[Fractures of the proximal humerus. Classification and treatment principles]

Abstract

The therapeutical strategy for fractures of proximal humerus is pointed out both by Neer's and by AO classification. Thus closed functional treatment is indicated in case of all undislocated or minimally displaced fractures. Conservative management is indicated for all reducible fractures as well. Severe and irreducible bone lesions i.e. three and four part fractures with or without dislocation are to be handled primarily by operation. Dislocated fractures require an emergency procedure. The operative strategy has to be suitable for the type of fracture. Stable T-plate osteosynthesis is preferred for simple fractures (i. e. Type A2 or A3 according to the AO classification). Serious bifocal and articular bone lesions are sufficiently managed by minimal internal fixation (osteosynthesis) especially in regard to the biological aspects. The sincere contact of bone fragments accompanied by sufficient anatomical axis should be the aim of the operative strategy. Manifold expedients for reduction like temporarily applied Steinmann pins are necessary. Larger lesions of spongiosa can mostly be substituted by autoclaved spongiosa transfer. As minimal osteosynthesis led rarely to necrosis of the humeral head it is preferred especially in case of severe fractures. According to our therapeutical draft head preserving procedure had the priority to primary humeral prosthetic arthroplasty.