Evaluation and Management of Proximal Humerus Fractures

Abstract

Proximal humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the proximal humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities.

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

“…42 Despite advances in bone-saving fixation techniques, the indications for arthroplasty have been widened to include head-splitting fractures, elderly patients with poor bone quality and also fractures not amenable to ORIF and/or with a high risk of avascular necrosis. 14,22,28 Arthroplasty options include hemiarthroplasty and reverse total shoulder arthroplasty (RTSA).…”

Techniques for Using a Novel Intramedullary Cage Technology for Fixation of Proximal Humeral Fractures

“…A significant advantage of using intramedullary nails is reduced soft tissue stripping [12]. Though nails are indicated for use with most fracture types, its best functional outcomes are reported for use with 2-part fractures.…”

“…The benefits of having a medial column support, such as an intramedullary fibular graft, have previously been reported. Specifically, patients treated with an intramedullary fibular strut graft did not have any screw penetration and had high clinical outcome scores [12,26]. In addition, the protrusion of the Cage outside the bone is minimal (Figure 3).…”

“…The anterior section of the axillary nerve courses around the humeral shaft approximately 35mm from the lateral prominence of the greater tuberosity [11], and is therefore susceptible to injury due to its closeness to fracture fragmentation [12]. During surgical intervention, care must be taken to protect the integrity of the axillary nerve.…”

Operative repair of proximal humerus fractures in septuagenarians and octogenarians: Does chronologic age matter?

“…While many orthopaedic surgeons may prefer surgical management in younger patients with displaced fractures of greater severity, a lack of consensus exists in older patients. 7 This controversy is only heightened in the elderly, with poorer bone quality 8 and increased risk for surgical intervention 9 and complication. It has been shown that these fractures are more prevalent in fit, independent patients, who function at a moderate level despite advanced age.…”