Treatment options for proximal humeral fractures in the older adults and their implication on personal independence

Factors influencing surgical management of proximal humerus fractures: do shoulder and trauma surgeons differ?

“…This is best explained by an evolution of PHF care as considerable research has been published establishing RSA as a viable alternative to HA and ORIF since their 2013 study. 6,8,9,[11][12][13] Taken together, these findings reflect a temporal trend toward both shoulder and trauma surgeons favoring operative over nonoperative treatment and an increased preference for arthroplasty (RSA specifically) over ORIF in elderly patients.…”

“…20 Despite this, many clinical studies in elderly patients with PHFs have reported superior outcomes in favor of RSA 3,6,8,15,18,24,41 over ORIF, 31 HA, 32 and equivalent outcomes for nonoperative management. 11,25,27,37 Systematic reviews analyzing PHFs in the elderly population have found superior outcomes for ORIF 19,35 and similar or more favorable outcomes for RSA compared with HA. 12,29,42 However, these findings come with important caveats.…”

Shoulder conditions and health related quality of life and utility: a current concepts review

“…Feissli et al 16 conducted a retrospective study to assess the efficacy of nonoperative compared with operative treatment to restore self-dependence in patients older than 65 years with AO type A2, A3, and B1 PHFs. The median EQ-5D score in the nonoperative group was 1.00 (median range = 0.47-1.00, n=17) was not significantly different than the operative group was 0.91 (median range = 0.40-1.00, n=22; P = .556).…”

Plate osteosynthesis of proximal humerus fractures: treatment options and technical advancements

“…Patients with higher requirements will benefit more from surgical treatment. Among patients aged 65 or older suffering from a PHF, 38% were, at least in part, dependent and 9% would become so after treatment 6 , hindering participation in the rehabilitation protocol. Poor bone quality in elderly individuals, increases the risk of impaction, loss of reduction, and failure of the implant, whereas good bone quality facilitates reduction and prevents screw cut-out 43,44 .…”

“…The most commonly reported etiology is a fall from standing height 2 . PHF produce an impressive social and economic burden, as they cause inability in activities of daily living and, therefore, impose the need for support in previously independent individuals 6 ; hospitalization is often required, with yearly healthcare related costs estimated to reach € 33.6 million 7 , with mortality during hospitalization reaching 1.1% 7 and rising to 7.83% within one year after the injury, which is 5.2 times higher than general population 5 . Therefore, appropriate treatment of these fractures is of paramount importance to restore shoulder function and independence to treated patients and to avoid complications.…”