Nonunion and malunion in proximal humerus fractures

Abstract

Proximal humerus fractures are common injuries and the development of nonunion or malunion is infrequent. However, these complications can occur with both operative and non-operative treatment of the fracture. A complete evaluation of these patients must include an investigation of the original fracture, bone and soft tissue quality as well as an extensive radiological study with X-Ray, CT and MRI. Asymptomatic and low demanding patients can benefit from conservative treatment, otherwise surgery is necessary. Multiple treatment options exist with no consensus upon the gold standard. The management of these complications is case-specific and needs extensive pre-operative planning. Arthroscopic procedures, osteotomies and bone grafting are viable joint preservation techniques. Bone loss or articular pathology are indications for joint replacement. The surgical treatment of nonunion and malunion is challenging even for experienced surgeons.

Locking blade nail in proximal humeral fractures

“…In Group B (Plates), 1 case of cut-out by 2 proximal screws, 1 pseudoarthrosis, and 1 superficial infection of the wound. This corresponds to data in the literature and confirms that both extra and intramedullary approaches are effective and safe solutions for proximal humerus osteosynthesis 10,11,14,17,18 . Group A included a greater proportion of patients over 75 and this may indicate a larger extension of surgical indications in eldery patients due to the reliability of this new nail, even in poor quality bone tissue.…”