis due to pickleball. But you know, it's something that I love for my patients. They enjoy it. They able to go back with joint replacements because you're not running as much while maintaining a cardiovascular health. But as far as specific pickleball injuries, maybe some tendonitis from the shoulder, but with proper warmup and cool-down, and some good counseling too, of what to do or what not to do, patients tend to be pretty healthy with that.

Joey Wahler (Host): And as you pointed out, it's kind of a poor man's tennis from an exertion standpoint, right? In that you don't have to go all out in certain ways, the way you would on a regulation tennis court.

Guest: Correct.

Dr. Wasik Ashraf: And it's funny you say that there's several tennis courts. I have friends that live in Florida that in their community tennis courts are being turned into pickleball courts down there.

Joey Wahler (Host): Wow. I bet the tennis people aren't too happy about that.

Dr. Wasik Ashraf: right? Yeah. We're all got to be cohesive in these things you know.

Joey Wahler (Host): Let me take you back to talking about younger people affected by these fractures. Generally speaking, since you're involved in sports medicine, what would you say to people that play a sport, whether it be pitching or otherwise where a fracture like this proximal humerus break can occur from overexertion as you point out. What's your advice in knowing as a thumbnail idea when you're playing sports? How do you know when to push yourself through a little bit of pain, but not to cross that line to where you're overdoing it and you may be either causing or worsening an injury. It's a fine line for a lot of athletes that want to, male or female play macho, man, so to speak and just fight through, right?

Dr. Wasik Ashraf: Yeah, absolutely. And that's a very tough, a tough thing. I see this with gymnasts, with cheerleading and baseball and all sports and they're limping, they're hurting and they A, don't report it. Number two, they kind of underscore how much it's really bothering them. And then they just work their selves through it. So, my recommendation always Is you need rest days, you can't just go seven days a week hard. And you know the question isn't always, how much are you playing in the game, but they're playing multiple leagues. They're training multiple days. And there's different trainers in different leagues and are not really keeping account of the pitch. Things like that. So I really kind of talk about longevity.

I tell patients, and I tell my kids that are athletes, that I'm going to take care of you now, but I'm really also thinking about you when you're in your forties and fifties. And I want to make sure what you're doing now, doesn't affect what you're going to be able to do later and go over the anatomy. And I feel like I want to talk to them like they're adults and just go over. It's going on and it helped them explain what it is that we're addressing. They understand, and you make them feel like they're part of the team. And I always tell them my goal is to get you back to what you want to do, and once you get them to buy in they're on board, but injury prevention is probably the biggest thing. And injury prevention happens from proper warmup, proper cool-down, proper stretching and proper rest.

Joey Wahler (Host): Great advice, indeed. Dr. Wasik Ashraf. Thanks so much again, for being with us.

Dr. Wasik Ashraf: Thank you, have a great day.

Joey Wahler (Host): You too. And so folks, we hope you're now more familiar with proximal humerus fractures. We want to thank you for listening to Doc Talk presented by Montefiore St. Luke's Cornwall for more information. Please visit Montefiore slc.org. That's Montefioreslc.org. Please do remember to subscribe, rate and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. If you found this podcast helpful, please do tout it on your social media and thanks as always for being with us. Hoping your health is good health. I am Joey Wahler.