Proximal Humerus Fractures in the Elderly

Proximal humerus fractures are the second most common upper limb injury among the elderly, with a notable increase in incidence attributed to osteoporosis. This chapter addresses the complexities involved in managing these fractures, particularly in older patients who may have unique challenges and risks.

A review of current management strategies for proximal humerus fractures in elderly patients was conducted, focusing on both conservative and surgical approaches. Conservative management was evaluated for its efficacy in treating minimally displaced fractures, especially in patients with lower functional demands or those unfit for surgical intervention. Surgical options, including open reduction and internal fixation (ORIF) with locking plates (PHILOS) and newer intramedullary nail designs (MULTILOC), were also examined. Additionally, minimally invasive techniques such as Resch and MIROS were considered for high-risk surgical candidates.

Conservative management, while often preferred, carries potential complications such as malunion, nonunion, and stiffness, which can adversely affect patient outcomes. Surgical intervention is frequently required for displaced or complex fractures, with ORIF being the gold standard due to its ability to provide stability and enhance outcomes in osteoporotic bone. The introduction of innovative intramedullary nail designs and minimally invasive techniques offers promising alternatives, particularly for patients at high surgical risk, by reducing soft tissue disruption and facilitating quicker recovery.

Effective management of proximal humerus fractures in the elderly requires a tailored approach, balancing the benefits and risks of conservative versus surgical treatment. Ongoing advancements in surgical techniques and devices hold the potential to improve outcomes for this vulnerable population, emphasizing the importance of individualized care in fracture management.