Proximal humerus fractures - current treatment options.

Proximal humerus fractures represent an increasing challenge for the health system due to epidemiological changes. As estimated by a Finnish study group the number of fractures may triple by the year 2030. The majority of patients with these fractures are older than 60 years and in this population most of the proximal humerus fractures have been related to osteoporosis. Nondisplaced fractures and fractures with minimal displacement and adequate stability are usually successfully treated non-operatively. The main challenge in the operative treatment of displaced and unstable proximal humerus fractures is to achieve effective stabilization of an adequately reduced fracture to maximize the functional patient outcome. Especially in osteoporotic bone and comminuted fractures operative stabilization is challenging and the management of displaced and unstable fractures remains controversial. The most important factor for favourable results in the treatment of complex three-part or four-part humerus fractures is anatomic reduction. Minimal exposure, high primary stability, and load transfer through the implant are important for avoiding complications such as secondary dislocation, osteonecrosis, and stiffness. Recently invented implants with angular stability provide better biomechanical properties and enhanced anchorage especially in the osteoporotic bone. These implants therefore have a potential for achieving better results in the treatment of these complex injuries.