title: Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment.
abstract: Fractures of the proximal humerus are relatively common injuries in the elderly population. Given the association between proximal humeral fractures and osteoporosis, elderly patients who sustain these injuries should always undergo a fragility fracture workup. Furthermore, a preoperative assessment of local bone quality can be critical in facilitating decision making regarding surgical and nonsurgical treatment. Modalities for quantifying osteoporosis in the proximal humerus include plain radiography and spiral computed tomography imaging. Optimal management of osteoporotic proximal humeral fractures has evolved and may now includes use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft. This article reviews the demographics of patients who sustain proximal humerus fractures, the appropriate postinjury fragility fracture workup, modalities for quantifying osteoporosis in the proximal humerus, techniques for augmenting fixation of proximal humerus fractures, and the authors' preferred approach to the treatment of these injuries.
authors: Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
authors: Surena
authors: S
authors: Namdari
authors: Pramod B
authors: PB
authors: Voleti
authors: Samir
authors: S
authors: Mehta
mesh_terms: D001843:Bone Cements; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D007432:Intraoperative Period; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D001843:Bone Cements