Three-and four-part proximal humerus fractures: evolution to operative care.
The recent increase in life expectancy is expected to bring about a concurrent rise in the number of proximal humerus fractures. Those presenting with significant displacement, osteoporosis, and comminution present distinct clinical challenges, and the optimal treatment of these injuries remains controversial. As implant technologies and treatment strategies continue to evolve, the role and appropriateness of certain operative and nonoperative treatment modalities are being debated. Prior concerns regarding humeral head viability forced many physicians to abandon operative management in favor of nonoperative modalities. However, with greater appreciation and understanding of the factors governing humeral head viability, operative intervention is increasingly used and investigated. Nevertheless, sub-optimal results with earlier implants continue to cloud the debate between nonoperative and operative treatment modalities. This paper will review historical considerations, biologic considerations, and implant considerations in the management of three-and four-part proximal humerus fractures.
Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 10003, USA.
William
W
Min
Roy I
RI
Davidovitch
Nirmal C
NC
Tejwani
D000328:Adult; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000266:history / Q000295:instrumentation; D001696:Biomechanical Phenomena; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000266:history / Q000295:instrumentation; D062785:Hemiarthroplasty; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012784:Shoulder Fractures / Q000175:diagnosis / Q000209:etiology / Q000266:history / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome