[Proximal and distal humerus fractures in advanced age]

Abstract

In contrast to distal humeral fractures, humeral head fractures represent a common injury to the old patient. For both fracture localizations osteoporosis and multi-morbidity are of significant importance. The classification for humeral head fractures in one-, two-, three- and four-part fractures is generally accepted. Valgus impacted head fractures as well as head-splitting fractures are considered a separate entity. In none or minimally displaced fractures good functional results are achieved by conservative means. Although numerous therapeutical procedure are offered in the treatment of displaced fractures of the proximal humerus the result are often disappointing. Generally, minimal invasive surgical procedures should be preferred. However, in dislocated multi-part fractures a primary humeral head replacement is often the treatment of choice. In patients with multifarious morbidity a conservative treatment is always to be included into the therapeutical considerations. Distal fractures of the humerus are classified into extraarticular, intraarticular uni-condylar and intraarticular bi-condylar fractures. The therapeutical recommendations, also in the elderly, is relatively homogeneous: primary open reduction and internal fixation (ORIF) should be carried out aiming for an early postoperative functional treatment. Depending from soft tissue conditions and accompanying injuries the functional results are often good or moderate and are generally comparable to those of younger patients. Following a correct indication for surgical intervention the main priority for both distal and proximal humeral fractures is an early definitive surgical treatment.