Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

  • Brian Bernstein University of Cape Town
  • J P Du Plessis University of Cape Town
  • M Laubscher University of Cape Town
  • S Maqungo University of Cape Town
Keywords proximal humerus fracture, fragility fracture, osteoporosis, implant evolution, internal fixation

Abstract

The ultimate goal of management of proximal humeral fractures in the elderly patient is to get the patient independently mobile. This article will review the current literature regarding this cohort of patient. Recent Cochrane reviews and a large multicentre randomised study question the role of surgical intervention. Implant design is evolving rapidly, and many elderly patients now behave more like the younger patient. There remains little compelling evidence to guide decision-making for the complex proximal humeral fracture in the elderly, and the decision needs to be made on a case-by-case basis taking into account the patient’s comorbidities, the fracture pattern and characteristics, the attending surgeon’s skill sets, and the availability of equipment.


Level of evidence: Level 5

Author Biographies

Brian Bernstein, University of Cape Town

MBBCh(Wits)FCS(SA)Orth; 1: Cape Orthopaedic Trauma Group. Life Orthopaedic Hospital, Alexandra road, Pinelands, 7405, Cape Town, South Africa; 2: Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

J P Du Plessis, University of Cape Town

MBChB(UCT), Dip PEC, FC Orth (SA), MMed Ortho (UCT); 1: Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 2: Orthopaedic Department, New Somerset Hospital, Cape Town; 3: Life Orthopaedic Hospital, Cape Town

M Laubscher, University of Cape Town

MBChB(UFS), Dip PEC, FC Orth (SA), MMed Ortho (UCT); Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

S Maqungo, University of Cape Town

MBChB(Natal), FC Orth (SA), MMed Ortho (UCT); Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

Published
2019-05-29
How to Cite
BERNSTEIN, Brian et al. Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?. South African Orthopaedic Journal, [S.l.], p. 37-43, may 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/305>. Date accessed: 23 aug. 2019.

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