Walters Jordan M, Ahmadi Shahryar
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Geriatr Orthop Surg Rehabil. 2020 Dec 10;11:2151459320971568. doi: 10.1177/2151459320971568. eCollection 2020.
High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer's classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.
老年患者的高能近端肱骨骨折可通过多种机制发生，跌倒和机动车碰撞事故是该年龄组常见的损伤机制。即使是典型的低能量机制也可能导致损伤严重度评分升高，而这与跌倒和机动车碰撞事故中的较高死亡率相关。这些损伤会导致近端肱骨骨折，通常通过Neer分类法进行分型。治疗外科医生有多种治疗选择。与几乎所有其他治疗方法相比，非手术治疗得到系统评价的广泛支持。切开复位内固定术对于健康患者的复杂骨折类型和骨折脱位特别有用。半关节置换术对于有发生缺血性坏死高风险且骨质不佳有螺钉穿出风险的骨折类型患者可能有用。反式全肩关节置换术也是老年患者常用的治疗方法，现在有文献表明，即使从非手术治疗或切开复位内固定术晚期转换为反式全肩关节置换术也能取得良好的临床效果。预防对于老年患者是可行且重要的。与初级保健医生和老年病医生协作，优化包括听力、视力、力量和骨质在内的医疗护理，对于预防骨折以及在跌倒发生时减少损伤非常重要。让老年病医生加入专门的创伤团队可能也会有帮助。
