Proximal humeral fractures in elderly patients
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 6
Abstract
Proximal humeral fractures (PHFs) constitute about 5% of all fractures and its’ frequency increase with age. There is no one applicable classification of these fractures. The evaluation of the type of the fracture and the degree of displacement of the bone segments is crucial in therapeutical decision making. There are no unambiguous indications for operative treatment and the biggest controversies stir up 3- and 4-part fractures. The Neer’s classification is the mostly common used one. The majority of PHFs are type intra-articular and so anatomical reduction is required. Common complication of considered trauma is humeral head ischemia. Failure in reducing the greater tuberosity of humerus leads to poor outcomes with no good salvage options. It is essential to observe the principles of stable osteosynthesis. Anatomical and stable fixation of the fracture must ensure the possibility of immediate passive rehabilitation of the shoulder. Lack of adequate postoperative rehabilitation may result in posttraumatic “frozen shoulder”. Surgical management of these fractures in younger patient is challenging because in that group there is lesser tolerance of dislocation. Fractures of the chirurgical neck of the humerus are considered to be extra-articular fractures and are mostly treated conservatively. Considering 3- and 4-part fractures sometimes the only reasonable way of proceeding is humeral hemiarthroplasty. Nevertheless it is vital to emphasise that nowadays there is no clear algorithms of treatment proximal humeral fractures.
Authors and Affiliations
Bartłomiej Kordasiewicz, Konrad Małachowski, Andrzej Podgórski, Piotr Zakrzewski, Stanisław Pomianowski
Keywords
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