![]() Displaced fractures of the greater and lesser tubercles are repositioned and stabilized with two small-fragment traction screws as long as the bone is of good enough quality and the fragments are of adequate size. Osteosynthesis-Whatever type of implant is chosen, the goal of surgical reconstruction is always the anatomical reposition and stable fixation of the fracture. In principle, a decision must be made whether to use a head-preserving or a head-replacing technique. Further indications for surgery include metaphyseal comminution, dislocated fractures, open fractures, head-split and anatomical neck fractures, and injuries to the neighboring blood vessels and nerves. The particular treatment to be used should, therefore, be chosen individually with consideration of the patient’s biological age and bone quality, accompanying illnesses, compliance, and personal wishes.įractures that do not meet the above criteria for conservative treatment should be treated surgically. There is, however, still no consensus on these values. Lill, for example, defines as displaced any fracture with a fragment displacement of 5 mm, an axial deviation of 20°, or a tubercle displacement of 2 mm ( 11). Although it is often stated in the literature that 60% to 80% of non-displaced or mildly displaced fractures can be treated conservatively ( 9), certainly most such fractures are now treated surgically, and the threshold values for a surgical indication are now being set lower than in the past ( 10). Mildly displaced fractures are now considered an indication for surgery more commonly than before. Although Neer’s values were long used as the standard for clinical decision-making, recent improvements in osteosynthetic techniques-above all, the development of fixed angle implants-have encouraged a trend toward operative treatment. It is problematic for the recommendation of any specific treatment that the threshold values posited by Neer to distinguish displaced from non-displaced fractures are not based on clinical or biomechanical data rather, they are theoretical constructs ( 8). In the elderly, the implantation of a prosthesis may need to be considered in order to restore painless, robust function of the humerus, and thus personal independence, as rapidly as possible. In younger patients, non-displaced or mildly displaced fractures are treated conservatively, while the treatment of choice for displaced proximal humerus fractures is anatomical reconstruction and osteosynthesis. The conclusion of a recent Cochrane review was that no evidence-based recommendations on the treatment of proximal humerus fracture can be derived from the currently available data ( 7). There are no standardized and generally accepted threshold values, and the trials that have been performed at various centers are poorly comparable with one another because of the different criteria that they employed. ![]() The wide variety of fracture morphologies and treatment options, ranging from conservative treatment to various osteosynthetic methods to the implantation of an endoprosthesis, makes such trials difficult to initiate. Although proximal humeral fracture is among the more common types of fracture, very few randomized trials of its treatment have been published. There are still no evidence-based schemes or guidelines for the treatment of proximal humeral fractures. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |