Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Abstract

Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial

“…Due to the difficulty in patient recruitment in the current study and that past RCTs have not resulted in sufficient evidence to recommend a treatment of choice, we anticipate that future RCTs are likely to encounter similar problems [ 52 – 54 ]. Prospective observational studies and registries are more likely to generate data from sufficiently large patient populations and are the recommended way to move the field forward.…”

Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

“…It causes various complications such as distraction, nonunion, screw back-out, and rotator cuff tear. [3,7,27] In the case of arthroplasty, the incidence rate of complications such as dislocation, nerve damage, and infection ranges from 5% to 40% [31]. Furthermore, Patients older than 70 years and patients with chronic debilitating disease showed significantly poorer clinical outcome after hemiarthroplasty for proximal humeral fracture.…”

“…In these cases we can perform several methods of surgery, percutaneous techniques, intramedullary nailing, plating, or arthroplasty. [3,27] Some authors recommend percutaneous pinning or screw fixation for 2-part fractures in the elderly patient. [5] [27]Intramedullary nails have the benefit of limited soft tissue dissection and blood loss for 2-par fracture, but there many complications like distraction, screw backout and nonunion.…”

“…[3,27] Some authors recommend percutaneous pinning or screw fixation for 2-part fractures in the elderly patient. [5] [27]Intramedullary nails have the benefit of limited soft tissue dissection and blood loss for 2-par fracture, but there many complications like distraction, screw backout and nonunion. [3] Open reduction and locking plate fixation is generally chosen [16,24].…”

The Effect of Postoperative Korean Traditional Medicine for the of Proximal Humeral Fracture: A Case Report

“…In cases such as displaced fractures and comminuted fractures, surgical treatment is considered, but there is controversy over whether the outcome is better than conservative treatment. The types of surgical treatments for proximal humeral fractures include fixation with percutaneous techniques, intramedullary nails, locking plates and arthroplasty [6]. Rehabilitation for proximal humeral fractures after surgery is focused on recovery of the fracture, improvement of the range of motion (ROM) in the shoulder, regaining joint function through muscle strengthening and ultimately improving quality of life of the patient.…”