Three- and four-part proximal humerus fractures in the elderly: Eminence versus evidence

摘要

The majority of proximal humerus fractures are minimally displaced and good outcomes can be achieved with nonoperative treatment strategies. However, controversy exists regarding the best management of highly comminuted and displaced proximal humerus fractures that occur in elderly patients with poor bone quality. Although surgical options including open reduction and internal fixation or hemiarthroplasty can restore excellent function, the rate of catastrophic failure remains high measuring between 20% and 40%. Reverse total shoulder arthroplasty has recently been introduced as a means for treatment of these fractures with intermediate results demonstrating improved range of motion, functional outcomes, and lower rates of revision. Proximal humerus fractures account for 5.7% of all fractures and demonstrate increased incidence with advanced age [1,2]. The majority of proximal humerus fractures are minimally displaced and good outcomes can be achieved with nonoperative treatment strategies [3,4]. Displaced fractures in patients with minimal comminution and good bone quality have demonstrated excellent outcomes with open reduction and internal fixation (ORIF) [5]. However, there remains considerable debate on the ideal management of highly comminuted and displaced fractures in the presence of poor bone quality.