Six-year experience with antegrade intramedullary nail for the treatment of proximal and diaphyseal humeral fractures

Rethinking Conservative Treatment of Humeral Diaphyseal Fractures in Elderly Patients With Dementia

“…However, there are many publications presenting conflicting results following conservative management, with some reports demonstrating better results when surgical management is sought on early. 10,11,[13][14][15]18 Patusso et al reported the management of 75 cases of humeral shaft fractures with IMNs: 10 of these patients required revision surgery with good functional scores and no further complications. Interestingly, they found a significant difference in functional scores between patients older than 65 years and younger patients.…”

“…Although both patient groups had significantly better functional scores after surgery, the younger group showed an even greater improvement. 13 In a large multicenter study, Serrano et al identified a 29% (out of a total of 1182 fractures) surgical conversion rate for humeral shaft fractures initially treated with a functional brace. Although dementia status was not reported, they did find alcoholism, which can cause a similar cognitive effect, to be associated with a higher rate of nonunion and is more likely to be associated with conversion to surgical management.…”

“…Although both patient groups had significantly better functional scores after surgery, the younger group showed an even greater improvement. 13…”

“…In addition, more recent studies have questioned the efficacy of this practice. [10][11][12][13][14] One study demonstrated significantly better union rates in diaphyseal humeral fractures treated with immediate surgery. 15 Compelling evidence on the optimal management of humeral diaphyseal fractures in elderly patients and those with dementia is lacking.…”

How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

“…It is still controversial which treatment might be more appropriate, however a recent systematic review showed that conservative treatment is associated to lower complications while assuring good functional outcomes compared with surgery. 7 However, the observation that most of the single center cohort studies reported good outcomes [8][9][10][11] suggested that surgeon experience act in determining the results. Moreover, Boesmueller et al observed that the results of surgically treated PHF were related not only to patient's factors (age and smoking habits) but also to the quality of reduction.…”