Skip to main content

Advertisement

Log in

Fractures of the proximal humerus in osteoporotic bone

Osteoporosis International Aims and scope Submit manuscript

Abstract

The purpose of this article was to review critically the current treatment options for fractures of the proximal humerus in patients with severe osteoporosis. The main difficulties lie in correctly diagnosing the fracture and hence selecting the most appropriate method of treatment. The reliability of the diagnosis can be increased by systematically appending additional information to a basic fracture classification. Classification is best carried out on a morphological basis, whereby a descriptor of bone quality can be added in order to introduce the degree of osteoporosis into the decision-making algorithm. Any classification system that claims to provide both treatment and prognosis is inappropriate, because prognosis will depend hopefully on the treatment. Approaches to treatment differ widely amongst centers and surgeons. It is still unclear as to what would be the optimal treatment. Factors such as the individual’s functional requirements and ability to cooperate should be given careful consideration. At our institution, hemiarthroplasty is the method of choice for ischemic humeral heads and/or when anatomic reconstruction cannot be obtained. In all other displaced fractures, the main objective is preservation of the head since the best functional results can generally be obtained with internal fixation. Selection of a balanced osteosynthesis, adapted to the weak bone, is mandatory. Bulky, stiff implants are inadequate and may cause additional damage. Load sharing, not load bearing, compound constructions are the aim. Obtaining metaphyseal elastic buttressing is the key element in achieving the necessary load-sharing fixation. The system should allow controlled impaction and be forgiving towards occasional load peaks that will occur and are beyond patient control. Thin and flexible implants are required to realize this type of fixation. Given the polypragmatic approach that is current in clinical practice there is room for further improvement of techniques and implants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4A,B
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Sallay PI, Pedowitz RA, Mallon WJ, Vandemark RM, Dalton JD, Speer KP (1997) Reliability and reproducibility of radiographic interpretation of proximal humeral fracture pathoanatomy. J Shoulder Elbow Surg 6:60–69

    Article  CAS  PubMed  Google Scholar 

  2. Neer CS, 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    PubMed  Google Scholar 

  3. Misra A, Kapur R, Maffulli N (2001) Complex proximal humeral fractures in adults—a systematic review of management. Injury 32:363–372

    Article  CAS  PubMed  Google Scholar 

  4. Zyto K (1998) Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury 29:349–352

    Article  CAS  PubMed  Google Scholar 

  5. Zyto K, Wallace WA, Frostick SP, Preston BJ (1998) Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus. J Shoulder Elbow Surg 7:85–89

    Article  CAS  PubMed  Google Scholar 

  6. Codmann EA (1934) Fractures in relation to the subacromial bursa. In: Codmann EA (ed) The shoulder, rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Krieger, Malabar, Florida, pp 313–331

  7. Hertel R, Hempfing A, Stiehler M, Leunig M (2003) Predictors of humeral head ischemia following intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg (in press)

  8. Hertel R, Mees C, Schöll E, Ballmer FT, Siebenrock K (2001) Morphologic classification of fractures of the proximal humerus. A validated, teachable and practicable alternative. Eighth International Conference on Shoulder Surgery (ICSS), 23–26 April. Cape Town, South Africa

  9. Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85:611–617

    Article  PubMed  Google Scholar 

  10. Park MC, Murthi AM, Roth NS, Blaine TA, Levine WN, Bigliani LU (2003) Two-part and three-part fractures of the proximal humerus treated with suture fixation. J Orthop Trauma 17:319–325

    Google Scholar 

  11. Jaberg H, Warner JJ, Jakob RP (1992) Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am 74:508–515

    CAS  PubMed  Google Scholar 

  12. Resch H (2003) Die Humeruskopffraktur [Fractures of the humeral head]. Unfallchirurg 106:602–617

    Article  CAS  PubMed  Google Scholar 

  13. Resch H, Huebner C, Schwaiger R (2001) Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury 32:SA25–32

    Article  PubMed  Google Scholar 

  14. Szyszkowitz R, Schippinger G (1999) [Fractures of the proximal humerus]. Unfallchirurg 102:422–428

    Article  CAS  PubMed  Google Scholar 

  15. Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123:74–81

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ralph Hertel.

Additional information

No personal or institutional funding was required or obtained

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hertel, R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16 (Suppl 2), S65–S72 (2005). https://doi.org/10.1007/s00198-004-1714-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-004-1714-2

Keywords

Navigation