Proximal Humerus Fractures: Understanding and Managing the Fracture

Abstract

The management of proximal humerus fractures has not yet been standardized. It is complex and there still remain a lot of disputes on which may be the best way to proceed depending on the fracture’s patterns, type of patient, and bone quality. Proximal humerus fractures comprise 4–5 % of all fractures and represent the most common humerus fractures (45 %). The proximal humerus is the second most frequently fractured upper limb bone. Women are mostly affected; the 2:1 female-to-male ratio is likely related to issues of bone density. Treatment should focus on maximizing the patient’s functional outcome and minimizing pain. Intervention options range from nonoperative modalities to osteosynthesis and in selected cases arthroplasty. Understanding and handling the several factors that may influence the management of proximal humerus fractures is paramount to proceed in the right way. The key point is the complex local anatomy: some fracture patterns can compromise the vascularity of the humeral head. The fracture patterns are often complex, complicated by poor bone quality, and may be difficult to reestablish the correct geometry of the proximal humerus.