[Fractures of the proximal humerus in the elderly : Osteosynthesis versus joint replacement]

Abstract

Background: Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly.

Objectives: This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations.

Methods: The published scientific data were reviewed and current opinion available to guide patient care are presented.

Results: The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis.

Conclusion: Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.