A review of current concepts in the management of proximal humerus fractures

Abstract

Fracture of the proximal humerus is a common orthopaedic injury and is likely to increase in incidence. This fracture type is associated with a wide variety in fracture morphology and as a direct result there are many treatment options available. It is often not clear what treatment modality should be utilised. This article reviews the current literature on proximal humerus fractures offering evidence for care pathways and management strategies from presentation to rehabilitation.

Imaging to improve agreement for proximal humeral fracture classification in adult patient: A systematic review of quantitative studies

“…All previous literature reviews agreed x-ray should be used as a first line for imaging, 10,11,14 with some arguing x-ray precludes the need for CT. 37 Most previous reviews agreed 2D CT has a role if x-ray is inadequate, however not because it improves agreement as we have suggested. 15,36,38,39 Previous reviews were less supportive of 3D CT than our review, concluding it did not improve agreement, 14 has little role, 36 or only has a role in pre-surgical planning. 14,17,39 Possibly this is because 3D CT had limited quality 10 years ago and pixelated images could be more confusing than useful.…”

“…15,36,38,39 Previous reviews were less supportive of 3D CT than our review, concluding it did not improve agreement, 14 has little role, 36 or only has a role in pre-surgical planning. 14,17,39 Possibly this is because 3D CT had limited quality 10 years ago and pixelated images could be more confusing than useful. The evidence indicating 3D CTs can improve agreement found in this current systematic review was mostly from studies published in the last decade.…”

“…Pain from repositioning often prevents collection of adequate x-ray views, whereas CT avoids repositioning. 14,15,36,39 By improving agreement about classification, CT likely produces more consistent decision making and better patient outcomes, thereby mitigating legal ramifications and lowering overall cost. 13,15 CT also assists with preoperative planning.…”

Hemiarthroplasty vs. locking plate osteosynthesis – what is the better solution for displaced proximal humerus fractures?

“…In their opinion postponing rehabilitation treatment leads to periarticular adhesions and contractions [23]. In general, the literature does not give a clear answer on which method of treatment is best [4]. Analyzing data obtained from the studies it can be concluded that the functional results do not fully correspond with the treatment satisfaction level.…”

“…11C/AO fractures are intra-articular fractures with heal-ing results often being disappointing [3]. When analyzing the international bibliography it can be noted that so far no algorithm for therapeutic procedures has been established and that there are no clear guidelines regarding the choice of best method of treatment [3,4]. Correct qualification for the procedure and adequate surgical technique are important.…”