High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

Abstract

High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.

How age and gender influence proximal humerus fracture management in patients older than fifty years

“… 9 Elderly female patients may have underlying bone density deficits before sustaining a fragility fracture that may be undiagnosed before injury. 27 , 48 With the gaining popularity of RSA for the treatment of the aging population and increasing prevalence of proximal humeral fragility fractures, this study aimed to evaluate how gender and age have affected definitive treatment selection over the last decade.…”

Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures

“…The meta-analysis of Walters et al. [ 23 ] concluded that the surgical choice should consider the age of the patient, the level of independence, the bone quality, the comorbidities, and the fracture pattern. Healthy patients with complex pattern fractures are candidates for surgical synthesis with plate and screws; HA should be reserved for patients with poor bone quality and pattern fractures that might lead to AVN (high risk of cutout screws); RSA should be considered for elderly patients, maybe after a first attempt with ORIF or HA [ 8 , 24 ].…”

Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus

“…Despite the improvement in fixation techniques, a large collection of poor outcomes and surgical complications are still prevalent, particularly in the presence of osteoporosis. 3,4 Many factors have been demonstrated to be responsible for the poor outcome of PHFs, including low local bone mineral density, medial calcar comminution, length of metaphyseal segment, and coronal displacement of the fracture at the onset. [3][4][5][6][7] Gardner et al 8 have underlined mechanical support of the medial column was essential to maintain fracture reduction.…”

“…3,4 Many factors have been demonstrated to be responsible for the poor outcome of PHFs, including low local bone mineral density, medial calcar comminution, length of metaphyseal segment, and coronal displacement of the fracture at the onset. [3][4][5][6][7] Gardner et al 8 have underlined mechanical support of the medial column was essential to maintain fracture reduction. They concluded that accurate reduction of the medial cortex created a load sharing condition and minimized the forces at the screwbone interface.…”