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Modern Minimally Invasive Treatment of Proximal Humeral Fractures

Moroder, Philipp MD*; Tauber, Mark MD*,†; Carbone, Stefano MD; Auffarth, Alexander MD*; Resch, Herbert MD*

doi: 10.1097/BTO.0000000000000032
Invited Review Articles

Proximal humerus fractures are often difficult to treat, especially in the case of displaced and comminuted fractures in combination with poor bone quality owing to osteoporosis. Because of constantly improving implants and evolving surgical techniques, the reduction and fixation of even the most complex proximal humeral fractures might be technically achievable nowadays. However, certain biological limitations need to be considered as they will dictate the fracture healing, vascularity of the fragments, and especially the clinical outcome. Therefore, it is of utmost importance to treat patients with a soft tissue and blood-supply–sparing technique that at the same time provides sufficient stability for retention of the previously achieved fracture reduction. The Humerusblock is a semi-rigid implant, which in combination with a percutaneous screw fixation system allows for minimally invasive treatment even of complex proximal humeral fractures. The greatest technical challenges are encountered in the percutaneous reduction of fragments with disrupted periostal bridges. In terms of clinical outcome, the results of the Humerusblock seem strongly related to the age and bone quality of the treated patient and the fracture type encountered. The fact that the minimally invasive and soft tissue–sparing Humerusblock technique enables a dynamic fixation of the head fragment that allows for controlled sintering and fracture consolidation without major cutout complications when adhering to the postoperative treatment protocol makes this technique especially attractive in the treatment of proximal humeral fractures in elderly patients with poor bone quality.

*Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria

Department of Shoulder and Elbow Surgery, Atos Clinic, Munich, Germany

Department of Orthopaedics and Traumatology, University of Rome Sapienza, Rome, Italy

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Philipp Moroder, MD, Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, Salzburg 5020, Austria. Email:

© 2013 by Lippincott Williams & Wilkins