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Review
. 2013 Sep;110(35-36):591-7.
doi: 10.3238/arztebl.2013.0591. Epub 2013 Sep 2.

The treatment of proximal humeral fracture in adults

Klaus J Burkhart  1 , Sven O Dietz, Leonard Bastian, Ulrich Thelen, Reinhard Hoffmann, Lars P Müller
Affiliations
Review

The treatment of proximal humeral fracture in adults

Klaus J Burkhart et al. Dtsch Arztebl Int. 2013 Sep.

Abstract

Background: The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Around the world, this type of fracture remains a major challenge for treating surgeons. While non-displaced fractures can be managed conservatively, displaced ones are often treated surgically.

Methods: Selective literature review.

Results: There are still no evidence-based schemes or guidelines for the treatment of proximal humeral fractures, and very few prospective randomized trials are available. The few that have been published recently show a trend in favor of conservative treatment, but they were carried out on small groups of patients and their findings are not directly generalizable. For younger patients, the goal of treatment is generally anatomical repositioning and osteosynthetic stabilization; for older patients, primary treatment with a prosthesis is a further option. Depending on the mode of treatment, complications can arise such as shoulder stiffness, necrosis of the humeral head, pain, infection, loss of reposition, and "cutting out."

Conclusion: Current evidence supports the individualized treatment of proximal humeral fractures. Treatment decisions must always be made jointly with the patient in consideration of his or her individual needs and characteristics. Particularly for elderly patients, the possibility of conservative treatment should be carefully considered. If conservative treatment is not possible, then the type of operation performed should also be a function of the surgeon's individual skills and experience with particular types of implant.

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Figures

Figure 1
Figure 1
Fragment displacement caused by the pull of attached rotator-cuff tendons. 1: dome of humeral head, 2: lesser tubercle; 3: greater tubercle, 4: shaft. Reprinted with the kind permssion of Georg Thieme Verlag, Stuttgart
Figure 1
Figure 1
a) A 61-year-old man with a mildly displaced four-fragment fracture b) Conservative treatment resulted in successful consolidation in an acceptable position
Figure 1
Figure 1
a) A 61-year-old man with a mildly displaced four-fragment fracture b) Conservative treatment resulted in successful consolidation in an acceptable position
Figure 3
Figure 3
a) This 52-year-old man fell and sustained a three-fragment proximal humeral fracture with valgus impaction. b) Treatment with open reposition and a fixed angle plate
Figure 3
Figure 3
a) This 52-year-old man fell and sustained a three-fragment proximal humeral fracture with valgus impaction. b) Treatment with open reposition and a fixed angle plate
Figure 4
Figure 4
After implantation of a fracture prosthesis, the tubercles were resorbed, with resulting proximalization of the prosthesis. The necessary conversion to an inverse prosthesis was performed with a modular prosthesis system so that the shaft did not have to be replaced
See this image and copyright information in PMC

References

    1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72:365–371. - PubMed
    1. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87–92. - PubMed
    1. Kim SH, Szabo RM, Marder RA. Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res. 2012;64:407–414. - PubMed
    1. Pentek M, et al. Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999-2003. Osteoporos Int. 2008;19:243–249. - PubMed
    1. Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108:285–287. - PubMed