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Current Surgical Treatment Options for Complex Proximal Humeral Fractures

George M Kontakis, MD1, Theodoros Tosounidis, MD2, and Kyriakos Kakavelakis, MD3

During the past few decades, significant advances have been made in the treatment of proximal humeral fractures. Nonetheless, their management remains controversial. This article describes the key points for decision-making and the currents trends in the treatment of complex proximal humeral fractures. The surgeon should define the fracture pattern and decide whether surgical intervention will benefit the patient. Furthermore, the preoperative plan needs to evaluate whether the viability of the humeral head can be preserved and proximal humeral anatomy can be restored. Osteosynthesis can be accomplished by various means, including open transosseous sutures, percutaneous fixation, conventional plating, intramedullary nailing, and locking plates. Locking plates have gained considerable popularity over the last few years because they address the issue of poor bone stock in elderly patients. Furthermore, prosthetic replacement with either hemiarthroplasty or the more recently introduced reverse total shoulder arthroplasty offers an option in difficult cases that need surgical treatment and are unsuitable for open reduction–internal fixation. Nonetheless, the superiority of any technique has not yet been proven in the clinical setting.Adv Orthop 2010;2(2):43–50.

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