[Results of treatment after conservative and surgical management of proximal humerus fractures].

The proximal fracture of the humerus is still the domain of conservative treatment. In 80% of our patients the humerus fracture was not operated. The remaining 20% were treated surgically. Neer's classification was used for a differentiated approach. In case of surgical therapy the guiding principle should be to choose the least invasive surgical treatment offering the greatest benefit. Minimal treatment should be preferred to prevent necrosis. Further, one should strive to gain an axial adjustment of the fracture rather than placing too much emphasis on compression. The aim should be an early and graded treatment and an early functional therapy. In fractures III, IV and V according to Neer, minimal osteosynthesis should be preferred. This will, if the fracture is not accompanied by other injuries and if there is adequate physiotherapy after surgery, result in a recovery of the function. In relatively young patients with solid spongiosa, good stability and anatomical restoration can be achieved by osteosynthesis. Unfortunately in fractures II and IV according to Neer, as well as in four-segment-fractures unsatisfactory results can not be avoided. In such cases minimal surgery should be performed. Implantation of a shoulder prosthesis is indicated only in case of a secondary painful arthrosis. The only cases in which primary alloarthroplasty is indicated are fractures of group II. In these cases implantation is promising because of the totally preserved muscular insertion. In four-segment and luxation fractures, atraumatic surgical reconstruction should be aimed at.