RT Journal
A1 Aaron, Daniel
A1 Shatsky, Joshua
A1 Paredes, Juan Carlos
A1 Jiang, Chunyun
A1 Parsons, Bradford O.
A1 Flatow, Evan L.
T1 Proximal Humeral Fractures: Internal Fixation
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2012
FD December 19
VO 94
IS 24
SP 2280
OP 2288
DO 
UL http://dx.doi.org/
AB 
Fractures of the proximal part of the humerus represent 4% to 5% of all fractures1,2. Older individuals are more likely to sustain these injuries: 71% of proximal humeral fractures occur in patients over the age of sixty years3,4. As the population ages, such data suggest a potential increase in the total number of proximal humeral fractures. Some authors have estimated a threefold increase in the upcoming thirty years5. Neer asserted that most proximal humeral fractures are minimally displaced or nondisplaced, allowing nonoperative treatment to yield high rates of union and functional restoration6; however, a recent multicenter study noted that 64% were displaced7. Management strategies for displaced fractures have evolved recently because of advances in technology and improved understanding of pathophysiology. Unless contraindications exist, the recommended general strategy for the management of displaced proximal humeral fractures is operative, with use of various forms of internal fixation. These include pins, screws, tension-band wires, plate and screw constructs, heavy sutures, and intramedullary devices. Arthroplasty, which has also undergone dramatic advances in recent years, is an additional option. Each technique has particular indications, and each is subject to its own set of potential complications. Therefore, familiarity with all of these techniques is essential for the practitioner caring for fractures of the proximal part of the humerus.