Extract
Decision-making in the treatment of proximal humeral fractures is generally
based on individual parameters such as the biological age and activity level
of the patient, the quality of bone, and specific fracture parameters such as
the degrees of displacement and
instability1,2.
Nondisplaced fractures and fractures with minimal displacement and adequate
stability are usually successfully treated
nonoperatively1-3.
There is a certain consensus that displaced four-part fractures with a high
degree of comminution, fracture-dislocations, and head-splitting fractures in
the elderly should be treated with primary
hemiarthroplasty1-4.
However, the recommendations for the treatment of displaced three or four-part
fractures of the proximal part of the humerus remain
controversial1-3.
A variety of treatment techniques has been proposed, and a wide range of
functional outcomes has been
reported5-22.
An extended exposure of the fracture elements and the use of bulky hardware
for internal fixation may increase the risk of osteonecrosis of the humeral
head2,15-17
and may provoke a variety of complications such as subacromial impingement or
screw and plate loosening due to poor bone stock. Therefore, minimally
invasive techniques combining indirect reduction of the fracture and
percutaneous screw fixation and cerclage or tension-band wiring have been
advocated to preserve the soft-tissue envelope and the blood supply to the
humeral
head10,11,15,17-21.
However, these techniques do not necessarily lead to better functional results
than nonoperative treatment does, especially in elderly patients with
osteoporosis23.