title: Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland.
abstract: BACKGROUND
  The therapeutic spectrum for the treatment of displaced proximal humeral fractures ranges from conservative therapy to head-preserving surgical interventions and joint replacement. This study initiated a survey on the current treatment options with regard to diagnostics, choice of therapy, and complications that are encountered at trauma surgeries and orthopedic hospitals in Germany, Austria, and Switzerland.
  
  
  METHODS
  The survey included 743 hospitals. The questionnaire covered information on demographics, diagnostics, classification, therapy, and complications of proximal humeral fractures.
  
  
  RESULTS
  The questionnaire was completed by 348 hospitals. Five of 6 hospitals treat more than 40% of the fractures surgically. The percentage distribution of the available implants is at 63.4% for angular stable plates, 30.9% for intramedullary nails, and 10.1% for fracture prostheses. The 5 complications reported most frequently were nonanatomic reduction (83%), implant perforation (73%), secondary displacement of the fracture (71%), avascular necrosis (67%), and implant-related impingement (59%).
  
  
  CONCLUSIONS
  A preference for surgical treatment of proximal humeral fractures was found, with stabilization predominantly being attempted by the use of angle-stable implants. The 2 most common complications were "nonanatomic reduction of fractures" and the more specific problem of "implant perforation" when fixed-angle implants were used for treatment.
authors: Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstrasse 95,Tübingen, Germany.
authors: Alexander
authors: A
authors: Tepass
authors: Gunnar
authors: G
authors: Blumenstock
authors: Kuno
authors: K
authors: Weise
authors: Bernd
authors: B
authors: Rolauffs
authors: Christian
authors: C
authors: Bahrs
mesh_terms: D001317:Austria; D005858:Germany; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D010818:Practice Patterns, Physicians'; D012784:Shoulder Fractures / Q000601:surgery*; D011795:Surveys and Questionnaires; D013557:Switzerland