title: [Fractures of the proximal humerus in the elderly : Osteosynthesis versus joint replacement].
abstract: BACKGROUND
  Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly.
  
  
  OBJECTIVE
  This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations.
  
  
  METHODS
  The published scientific data were reviewed and current opinion available to guide patient care are presented.
  
  
  RESULTS
  The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis.
  
  
  CONCLUSIONS
  Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland, ggradl@ukaachen.de.
authors.forename: G
authors.initials: G
authors.lastname: Gradl
authors.forename: H-C
authors.initials: HC
authors.lastname: Pape
authors.forename: M
authors.initials: M
authors.lastname: Tingart
authors.forename: D
authors.initials: D
authors.lastname: Arbab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000601:surgery*; D018579:Patient Selection; D012307:Risk Factors; D012784:Shoulder Fractures / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome