Strategy for ipsilateral multiple concomitant upper extremity fractures in an elderly polytraumatized patient with severe osteoporosis: A case report

Elderly patients with severe osteoporosis present significant challenges in managing multiple concomitant upper extremity fractures, especially when high-energy trauma is involved. The rarity of such cases necessitates a structured approach to achieve optimal outcomes, balancing surgical intervention and early rehabilitation. A 79-year-old woman presented to the emergency department following a severe car accident. She had multiple concomitant fractures, including those of the proximal humerus, proximal ulna, and open fractures of the radius in the ipsilateral upper extremity, as well as multiple organ injuries involving the brain, lung, and liver. The patient was diagnosed with an open fracture of the right proximal radius, a comminuted intra-articular fracture of the proximal ulna, and comminuted intra-articular fractures of the right proximal humerus involving the glenoid and coracoid. Additionally, non-displaced fractures of the left distal clavicle and left sacral body, and minimally displaced fractures of both the superior and inferior rami of the pelvis were confirmed. The patient underwent hemiarthroplasty for the shoulder fracture due to severe comminution, open reduction and internal fixation for the proximal ulna, and intramedullary nailing for the radius. Post-operative management included the sequential administration of teriparatide and denosumab to support bone healing and facilitate early rehabilitation. The patient had a relatively short hospital stay of 5 days and showed favorable outcomes, with early callus formation and bone union confirmed at 6 months. At the 1-year follow-up, the patient demonstrated satisfactory joint stability and improved bone mineral density. This case highlights the potential of combined surgical approaches and bone-strengthening therapies in achieving effective outcomes in elderly polytraumatized patients. Sequential administration of teriparatide and denosumab may be beneficial for promoting bone healing in severe osteoporotic fractures.Level of evidence: Level V, case report.