Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures

Abstract

Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. Factors such as surgeon experience as well as the quality and maintenance of the reduction may influence operative outcomes, and their impact on these findings merits further investigation.In the treatment of 2 and 3-part fractures involving the surgical neck, intramedullary nailing has demonstrated functional outcomes that are comparable with those of open reduction and internal fixation (ORIF).In the geriatric population, reverse total shoulder arthroplasty has demonstrated improved functional outcomes, with a decreased rate of reoperation, compared with hemiarthroplasty. Tuberosity repair has been shown to improve functional outcomes and range of motion after both procedures and should be performed at the time of arthroplasty.Several authors have demonstrated the negative effect of osteopenia on outcomes after ORIF of proximal humeral fractures. Augmentative procedures, including cortical strut augmentation, are being investigated to address this issue; their role in the treatment of these fractures is unclear at this time.

Application of a lateral intertubercular sulcus plate in the treatment of proximal humeral fractures: a finite element analysis

“…Proximal humeral fractures are frequently encountered in clinical practice, with an incidence of 4–5% [ 1 ], which continues to increase each year. Current treatment methods for proximal humeral fractures include intramedullary nailing, internal fixation using a PHILOS locking plate (PLP), and shoulder joint replacement [ 2 ]. Although PLPs are commonly used due to their wide scope of application [ 3 ], they have been associated with postoperative complications such as poor reduction, varus deformity, screw cutting, nonunion of fractures, infection, and limited function [ 4 ].…”

Suture Augmentation Neutralizes Deforming Muscular Forces in a Simulated 2-Part Osteoporotic Proximal Humeral Fracture Model

“…Multiple tactics using proximal humeral locking plates have been identified to improve surgical fixation of these injuries. 1,2 Use of suture material is common during proximal humerus fracture fixation and aids in tuberosity reduction and fixation. It also provides additional support to unicortical screw fixation from a lateral plate into the humeral head.…”

Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults

“…Many PHF cases can be managed nonsurgically with acceptable outcomes. However, for fractures with signi cant displacement and tuberosity malalignment, surgery is often considered necessary [3,4]. Although arthroplasty has become a common treatment, internal xation with locking plates and intramedullary nails as the main implants remains the most commonly used method for acute PHF treatment [1,5,6].…”