Treatment of Geriatric Proximal Humerus Fractures: Indications and Outcome

Abstract

This review aims to summarize the current knowledge about the treatment of geriatric PHF and provide a therapeutic algorithm focusing on the geriatric population. Get to know your patientThe initial step for choosing the right treatment for your geriatric patient with PHF is an assessment of the medical history. Co-morbidities with special focus on vascular and neurological diseases, medication and the biological age of the patient are relevant parameters (17). The pre-fracture functional status of the shoulder and the general level of daily activity are highly relevant information. Furthermore, the patient's functional expectations should be assessed and documented (16). The clinical examination, with special focus on neurovascular injuries completes the initial assessment of the patient. Based on this information a risk-benefit analysis has to be performed to define the best treatment option for the patient. Get to know the fractureStandardized conventional X-rays of the affected shoulder are the first diagnostic step. The trauma-series after Neer includes three plains (AP, axial and Y-scapula-view), with the axial view not being possible in some patients because of pain (abduction of the shoulder is required). However, conventional X-rays are not always enough for fracture analysis (32), and an additional CT-scan is needed. The possibility of multiplanar reconstructions, including 3D views, (Fig. 1), that are freely rotatable facilitate the identification of the number and degree of displacement of all fragments (22). Although the CT-scan provides necessary information