Conservative or operative treatment of numeral head fractures in the elderly?

The humeral head fracture in the elderly represents an unresolved problem, which is reflected by the variety of existing therapeutic strategies rangin g from conservative treatment to humeral head replacement. The main factors influencing the prognostic outcome are the fracture type, age of the patie nt and biologic criteria such as osteoporosis, blood supply at the fragment s, and the degree of soft tissue trauma. For selection of the optimal treat ment, the general condition of the patient, additional injuries and chronic diseases have to be respected as much as the patient's compliance and pers onal demands. According to experimental and clinical findings, for displace d two- and three-part fractures of the elderly patient minimal osteosynthes is and in the future plate osteosynthesis with angular stability should be preferred. For these fracture types, conservative treatment must be include d in the therapeutic spectrum. In contrast, displaced four-part fractures a nd fracture dislocations are indications for primary humeral head replaceme nt. This is explained by the fact that neither conservative treatment nor s urgical reconstruction procedures meet the main goal of primary therapy, ai ming for early painless mobilization and for timely discharging the elderly patients in their social environment.