Proximal and distal humeral fractures in the elderly

In contrast to distal humeral fractures, humeral head fractures represent a common injury to the old patient. For both fracture localizations osteopor osis and multi-morbidity are of significant importance. The classification for humeral head fractures in one-, two-, three- and four-part fractures is generally accepted. Valgus impacted head fractures as well as head-splitti ng fractures are considered a seperate entity. In none or minimally displac ed fractures good functional results are achieved by conservative means. Al though numerous therapeutical procdure are offered in the treatment of disp laced fractures of the proximal humerus the result are often disappointing. Generally, minimal invasive surgical procedures should be preferred. Howev er, in dislocated multi-part fractures a primary humeral head replacement i s often the treatment of choice. In patients with mutifarious morbidity a c onservative treatment is always to be included into the therapeutical consi derations Distal fractures of the humerus are classified into extraarticula r, intraarticular unicondylar and intraarticular bicondylar fractures. The therapeutical recommendations, also in the elderly, is relatively homogenou s: primary open reduction and internal fixation (ORIF) should be carried ou t aiming for an early postoperative functional treatment. Depending from so ft tissue conditions and accompanying injuries the functional results are o ften good or moderate and are generally comparable to those of younger pati ents. Following a correct indication for surgical intervention the main pri ority for both distal and proximal humeral fractures is an early definitive surgical treatment.