Abstract
Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and clavicle fractures, and shoulder instability.
The majority of proximal humerus fractures can be managed non-operatively with surgery reserved for approximately 10–20% of patients. The choice of surgical treatment is usually between a humeral head head-conserving fracture reduction and internal fixation and humeral head sacrifice hemiarthroplasty. Current indications for primary hemiarthroplasty include a displaced four-part fracture (with or without associated dislocation of the humeral head) and a head-splitting fracture (with involvement of >40% of the articular surface), due to the high associated risk of avascular necrosis. However, the indications for internal fixation of proximal humerus fractures have expanded over the last decade, and many fractures which have previously been considered unsalvageable and treated either non-operatively or with hemiarthroplasty are now deemed reconstructable. This is partially as a result of improved appreciation of sub-groups of fractures which have a better prognosis from head-salvage, the possibility that subsequent development of osteonecrosis may be relatively asymptomatic and the realisation that functional results after hemiarthroplasty are often sub-optimal.
The purpose of this talk is to discuss the current concepts in fracture classification and the indications for operative treatment for these fractures. The novel surgical approaches, techniques and implants which have renewed interest in their treatment are also highlighted.
None of the authors have received any payment or consideration from any source for the conduct of this study.
