علاج كسر الحُميرة القريبة في المرضى الذين تبلغ أعمارهم 65 عامًا أو أكثر مع أنماط الكسر النازح أو غير المستقر

References

DOI: 10.1016/j.jcot.2019.04.016

The majority (>80%) of these are fragility fractures, occurring in low demand (often elderly) patients. Weak osteoporotic bones not only break easily but are also difficult to stabilize and are often associated with high failure rates, after the surgery. Dislocated head. Head facing superiorly/posteriorly (though in the socket, but not facing the glenoid). Splitting of head. GT is lying above the humeral head or displaced posteriorly. Significant varus angulation of the head (usually indicates severe medial pillar instability & progressive malposition).

Fractures of neck needing an ORIF are best fixed with locking plates and screws. It is also an implant of choice in displaced 3 & 4 part fractures. However, it must be realized that the complication rates are high (20-50%) in the older population. Hence, the bone void in humeral head must be filled with bone graft (autogenous, allografts or bone substitutes). A well-positioned calcar screw, fibular strut graft or a small medial plate can prevent this complication. The crux of PHF surgery is to bring back the fractured GT in its anatomical position, to achieve satisfactory rotator cuff function. Sufficient time must be spent to identify, tag and repair the GT. Suture bites must be taken from the bone-tendon junction (not thru the bone).