Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges
Hayden P Baker, Joseph Gutbrod, Michael Cahill, Lewis Shi Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USACorrespondence: Hayden P Baker, Email hpbaker65@gmail.comAbstract: Proximal humeral fractures (PHFs) are a common type of fracture, particularly in older adults, ac...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-06-01
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| Series: | Orthopedic Research and Reviews |
| Subjects: | |
| Online Access: | https://www.dovepress.com/optimal-treatment-of-proximal-humeral-fractures-in-the-elderly-risks-a-peer-reviewed-fulltext-article-ORR |
| _version_ | 1797789292265734144 |
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| author | Baker HP Gutbrod J Cahill M Shi L |
| author_facet | Baker HP Gutbrod J Cahill M Shi L |
| author_sort | Baker HP |
| collection | DOAJ |
| description | Hayden P Baker, Joseph Gutbrod, Michael Cahill, Lewis Shi Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USACorrespondence: Hayden P Baker, Email hpbaker65@gmail.comAbstract: Proximal humeral fractures (PHFs) are a common type of fracture, particularly in older adults, accounting for approximately 5– 6% of all fractures. This article provides a comprehensive review of PHFs, focusing on epidemiology, injury mechanism, clinical and radiographic assessment, classification systems, and treatment options. The incidence of PHFs varies across regions, with rates ranging from 45.7 to 60.1 per 100,000 person-years. Females are more susceptible to PHFs than males, and the incidence is highest in women over the age of 85. The injury mechanism of PHFs is typically bimodal, with high-energy injuries predominant in younger individuals and low-energy injuries in the elderly. Clinical assessment of PHFs involves obtaining a thorough history, physical examination, and evaluation of associated injuries, particularly neurovascular injuries. Radiographic imaging helps assess fracture displacement and plan for treatment. The Neer classification system is the most commonly used classification for PHFs, although other systems, such as AO/OTA, Codman-Hertel, and Resch classifications, also exist. The choice of treatment depends on factors such as patient age, activity level, fracture pattern, and surgeon expertise. Nonoperative management is typically preferred for elderly patients with minimal displacement, while operative fixation is considered for more complex fractures. Nonoperative treatment involves sling immobilization followed by physiotherapy, with good outcomes reported for certain fracture patterns. Operative management options include closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), or arthroplasty. CRPP is suitable for specific fracture patterns, but the quality of reduction is crucial for favorable outcomes. ORIF is used when CRPP is not feasible, and various surgical approaches are available, each with its advantages and potential complications. PHFs are a significant clinical challenge due to their prevalence and complexity. Treatment decisions should be patient centered based on patient factors and fracture severity.Keywords: proximal humerus, fracture, elderly, management, shoulder arthroplasty |
| first_indexed | 2024-03-13T01:48:32Z |
| format | Article |
| id | doaj.art-7cb8e1b7d3eb4977957510e3d535c930 |
| institution | Directory Open Access Journal |
| issn | 1179-1462 |
| language | English |
| last_indexed | 2024-03-13T01:48:32Z |
| publishDate | 2023-06-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Orthopedic Research and Reviews |
| spelling | doaj.art-7cb8e1b7d3eb4977957510e3d535c9302023-07-02T19:49:21ZengDove Medical PressOrthopedic Research and Reviews1179-14622023-06-01Volume 1512913784697Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management ChallengesBaker HPGutbrod JCahill MShi LHayden P Baker, Joseph Gutbrod, Michael Cahill, Lewis Shi Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USACorrespondence: Hayden P Baker, Email hpbaker65@gmail.comAbstract: Proximal humeral fractures (PHFs) are a common type of fracture, particularly in older adults, accounting for approximately 5– 6% of all fractures. This article provides a comprehensive review of PHFs, focusing on epidemiology, injury mechanism, clinical and radiographic assessment, classification systems, and treatment options. The incidence of PHFs varies across regions, with rates ranging from 45.7 to 60.1 per 100,000 person-years. Females are more susceptible to PHFs than males, and the incidence is highest in women over the age of 85. The injury mechanism of PHFs is typically bimodal, with high-energy injuries predominant in younger individuals and low-energy injuries in the elderly. Clinical assessment of PHFs involves obtaining a thorough history, physical examination, and evaluation of associated injuries, particularly neurovascular injuries. Radiographic imaging helps assess fracture displacement and plan for treatment. The Neer classification system is the most commonly used classification for PHFs, although other systems, such as AO/OTA, Codman-Hertel, and Resch classifications, also exist. The choice of treatment depends on factors such as patient age, activity level, fracture pattern, and surgeon expertise. Nonoperative management is typically preferred for elderly patients with minimal displacement, while operative fixation is considered for more complex fractures. Nonoperative treatment involves sling immobilization followed by physiotherapy, with good outcomes reported for certain fracture patterns. Operative management options include closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), or arthroplasty. CRPP is suitable for specific fracture patterns, but the quality of reduction is crucial for favorable outcomes. ORIF is used when CRPP is not feasible, and various surgical approaches are available, each with its advantages and potential complications. PHFs are a significant clinical challenge due to their prevalence and complexity. Treatment decisions should be patient centered based on patient factors and fracture severity.Keywords: proximal humerus, fracture, elderly, management, shoulder arthroplastyhttps://www.dovepress.com/optimal-treatment-of-proximal-humeral-fractures-in-the-elderly-risks-a-peer-reviewed-fulltext-article-ORRproximal humerusfractureelderlymanagementshoulder arthroplasty |
| spellingShingle | Baker HP Gutbrod J Cahill M Shi L Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges Orthopedic Research and Reviews proximal humerus fracture elderly management shoulder arthroplasty |
| title | Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges |
| title_full | Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges |
| title_fullStr | Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges |
| title_full_unstemmed | Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges |
| title_short | Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges |
| title_sort | optimal treatment of proximal humeral fractures in the elderly risks and management challenges |
| topic | proximal humerus fracture elderly management shoulder arthroplasty |
| url | https://www.dovepress.com/optimal-treatment-of-proximal-humeral-fractures-in-the-elderly-risks-a-peer-reviewed-fulltext-article-ORR |
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