Management of Greater Tubercle Fracture of the Humerus in an Elderly Patient

Immediate Assessment and Pain Management

The American College of Rheumatology recommends providing appropriate pain relief as soon as possible before completing diagnostic investigations, starting with regular acetaminophen unless contraindicated, adding opioids as needed for adequate pain control 3, 4
The European Society for Medical Oncology suggests avoiding NSAIDs until renal function is assessed, as approximately 40% of trauma patients have moderate renal dysfunction and NSAIDs are relatively contraindicated in impaired kidney function 4
Document pain scores at rest and with movement before and after analgesia administration, as recommended by the American Academy of Orthopaedic Surgeons 4

The American Geriatrics Society recommends ensuring comprehensive preoperative assessment including chest X-ray, ECG, full blood count, clotting studies, renal function, and cognitive baseline function assessment, which is critical in elderly patients who often have pre-existing chronic diseases affecting management and outcomes 3
Provide surgery within 48 hours of injury when indicated, as this significantly reduces short-term and mid-term mortality rates and reduces complications from immobility, according to the American College of Surgeons 3
Consider orthogeriatric comanagement for elderly patients, as this has been shown to improve functional outcomes, reduce length of hospital stay, and reduce mortality, as suggested by the British Geriatrics Society 3

The National Osteoporosis Foundation recommends that all elderly patients with fragility fractures require systematic investigation for future fracture risk and osteoporosis evaluation, which is a strong recommendation with high-level evidence 1, 2, 5
High-risk patients should receive appropriate pharmacological treatment to decrease risk of subsequent fracture, as proximal humerus fractures are among the most common fragility fractures associated with increased morbidity and mortality, according to the International Osteoporosis Foundation 1, 2
Ensure calcium supplementation (1000-1200 mg/day) and vitamin D (800 IU/day), which is associated with 15-20% reduction in non-vertebral fractures and falls in elderly patients, as recommended by the American Geriatrics Society 4