[Osteoporotic fractures of the proximal humerus]

Fractures of the proximal humerus are typical osteoporotic fractures of the elderly with an increasing incidence. Computed tomography (CT) with 3D reconstruction plays a more and more decisive role in the diagnostics because of an improved understanding of fractures in 3D images. The resulting correct fracture classification has significance for the decision of the best therapy procedure. Currently an extended version of the Codman classification with its four and more fragments is used to give additive information about varus or valgus dislocation, impression or distraction. The comparison of conservative and operative treatment showed no predominance of one of the procedures, therefore both strategies are justified. An operative treatment is recommended in complex fractures. Thus, early functional mobilization, early self-dependence and return to the activities of daily living are possible. Intramedullary nailing is advised in 2-part fractures, in dislocated multipart fractures locking plating or a primary reverse shoulder arthroplasty with refixation of the tuberosities in patients over 75 years. However, the improved plate and nail systems with polyaxiality, calcar screws, modern plate and nails designs as well as the possibility of arthroscopy-assisted nail implantation or plate removal combined with arthroscopic arthrolysis are innovative.