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Review
. 2021 May 5;103(9):829-836.
doi: 10.2106/JBJS.20.00665.

Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures

Samuel J Mease  1 , Matthew J Kraeutler  2 , Daniel C Gonzales-Luna  3 , James M Gregory  3 , Michael J Gardner  4 , Andrew M Choo  3
Affiliations
Review

Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures

Samuel J Mease et al. J Bone Joint Surg Am. .

Abstract

➤: Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. Factors such as surgeon experience as well as the quality and maintenance of the reduction may influence operative outcomes, and their impact on these findings merits further investigation.

➤: In the treatment of 2 and 3-part fractures involving the surgical neck, intramedullary nailing has demonstrated functional outcomes that are comparable with those of open reduction and internal fixation (ORIF).

➤: In the geriatric population, reverse total shoulder arthroplasty has demonstrated improved functional outcomes, with a decreased rate of reoperation, compared with hemiarthroplasty. Tuberosity repair has been shown to improve functional outcomes and range of motion after both procedures and should be performed at the time of arthroplasty.

➤: Several authors have demonstrated the negative effect of osteopenia on outcomes after ORIF of proximal humeral fractures. Augmentative procedures, including cortical strut augmentation, are being investigated to address this issue; their role in the treatment of these fractures is unclear at this time.

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Conflict of interest statement

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G359).

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