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. 2020 Aug 6;12(2):8529.
doi: 10.4081/or.2020.8529.

How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

Antonio Benedetto Cecere  1 , Giuseppe Toro  1   2 , Annalisa De Cicco  1 , Adriano Braile  1 , Marco Paoletta  1 , Giovanni Iolascon  1 , Alfredo Schiavone Panni  1
Affiliations

How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

Antonio Benedetto Cecere et al. Orthop Rev (Pavia). .

Abstract

Proximal humeral fractures (PHF) are the third most common non-vertebral fragility fractures after hip and distal radius. It still controversial which treatment might be more appropriate, and surgically treated outcomes depends also on an appropriate technique. In order to clarify surgical indications, tips and pitfall a narrative review was conducted. Pinning, external fixation, plating and internal fixators has each one its advantages and disadvantages. During the procedure an appropriate use of the fixation device and handling of the soft tissue might be associated with better outcomes. Calcar comminution, varus angulation, medial dislocation of the shaft, fracture-dislocation are factors that could lead to choose a replacement. Hemiarthroplasty and reverse total shoulder arthroplasty are the most common prosthesis used in PHF. The restoration of humeral length and tuberosities might lead to an improvement in clinical outcomes and prosthesis survivorship.

Keywords: Fragility fracture; Locking plate; Osteoporosis; Proximal humeral fracture; Shoulder arthroplasty.

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Conflict of interest statement

Conflict of interest: The authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
A 4-part PHF occurred in a 65 years old female. (a) Note the varus head displacement and subluxation. (b) A locking plate was used to fix the fracture. Note the head malreduction. (c) Avascular necrosis of the humeral head occurred 9 months after the surgery.
Figure 2.
Figure 2.
A 2-part PHF occurred in a 67 years old female treated with EF after a closed reduction.
Figure 3.
Figure 3.
A 4-part PHF occurred in a 69 years old female. (a) Note the medial displacement of the humeral shaft. (b) Note the undamaged calcar. The patient was treated with a plate-and-screws plus k-wires synthesis augmented by a “DaVinci” triangular metal block to fill the bone gap, resulting in complete fracture healing (c).
Figure 4.
Figure 4.
A 4-part PHF occurred in a 71 years old female with a medial humeral shaft displacement and head luxation (a), treated with a reverse total shoulder arthroplasty (b).
See this image and copyright information in PMC

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