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Proximal Humerus Nonunions

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Nonunions

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Abstract

Proximal humerus fractures are common and most unite uneventfully. A small percentage will develop a nonunion but small studies cause difficulties determining the true incidence. Proximal humerus nonunions present challenges due to the biologic insults from the injury and surgeries, bone loss, osteopenia, contractures, and infection. Risk factors include fracture translation and metaphyseal comminution, nutritional or metabolic deficiencies, smoking, and medical comorbidities. Nonunions are identifiable as early as three months after injury based on restricted range of motion, Constant scores, and difficulty resuming daily living activities. Nonunions treated within six months of injury may be more successful due to decreased glenohumeral contracture rates. If addressed later, treatment of soft tissue contractures must be performed. Treatments range from nonsurgical management to osteosynthesis with plates or intramedullary implants, or arthroplasty. Fractures amenable to fixation have better prognoses due to simpler patterns, adequate bone stock, and vascularity. Patient factors such as younger age and less medical comorbidities predict better functional outcomes. Locking plate and interlocking nail design advances have expanded the nonunions amenable to osteosynthesis. Arthroplasty offers favorable pain control but an unpredictable range of motion, which seems related to tuberosity union. Reverse total shoulder arthroplasties are less dependent on tuberosity union but more research is needed to elucidate their role in proximal humeral nonunions.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of California at Davis Medical Center, 4860 Y St, Suite 3800, Sacramento, CA, 95608, USA

    Ethan S. Lea MD, MSc & Philip R. Wolinsky MD

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  1. Ethan S. Lea MD, MSc
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  2. Philip R. Wolinsky MD
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Correspondence to Philip R. Wolinsky MD .

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  1. Boerne, Texas, USA

    Animesh Agarwal

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Lea, E.S., Wolinsky, P.R. (2018). Proximal Humerus Nonunions. In: Agarwal, A. (eds) Nonunions. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-7178-7_4

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  • DOI: https://doi.org/10.1007/978-1-4939-7178-7_4

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