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Online ISSN 1827-1707
SHOLDER AND ELBOW SURGERY
Leblanc J. E. M., Lebel M. E., Drosdowech D. S., Faber K. J., Athwal G. S.
Orthopedic Surgery, Department of Surgery University of Western Ontario London, ON, Canada
Proximal humerus fractures are common and most often occur in the elderly, who may also suffer from osteopenia and multiple medical comorbidities. Codman first described these fractures as consisting of four parts: articular head, greater tuberosity, lesser tuberosity and diaphysis. There are multiple modalities to treat these fractures, with the literature reporting that up to 80% can be effectively managed non-operatively. When surgery is indicated, one of the options is arthroplasty. Knowledge of normal shoulder anatomy is important as accurate reduction and fixation of the tuberosities is vital to a good outcome following arthroplasty for trauma. Hemiarthroplasty for fracture of the proximal humerus was first described by Neer, and has been used for over forty years. The results have demonstrated reliable pain relief but variable self-reported scores and functional outcomes, with dependence on anatomic tuberosity healing for satisfactory results. Reverse total shoulder arthroplasty has recently been introduced for treatment of proximal humerus fractures, demonstrating reliable pain relief and restoration of forward elevation. This review will summarize the available evidence and techniques for arthroplasty for the management of proximal humerus fractures.