Description
The presentation by Lee Van Rensburg focuses on the complexities involved in treating proximal humeral fractures. He starts by addressing his lack of financial conflicts but admits to having significant mental conflict regarding treatment decisions—highlighting the indecision common among practitioners between fixing or replacing fractures. Van Rensburg introduces the concept known as 'the Final Destination' in relation to the revision rates of hemiarthroplasty for fractures, illustrating that which type of stem is used (cemented vs. cementless) significantly impacts the likelihood of needing revision surgery.
He emphasizes the importance of shared decision-making with patients, stressing that patients should be informed and involved in their treatment options to avoid dissatisfaction after outcomes are perceived as less than optimal. The presentation discusses findings from the ProFHER trial, which compares operative versus non-operative treatments, demonstrating that outcomes are similar in both cases for certain demographic groups. Van Rensburg provides various case studies, elaborating on the decision-making process for different types of proximal humeral fractures and the underlying biological factors influencing treatment outcomes.
His reflections span from advocating for timely surgical interventions in younger patients to being cautious with surgical decisions in those over 75 years of age, alluding to different biological recovery potentials associated with age. He concludes his discourse by distilling the intricate considerations into a practical framework for deciding whether to fix or replace the fractured humerus, ultimately aiming to achieve the best functional outcome for the patient.