Murena Luigi, Canton Gianluca, Ratti Chiara, Hoxhaj Bramir, Giraldi Gioia, Surace Michele Francesco, Grassi Federico Alberto
Orthopedics and Trauma Unit - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste.
Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese.
Orthop Rev (Pavia). 2020 Apr 28;12(1):8559. doi: 10.4081/or.2020.8559. eCollection 2020 Apr 22.
Proximal humerus fractures (PHF) are common injuries in the elderly population. Conservative treatment is indicated for undisplaced and stable fractures, which account for almost 80% of the cases. More complex fracture patterns might need surgery, with a wide variety of indication criteria and surgical techniques described in the literature. Surgical treatment should be reserved for patients in good clinical conditions, autonomous in daily living activities and able to adhere to postoperative rehabilitation protocols. In the elderly population with severe osteoporosis, cognitive impairment and clinical comorbidities, the risk of surgical failures is high. In these patients, the choice between surgical and conservative treatment, as well as for the type of procedure, is even more difficult, with no general consensus in the literature. Final indication is usually conditioned by surgeon's experience and preference. Two independent reviewers (B.H and G.G) independently extracted studies on proximal humeral fractures. All selected studies were screened independently (B.H and G.G) based on title and abstract. Then the full text of any article that either judged potentially eligible was acquired and reviewed again. Any disagreement was resolved by discussing the full text manuscripts. Aim of the present paper is to review the literature about indications and results of osteosynthesis for proximal humerus fragility fractures in the elderly population.
肱骨近端骨折（PHF）是老年人群中的常见损伤。对于无移位和稳定的骨折，应采用保守治疗，此类骨折几乎占所有病例的80%。更复杂的骨折类型可能需要手术治疗，文献中描述了各种各样的适应症标准和手术技术。手术治疗应仅适用于临床状况良好、日常生活能够自理且能够遵守术后康复方案的患者。在患有严重骨质疏松症、认知障碍和临床合并症的老年人群中，手术失败的风险很高。在这些患者中，手术治疗与保守治疗的选择以及手术方式的选择更加困难，文献中尚无普遍共识。最终的适应症通常取决于外科医生的经验和偏好。两名独立评审员（B.H和G.G）独立提取关于肱骨近端骨折的研究。所有选定的研究均由（B.H和G.G）根据标题和摘要进行独立筛选。然后获取并再次审查任何被判定可能符合条件的文章的全文。任何分歧都通过讨论全文手稿来解决。本文的目的是回顾有关老年人群肱骨近端脆性骨折内固定的适应症和结果的文献。
