Proximal humeral fracture osteosynthesis: a clinical and biomedical evaluation on how to decrease failure

Proximal humeral fractures (PHF) comprise circa 5% of all fractures and are the third most common fractures affecting people older than 65 years of age. Women are two to three times more affected than men. Most of the PHF can be treated conservatively, however, certain (displaced) fractures are at high risk for progression to humeral mal-unions, non-unions, stiffness, avascular necrosis and post-traumatic arthrosis. These patients benefit from reduction and surgical fixation, even in the elderly population. Angular stable osteosynthesis has become the gold standard in the operative treatment of PHF fractures. Anatomical reduction of the glenohumeral joint and preservation of nerves and blood vessels are mandatory to achieve good results. However, surgical treatment of PHF remains difficult. Failure after PHF osteosynthesis rates up to 35%. In order to reduce this high failure rate and thus to improve patient outcome, further research in different fields is required.