A Modern View on the Surgical Treatment of Proximal Humerus Fractures (Literature Review)

This scientific work is devoted to a review of literary sources regarding the surgical treatment of patients with fractures of the proximal humerus...

Despite the development and widespread use of quite a few different methods of surgical intervention, postoperative complications and unsatisfactory results range from 12 to 35% in the form of instability of the installed plate, nail migration, the appearance of impingement syndrome, aseptic necrosis of the humeral head [10,11]. When choosing the operational method for stabilization of fragments, it is necessary to focus on the data of the X-rays taking into account the state of the bone tissue, the size and number of bone fragments in which the choice of tactics in each case is individual [12,13]. Closed percutaneous pinning can be performed in patients with biphasic proximal shoulder fractures with good bone density with the appropriate equipment -an electron-optical transducer [14,15]. with plates and nails is more appropriate for young patients to obtain the best long-term results, and in elderly patients over 60 years of age the most delicate and at the same time reliable fixation method is recommended [15,23].
In case of multi-fragmented (three-and four-fragmented) fractures, caused by high-energy injuries, it is impossible to achieve sufficient adequate fixation by using pin fixation, which led to the development and use of more optimal types of plates, such as BIOS, LCP, DCP, providing stable fixation of fragments that do not violate the normal anatomy and functionality of the shoulder segment [24,25]. compared with closed reposition and fixation of fragments by pins, which in the latter occurs in 2.4% to 11% cases [5,20].
In In his opinion, surgery should be performed as soon as possible.
AO / ASIF itself was created in 1958 and four basic principles of osteosynthesis were then formulated: 1.
Anatomical reposition (perfect matching of fragments during surgery)

3.
Preservation of blood supply to bone fragments.
Also today, many authors support the above principles in their functional activities.
At one time, AS / ASIF plates were rational in use, became widespread in all developed schools of the world, led to many controversial disagreements with large-scale use, on the basis of which, new improved bone retainers were developed [22,27]. The only drawback of the AO / ASIF plate is the lack of compression when it is installed on the surface of the cortical layer of the bone due to classic simple holes, and also is not a retainer of choice in patients with multi-fragmented fractures arising from osteoporosis [5,30]. The unresolved issue is the choice of the type of fixation between the plate and the shaft for fractures of the proximal humeral metaepiphysis. According to many researchers, when comparing the type of osteosynthesis with three-and four-fragment fractures of the proximal humerus, there is a significant difference between the use of two types: lockable plates and lockable shafts from a position of stability is not detected, however, osteosynthesis with a shaft can be performed less invasively. Many scientists explain that the expression "stability" can be either absolute or relative, reaching during surgery depending on the location of the fracture. This allows you to start earlier movement development [16]. including accompanied by its fracture [28].
For several years, many authors proposed in the case of three-and four-fragment fractures to do primary hemiartroplasty (according to Neer) or to perform unipolar shoulder joint replacement taking into account the inefficiency and many disadvantages of the known bone and intraosseous methods of osteosynthesis [32].