[Fractures of the proximal humerus].

Area of Science:

• Orthopedic Surgery
• Traumatology
• Geriatric Medicine

Context:

• Proximal humeral fractures are common, especially in the elderly population.
• Treatment decisions involve patient's biological age, bone structure, living conditions, and individual needs.
• Fracture severity ranges from minimally displaced to severely unstable with marked displacement.

Purpose:

• To outline current management strategies for proximal humeral fractures.
• To discuss the evolving trends in surgical interventions.
• To highlight the importance of tailored treatment and multidisciplinary collaboration.

Summary:

• Minimally displaced fractures often respond well to conservative treatment (sling immobilization, physiotherapy).
• There's a trend towards percutaneous cannulated screw fixation for slightly displaced fractures, enabling earlier functional recovery.
• Severely unstable fractures may require operative stabilization, with a shift from plating to cannulated screws and sutures; hemiarthroplasty is common for the most severe cases (e.g., Neer 4-segment, AO C-2/C-3).
• Minimally invasive techniques preserve blood supply to the humeral head.
• Despite advances, humeral head necrosis remains a concern in severe fractures, though functional outcomes can still be reasonable.

Impact:

• Individualized treatment plans, considering patient-specific factors and fracture morphology, are crucial for optimal outcomes.
• Close collaboration between surgeons and physiotherapists is essential for effective rehabilitation.
• The choice of fixation (conservative, screws, plating, or arthroplasty) depends on fracture severity, patient factors, and surgeon expertise.