Abstract
Study Design
Clinical commentary.
Introduction
Proximal humeral fractures (PHF) are the third most common fracture in the elderly
with an increased incidence expected in the coming years with the aging population,
causing an important burden to the healthcare system. The management of PHF is challenging
due to its complexity and the wide variety of fractures and treatment options.
Purpose
The objective of this clinical commentary is to update the available evidence on clinical
presentation, classification, imaging, medical treatment, and rehabilitation of acute
PHF.
Methods/Results/Discussion
N/A for clinical commentary.
Conclusions
The first step to a successful management of PHF is the clinical and radiographic
examination of the shoulder, which enables the physician to classify the fracture
and choose the appropriate treatment option. The Neer and OA classifications are commonly
used and are based on the identification of the fractured parts of the humerus, as
well as the displacement of the fragments. In case of non-displaced or minimally displaced
fractures, a conservative treatment, consisting of initial immobilization and a rehabilitation
program will be chosen. Displaced or unstable fractures will be managed operatively.
Different surgical options exist and will vary according to the fracture type, patient's
age, and functional needs, followed by rehabilitation.
Level of Evidence
5.
Keywords
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JHT Read for Credit
Quiz: #484
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.Management of PHF is initially based on
- a.the age and general health of the patient
- b.the therapist's evaluation
- c.classification via X-ray
- d.pain and AROM on the first visit to therapy
- a.
- #2.The distinction between _____________ and ______________ fractures is critical in setting the plan of treatment
- a.displaced and non-displaced
- b.dominant and non-dominant arm
- c.longitudinal and horizontal
- d.non-displaced and stress
- a.
- #3.There is a steep rise in the incidence of PHF after the age of
- a.35
- b.65
- c.55
- d.45
- a.
- #4.Results of conservative treatment have been shown to be best when mobilization has been initiated at about ____ week(s) post fracture
- a.four
- b.six
- c.one
- d.two
- a.
- #5.The vast majority of non-displaced PHFs can be successfully treated conservatively
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Accepted:
May 5,
2017
Received in revised form:
March 3,
2017
Received:
February 2,
2017
Footnotes
Conflict of interests: Dr Bureau reports equipment support (in kind) from Siemens Healthcare Limited. Dr Rouleau is a consultant for Bioventus and Wright. The institution (HSCM) of one or more of the authors (Dr Rouleau) has received funding from Arthrex, CONMED, DePuy, Linvatec, Smith & Nephew, Stryker, Synthes, Tornier, Wright, and Zimmer.
Identification
Copyright
© 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
