Description
In this presentation, Dr. Mike Gardner from Stanford University addresses proximal humerus fractures in elderly patients, discussing the controversies surrounding operative versus non-operative treatment. He highlights the mixed outcomes related to Open Reduction Internal Fixation (ORIF) for low-energy geriatric fractures, noting that literature generally advises against this approach due to varying complication rates and a lack of focus on the quality of fracture reduction. Gardner reviews various studies, including the Proper Trial, which showed no significant differences in functional outcomes between operative and non-operative treatments, while also pointing out limitations such as insufficient assessment of reduction quality and exclusion of certain patients from the study.
Gardner emphasizes the importance of individualized patient assessment, considering the patient's desires for recovery and overall health. He elaborates on the necessity of careful evaluation for displaced fractures, often concluding that non-operative treatment may be appropriate given the high complication risks associated with surgical intervention in elderly patients.
Explicitly, he identifies high-risk situations for surgical candidates, including osteoporosis and specific fracture patterns that complicate repair, advocating for detailed planning and patient education. He describes techniques for ensuring optimal fixation, including the importance of anatomical reduction and the strategic use of augmentation methods, such as cement and fibular struts, to improve stability and healing outcomes. Finally, he summarizes the key steps in management of proximal humerus fractures in the elderly, advocating for meticulous techniques and tailored surgical approaches to mitigate risks.