• S Ruchholtz and D Nast-Kolb.
• Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen. steffen.ruchholtz@uni-essen.de
• Unfallchirurg. 2003 Jun 1; 106 (6): 498-512; quiz 512-3.

AbstractHumeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. Particularly isolated K-wire osteosynthesis is associated with a high risk of implant or fragment dislocation. Dislocated 3- or 4-part fractures need additional reduction and fixation of the tubercles. In osteoporotic fractures, intraosseous fixation may lead to complications. Especially cerclage and/or isolated screws (eventually additional K-wires) osteosynthesis allows good reduction for functional treatment in the older patient. Sufficient results in long-term outcome are achieved by minimal invasive techniques even in partial avascular head necrosis. In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.

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