Therapeutic Indications in Fractures of the Proximal Humerus

Summary

Although the precise radiographic analysis of the fractures of the proximal humerus allowed by modern imaging techniques has clarified the therapeutic indications, difficulties in interpretation do not make it any easier to choose the right technique from the many proposed. Classical open internal fixation has certainly yielded disappointing functional results, especially when performed with bulky implants not adapted to high fractures, comminutive fractures, and osteporotic bone. However, although it solves the difficult technical problems of reconstructing the proximal humerus, a prosthesis is not the universal solution to displaced fracture. Finally, the acute proximal humerus fractures for which a shoulder replacement is indicated are: (a) four-part displaced fractures and fracture-dislocations, (b) selected three-part fractures in elderly patients with osteopenic bone stock, (c) some head-splitting fractures, in which the articular segment is split with displacement, (d) some impression fractures involving about half or more of the articular surface.