Fraktura ng Proksimal Humerus Impormasyon

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang matulis na sakit sa itaas na bahagi ng iyong braso, malapit sa joint ng balikat. Karaniwang kumakalat ang sakit na ito pababa sa iyong braso o pataas papunta sa iyong leeg. Ang pinsala ay isang pagkabasag sa itaas na bahagi ng iyong buto ng braso, na maaaring mangyari kung mahulog ka o kung ang iyong mga buto ay mahina dahil sa pagpapapayat na nauugnay sa edad.

Karaniwang lumalala ang sakit kapag sinusubukan mong galawin ang iyong braso. Ang mga simpleng gawain tulad ng pag-angat ng tasa, pag-abot sa isang shelf, o pagtutukoy ng iyong kamiseta ay maaaring maging mahirap o imposible. Maaaring mahirapan kang umabot sa likod ng iyong likod upang i-fasten ang bra o i-button ang kamiseta. Kahit ang mga bahagyang galaw ay maaaring mag-trigger ng pagtaas ng kaguluhan.

Maraming tao ang nakakakita na ang sakit ay pinakamalakas sa gabi. Ang paghiga sa nasirang gilid ay madalas na masyadong masakit, kaya maaaring mahirapan kang makahanap ng komportableng posisyon sa pagtulog. Karaniwang gumising ka na may mapait at masakit na balikat. Ang pagpapahinga ng braso sa isang sling ay maaaring makatulong upang bawasan ang sakit sa pamamagitan ng pagpapanatili ng basag na buto na tahimik. Gayunpaman, ang pagpapanatili ng iyong braso na tahimik sa loob ng mahabang panahon ay maaari ring gawing matigas at mahigpit ang joint.

Habang ang sakit ay matindi, mahalagang malaman na ang karamihan sa mga fracture na ito ay gumagaling nang maayos nang walang operasyon. Ang iyong surgeon ay gabayin ka kung paano protektahan ang braso habang ito ay gumagaling. Sa karamihan ng mga kaso, ang non-surgical treatment ay nagdudulot ng matagumpay na paggaling at union rates na higit sa 90%. Ibig sabihin, ang buto ay nag-uugnay pabalik nang maayos para sa karamihan ng mga pasyente.

Kung ikaw ay isang mas matandang adulto, ang iyong treatment plan ay mag-aconsider ng iyong pangkalahatang kalusugan at lakas ng buto. Para sa mga mas batang adulto sa ilalim ng 65, ang operasyon ay hindi laging mas mabuti kaysa sa pahinga at suporta. Ang iyong surgeon ay titingnan ang imaging upang makita kung saan eksaktong ang basag at desisyonin ang pinakamainam na landas pasulong.

Para sa ilang mas matandang pasyente na may mas kumplikadong mga basag, maaaring pag-usapan ang joint replacement. Ang opsyong ito ay nag-aalok ng matibay na resulta para sa paggamot ng mga acute fractures sa mga mas matandang adulto. Ito ay isang ligtas at makatwirang pagpili kapag ang pinsala sa buto ay seryoso.

Ang karamihan sa mga bata na may ganitong uri ng fracture ay mabilis na gumagaling na may kaunting komplikasyon. Kung ikaw ay nag-aalaga ng isang bata, ang outlook ay karaniwang napakabuti.

Maging alerto na ang pinsalang ito ay maaaring makaapekto sa iyong pang-araw-araw na buhay nang malaki. Maaari itong magdulot ng pansamantalang disability at bawasan ang iyong pakiramdam ng well-being. Gayunpaman, ang tamang pag-aalaga at pasensya, ang karamihan sa mga tao ay muling nakakakuha ng paggamit ng kanilang braso. Sundin ang payo ng iyong surgeon sa paggalaw at pahinga upang suportahan ang iyong paggaling.

Ano ang nangyayari talaga

Ang itaas na bahagi ng iyong buto sa itaas na braso ay isang kumplikadong kontrolado na volume para sa galaw ng balikat. Kapag nahulog ka, maaaring magbasag ang lugar na ito sa mga piraso. Ang pinakamahalagang bahagi ay ang mga tuberosities, na mga butong bubong kung saan dumidikit ang mga tendon ng iyong rotator cuff. Isipin ang mga tendon na ito bilang matibay na lubid na nagpapataas at nagpapaliko ng iyong braso. Kung lumipat ang mga bubong na ito sa kanilang posisyon, nawawalan ng anchor ang mga lubid. Nagbabago ang paraan kung paano dumadaloy ang puwersa sa iyong joint ng balikat. Kahit maliliit na paglipat sa posisyon ay maaaring malaki ang epekto sa paraan kung paano gumagalaw at nagdudulot ng bigat ang joint.

Tinitingnan ng iyong surgeon ang katatagan ng mga koneksyong ito. Ang joint capsule ay ang sleeve sa paligid ng balikat, at ang cartilage ay ang makinis na coating sa mga dulo ng buto. Kapag lumipat ang mga fragment ng buto, maaaring magkagaspang ang isa sa isa o magpindot nang hindi pantay sa cartilage. Ito ang nagdudulot ng sakit at nagbabawas sa iyong range of motion. Sa ilang kaso, ang blood supply sa ulo ng buto ay nakakaapekto. Maaari itong magdulot ng stiffness o weakness kung hindi magaling ang paggaling ng mga piraso sa tamang alignment.

Nauunawaan namin na ang mga pagpipilian sa paggamot ay nakadepende sa iyong edad at sa partikular na pattern ng basag. Para sa maraming one-part fractures, kung saan basag ang buto ngunit naka-align pa rin, ang non-operative treatment ay epektibo. Karamihan sa mga matatandang may mga stable na fractures ay patuloy na tumatanggap ng non-surgical na paggamot na may positibong resulta. Ang non-surgical na pamamahala ay nagpapakita ng matagumpay na mga resulta at union rates na higit sa 90%. Ibig sabihin, gumagaling ang buto nang wasto nang walang surgery sa karamihan ng mga kaso.

Gayunpaman, kung ang mga fragment ng buto ay displaced o unstable, maaaring irekomenda ng iyong surgeon ang surgery. Ang layunin ay ibalik ang anatomy upang muling maging epektibo ang paghila ng iyong mga tendon. Gumagamit kami ng locking plates o nails upang hawakan ang mga piraso habang nagpapagaling. Ito ay nagbibigay ng stable na fixation para sa proximal humerus. Sa mga severe na kaso kung saan ang buto ay sobrang sira upang ayusin, maaari naming isaalang-alang ang joint replacement. Ang pagpipiliang ito ay nag-aalok ng makabuluhang ebidensya ng epektibidad at functional durability sa paggamot ng acute proximal humerus fractures sa mga matatanda.

Mga maitutulong namin dito

Ang aming paraan ng pag-aalaga sa iyo ay sumasalamin sa pamamaraan ni Dr Kieran Hirpara, isang surgeon sa upper-limb sa Mater Private Hospital Rockhampton, sa pamamahala ng mga sugat na ito sa aming klinika. Ang karamihan sa mga proximal humerus fractures na may iisang bahagi ay gumagaling nang maayos nang walang operasyon. Sa karamihan ng mga kaso, ang non-operative na paggamot ay nagdudulot ng magagandang resulta. Ang mga rate ng union para sa nonsurgical na pamamahala ay higit sa 90%. Ang iyong paglalakbay ay madalas na nagsisimula sa self-management at physiotherapy. Maaari kaming gumamit ng sling upang suportahan ang iyong braso. Ang maikli o mahabang panahon ng immobilization ay nagdudulot ng katulad na resulta, kaya iniaangkop namin ang tagal base sa iyong kaginhawaan at pattern ng fracture. Layunin ng physiotherapy na ibalik ang galaw at lakas habang gumagaling ang buto. Ang karamihan sa mga matatandang may ganitong mga fracture ay patuloy na tumatanggap ng ganitong uri ng pag-aalaga na may magandang functional na mga resulta.

Ang medical na pamamahala ay nakatuon sa pagpapanatili ng iyong kaginhawaan habang nagse-set ang buto. Gumagamit kami ng gamot sa sakit at anti-inflammatories upang kontrolin ang discomfort. Kung tumatagal ang pamamaga o stiffness, maaari naming pag-usapan ang mga injection. Ang mga cortisone injection ay nagbabawas ng inflammation at sakit para sa isang limitadong panahon. Ang mga hyaluronic acid injection ay naglulubog ng joint upang mapabuti ang galaw. Ang mga platelet-rich plasma (PRP) injection ay gumagamit ng sarili mong blood components upang suportahan ang paggaling. Ang mga opsyon na ito ay tumutulong sa pamamahala ng mga sintomas kapag ang conservative na pag-aalaga lamang ay hindi sapat. Para sa mga degenerative o matagal nang problema, karaniwan naming sinisimulan ang mga hakbang na ito na non-operative. Kinikonsider namin ang operasyon lamang kapag hindi na ito nagbigay ng sapat na pagpapabuti.

Kinikonsider ang operasyon kapag naabot na ng conservative na pag-aalaga ang hangganan nito o kapag ang fracture ay kumplikado. Para sa mga displaced na two-part fractures sa mga pasyenteng 60 taong gulang pataas, walang makabuluhang pagkakaiba sa clinical na mga resulta sa loob ng 2 taon pagitan ng operasyon at non-operative na paggamot. Gayunpaman, para sa mga three- o four-part fractures sa mga matatanda, maaaring magbigay ang operasyon ng mas mahusay na long-term na functional na mga resulta. Ang reverse total shoulder arthroplasty (joint replacement) ay isang makatwirang at ligtas na opsyon para sa mga matatanda na may malubhang mga fracture. Ito ay nagbibigay ng epektibo at matibay na functional na mga resulta. Ang percutaneous na paggamot ng mga napiling fracture ay nagdudulot din ng predictable na union na may mababang rate ng mga komplikasyon. Ang rate ng mga komplikasyon pagkatapos ng operative na paggamot ay mataas, kaya iniiwan namin ang operasyon para sa mga partikular na senaryo. Para sa mga structural o acute na problema, maaaring irekomenda agad ang operasyon. Ipinapakita namin ang mga opsyong ito bilang isang shared decision, batay sa iyong edad, kalidad ng buto, at pattern ng fracture.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa malaking bahagi sa iyong edad at sa kabiguan ng pagkabasag. Para sa karamihan ng mga matatandang mag-aaral, ang mga basag na ito ay gumagaling nang maayos nang walang operasyon. Ang pamamahala nang walang operasyon ay nagdudulot ng matagumpay na paggaling sa higit sa 90% ng mga kaso. Malamang na magdala ka ng sling sa maikling panahon, tulad ng isang linggo, o sa mas mahabang panahon, tulad ng tatlong linggo. Parehong pagpipilian ay nagbibigay ng katulad na resulta. Ang karamihan ng mga pasyente ay nakakabalik ng mahusay na pag-andar gamit ang pamamaraang ito.

Kung ikaw ay mas bata sa 65, ang iyong doktor ay maaaring pag-usapan ang operasyon. Gayunpaman, ang ebidensya ay hindi nagpapakita ng malinaw na benepisyo ng operasyon kumpara sa walang-operasyon na pag-aalaga para sa mga matatanda sa ilalim ng edad na ito. Para sa mga kumplikadong pagkabasag sa mga matatanda, ang operasyon ay madalas na nagbibigay ng mas mahusay na pangmatagalang pag-andar kaysa sa pag-iiwan nito. Ang mga pamamaraan tulad ng reverse total shoulder replacement o internal fixation gamit ang mga plate at kuko ay tumutulong sa pagpapatibay ng buto. Layunin ng mga pamamaraang ito na ibalik ang galaw at bawasan ang sakit sa paglipas ng panahon.

Ang paggaling ay isang unti-unting proseso. Maaaring mapansin mo na ang iyong balikat ay parang matigas o mahina sa loob ng ilang buwan. Sa operasyon, maaaring maranasan mo ang ilang pagkabigo, dahil mas mataas ang rate ng komplikasyon at reoperasyon para sa mga kumplikadong pagkabasag. Sa kabila nito, maraming pasyente ang nakakamit ng magandang pangmatagalang resulta. Ang iyong doktor ay gabayan ang iyong rehabilitasyon upang matiyak na mababalik mo ang lakas nang ligtas.

Mahalagang maunawaan ang mas malawak na larawan ng kalusugan. Ang mga fragility fractures sa mga matatanda ay may mas mataas na panganib ng seryosong kaganapan sa kalusugan. Ang panganib ng kamatayan sa loob ng isang taon pagkatapos ng sugat ay 9.8%. Ang panganib na ito ay tumataas sa 28.2% sa limang taon. Ang pagtaas na ito ay higit sa doble ng populasyon ng pangkalahatan. Ang iyong doktor ay babantayan ang iyong pangkalahatang kalusugan nang mahigpit sa panahon ng paggaling upang pamahalaan ang mga panganing na ito.

Ang karamihan ng mga bata ay gumagaling nang buo na may kaunting komplikasyon. Para sa mga matatanda, ang pasensya ang susi. Habang ang ilang kahirapan ay maaaring manatili, ang karamihan ng mga pasyente ay bumabalik sa mga araw-araw na gawain. Ang iyong doktor ay magtatakda ng iyong plano ng pag-aalaga batay sa iyong partikular na pattern ng pagkabasag at estado ng kalusugan. Ang regular na mga follow-up ay tinitiyak na ang iyong buto ay gumagaling nang tama at tumutulong sa pagharap sa anumang mga alalahanin nang maaga.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang kahinaan o kawalan ng katatagan sa iyong balikat. Humingi ng agad na paggamot kung ang iyong balikat ay nakakabit o biglang bumabagsak. Kontakin ang iyong doktor kung ang mga sintomas ay nakakaapekto sa iyong tulog o trabaho. Biglaang paglala ng sakit ay dahilan din upang humingi ng tulong. Karamihan sa mga isang-part na fracture ay gumagaling nang maayos nang walang operasyon. Gayunpaman, ang tumpak na pagsusuri ay mahalaga. Gagamitin ng iyong surgeon ang mga imahen upang suriin kung may mga komplikasyon. Ang maagang pagsusuri ay tumutulong na maiwasan ang pangmatagalang kapansanan. Huwag balewalain ang mga senyales na hindi gumagalaw ang iyong paggaling ayon sa inaasahan.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults [1].
Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
Most one-part proximal humerus fractures are amenable to non-operative treatment with positive outcomes reported in the vast majority of cases [8].
The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years [15].
Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade [3].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
Patients with pathologic humerus fractures had significantly higher complication rates compared with native humerus fractures after surgical treatment [29].
Guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin [29].
The selection of reverse total shoulder arthroplasty (RTSA) over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients [25].
Patients with a proximal humerus fracture undergoing reverse total shoulder arthroplasty have significantly worse perioperative outcomes, including higher rates of complications, longer hospital stays, and higher costs, compared to patients with other indications [67].
Prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures [17].
Besides age, most randomized controlled trials on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria [16].

Anatomy & Pathophysiology

Inferior tuberosity displacement after prosthetic reconstruction of shoulder fractures is associated with diminished functional results [33].
Inferior tuberosity positioning after hemiarthroplasty for proximal humerus fractures is associated with diminished function [40].
Range of motion and strength thresholds can identify subjects with normal shoulder function [36].
Shoulder flexion, extension, and abduction are only moderately correlated with patient-reported outcome measures (PROMs) [57].
Holistic assessment of outcomes requires both subjective and objective outcomes [57].
The changed position of the humeral head on the coronal plane does not affect final functional results in conservatively treated displaced proximal humerus fractures in the elderly [54].
Bone quality significantly impacts implant anchorage in osteosynthesis for proximal humerus fractures [58].
Positioning the arm in abduction and internal rotation may help mitigate deforming muscular forces in proximal humerus fractures [46].
Rotator cuff tears are a detrimental factor and a major cause of painful shoulders in proximal humeral fractures with minimal displacement treated conservatively [63].
The double plate strategy can increase the stability of the medial column of the proximal humerus and enhance the overall biomechanical property of the repaired proximal humerus [64].
Reverse shoulder arthroplasty could be considered primary treatment for proximal humerus fractures, especially when optimal range of motion is of great importance to the patient [72].
Glenoid loosening and severe scapular notching in reverse shoulder arthroplasty for proximal humerus fractures are related to poor positioning and/or incorrect orientation of the glenosphere [74].

Classification

Proximal humerus fractures are osteoporotic injuries with increasing incidence due to aging populations [5].
Accurate clinical evaluation, imaging, and classification are paramount for informed treatment decisions [5].
Evaluation of classification systems for fractures of the proximal humerus with plain radiographs has yielded low interobserver reliability [32].
The Mayo-FJD classification system for proximal humerus fractures allows high intraobserver and interobserver agreement using both radiographs and computed tomography [45].
The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs [28].
Morphologic classification of proximal humerus fractures as the sole basis for treatment algorithms and surgical success should be scrutinized [50].
Current diagnosis coding practices (ICD-10) do not adequately capture the fracture complexity needed to conduct subgroup analysis for proximal humerus fractures [75].
There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third [69].

Clinical Presentation

Proximal humerus fractures are now typically osteoporotic fractures in women over 70, with prevalence increasing due to an aging population in poor general condition [19].
There is a substantial mortality in patients with a proximal humerus fracture [6].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
Surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year [6].
Complications associated with proximal humerus fractures are varied and can be categorized as occurring at the time of initial injury, during operative management, or as delayed sequelae [11].
Treatment algorithms and outcomes following proximal humerus fractures in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population [13].
Surgical treatment of proximal humerus fractures remains far from straightforward, with unpredictable outcomes where factors associated with poor results include being a woman, four-part fracture dislocation, and absence of metaphyseal head extension [37].
Computed tomography improves the diagnostic accuracy but not the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography scan was more specific than radiographs in the assessment of proximal humerus fracture sequelae [18].

Investigations

Accurate clinical evaluation, imaging, and classification are paramount for informed treatment decisions in proximal humerus fractures [5].
Computed tomography improves the diagnostic accuracy of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography does not improve the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography scan is more specific than radiographs in the assessment of proximal humerus fracture sequelae [18].
Artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs [28].
Convolutional neural networks proficiently rule out proximal humerus fractures on plain radiographs [76].
The routine use of 3D-printed models may not be beneficial for classifying proximal humeral fracture patterns beyond the information gained from currently available imaging modalities [79].
The routine use of 3D-printed models should be avoided as the sole determinant for recommending surgical intervention in proximal humeral fractures [79].
In children with shoulder dislocation combined with proximal humerus fracture, bilateral anteroposterior shoulders x-ray is suggested routinely to confirm shoulder location in addition to palpation and anteroposterior and lateral humeral x-ray [83].

Treatment

Non-Operative Management

In the vast majority of cases, proximal humerus fractures may be treated nonoperatively [2].
Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
Non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention [24].
There is little utility to the routine use of postoperative radiographs in follow-up of pediatric proximal humerus fractures [24].
Proximal humerus fractures in children have tremendous potential for remodeling, making non-operative management the treatment of choice for most fractures [56].
Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [27].
A majority of patients with proximal humeral fractures underwent non-operative treatment [41].
Nonsurgical management of proximal humerus fractures decreased during the study period [35].
Nonsurgical treatment should have a more prominent role in the treatment of proximal humeral fractures [48].
Nonsurgical treatment provides better midterm outcomes compared to locking plate fixation for proximal humeral fractures [48].
There is no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus [39].
Evidence-based recommendations to guide treatment of proximal humerus fractures are lacking, and no good evidence exists whether surgery is clearly superior to nonoperative treatment [65].

Operative Management

Consensus when managing proximal humerus fractures is limited to specific scenarios, whereas lack of consensus still exists in others [7].
Most RCTs on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria [16].
Hemiarthroplasty and reverse prosthesis are indicated for complex proximal humerus fractures in patients no younger than 70 years of age [21].
Reverse total shoulder replacement is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome [22].
The selection of RTSA over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients [25].
Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications [26].
No single fixation method is a panacea for proximal humeral fractures; choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [38].
Minimally invasive plate osteosynthesis (MIPO) with PHILOS plate is a safe and effective option for the treatment of proximal humerus fractures, with good functional recovery and fewer complications, which are typically technique dependent [49].
There are no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in reverse shoulder arthroplasty (RSA) for proximal humerus fractures [51].

Complications

Proximal humerus fractures are associated with substantial mortality [6].
Surviving patients with proximal humerus fractures frequently have persistent symptoms that can be predicted as early as after 1 year [6].
Low arthroplasty survival is observed after treatment for proximal humerus fracture sequelae [9].
Patients with pathologic humerus fractures have significantly higher complication rates compared with native humerus fractures after surgical treatment [29].
Predictive models using machine learning techniques demonstrate favorable discrimination and satisfactory-to-excellent performance in forecasting prolonged length of stay and serious adverse complications occurring within 30 days of surgical intervention for proximal humerus fracture [59].

Recovery

Both age and gender are associated with the definitive treatment received for proximal humerus fractures in patients older than fifty years [3].
Treatment algorithms and outcomes for proximal humerus fractures in patients aged 60 years or younger are distinctly different from those in a more elderly population [13].
Long-term treatment with reverse shoulder arthroplasty (RSA) for displaced 3- or 4-part proximal humerus fractures provides better functional outcomes compared to nonoperative treatment, a difference attributed to the deterioration of functional outcomes of the nonoperative treatment over time [44].
There is substantial mortality in patients with a proximal humerus fracture, and surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year [6].
After one year, long-term follow-up of fixed proximal humerus fractures may be unnecessary for those without symptoms [20].
Reverse shoulder arthroplasty is used for the treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old) [30].
It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome [22].
The locking plate provides satisfactory functional outcomes after a mid-term follow-up in patients with displaced proximal humerus fractures [23].
ORIF of nonosteoporotic proximal humeral fractures with locking plates led to favorable functional and radiologic outcomes at a minimum of 10 years of follow-up [52].
Minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock yields good midterm clinical and radiological results [31].
Timing of surgery does not impact outcomes of patients who underwent ORIF for proximal humerus fractures, with delays beyond 5 days not affecting outcome [84].

Key Evidence

[L4] Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults. [1] (10.5312/wjo.v5.i5.685)
[L4] In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. [2] (10.1155/2012/861598)
[L3] Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade. [3] (10.1016/j.jseint.2021.11.007)
[L4] Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. [4] (10.1016/j.jseint.2021.08.006)
[L3] Our results suggest that there is a substantial mortality in patients with a proximal humerus fracture, as we have previously reported, and that surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year. [6] (10.1080/17453670510041295)
[L5] Consensus when managing proximal humerus fractures is limited to specific scenarios, whereas lack of consensus still exists in others. [7] (10.1016/j.jse.2024.12.005)
[L3] These results are pertinent when deciding on the treatment of proximal humerus fracture sequelae. [9] (10.1080/17453674.2020.1793548)
[L5] Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent. [12] (10.5435/jaaos-d-14-00033)
[L4] Treatment algorithms and outcomes following proximal humerus fractures in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population. [13] (10.1016/j.xrrt.2023.01.002)
[L3] Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors. [14] (10.1016/j.jse.2022.03.006)
[L1] The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years. [15] (10.1016/j.xrrt.2021.04.014)
[L2] Besides age, most RCTs on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria. [16] (10.1016/j.xrrt.2025.07.023)
[L3] However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures. [17] (10.1016/j.injury.2013.08.024)
[L2] Computed tomography scan was more specific than radiographs in the assessment of proximal humerus fracture sequelae. [18] (10.1177/17585732221150785)
[L2] Proximal humerus fractures are now typically osteoporotic fractures in women over 70, with prevalence increasing due to an aging population in poor general condition. [19] (10.1016/j.otsr.2012.05.013)
[L3] After one-year, long-term follow-up of fixed proximal humerus fractures may be unnecessary for those without symptoms. [20] (10.1007/s00590-021-03099-6)
[L4] They are indicated for complex proximal humerus fractures in patients no younger than 70 years of age. [21] (10.1016/j.otsr.2008.09.002)
[L3] It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome. [22] (10.1186/s12891-023-06669-3)
[L4] The locking plate provides satisfactory functional outcomes after a mid-term follow-up in patients with displaced proximal humerus fractures. [23] (10.1007/s00590-010-0655-z)
[Paper] Non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention, and there is little utility to the routine use of postoperative radiographs in follow-up of these patients. [24] (10.1016/j.otsr.2016.09.022)
[L5] The selection of RTSA over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients. [25] (10.1097/corr.0000000000002430)
[L4] Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications. [26] (10.1016/j.jse.2006.09.006)
[L5] Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes. [27] (10.2106/jbjs.l.01293)
[L4] The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs. [28] (10.1080/17453674.2018.1453714)
[L3] After surgical treatment, patients with pathologic humerus fractures had significantly higher complication rates compared with native humerus fractures, suggesting that guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin. [29] (10.1016/j.jse.2020.10.024)
[L4] We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals ( ≥ 65 years old). [30] (10.1007/s12178-020-09597-0)
[L4] Minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock yields good midterm clinical and radiological results. [31] (10.1016/j.injury.2015.05.017)
[L5] Evaluation of the classification systems for fractures of the proximal humerus with plain radiographs has yielded low interobserver reliability. [32] (10.1016/j.ocl.2008.05.002)
[L5] These biomechanical observations may explain diminished functional results observed in patients treated with inferior tuberosity displacement after prosthetic reconstruction of shoulder fractures. [33] (10.1016/j.jse.2007.02.110)
[L4] Nonsurgical management of proximal humerus fractures decreased during the study period. [35] (10.1016/j.jhsa.2020.03.022)
[L3] Range of motion and strength thresholds can identify subjects with normal shoulder function. [36] (10.1016/j.jse.2010.06.005)
[L5] Surgical treatment of proximal humerus fractures remains far from straightforward, with unpredictable outcomes where factors associated with poor results include being a woman, four-part fracture dislocation, and absence of metaphyseal head extension. [37] (10.1097/corr.0000000000002242)
[L4] No single fixation method is a panacea for proximal humeral fractures; choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications. [38] (10.1016/j.injury.2010.10.016)
[L1] This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. [39] (10.1371/journal.pmed.1002855)
[Abstract] These biomechanical changes may explain diminished function in patients with inferior tuberosity positioning after hemiarthroplasty for proximal humerus fractures. [40] (10.1016/j.jse.2007.02.027)
[L3] A majority of patients with proximal humeral fractures underwent non-operative treatment. [41] (10.1186/s12891-019-2812-9)
[L1] Long-term treatment with RSA for displaced 3- or 4-part proximal humerus fractures provides better functional outcomes compared to nonoperative treatment, a difference attributed to the deterioration of functional outcomes of the nonoperative treatment over time. [44] (10.1016/j.jse.2024.09.032)
[L4] The Mayo-FJD classification system for proximal humerus fractures seems to allow high intraobserver and interobserver agreement using both radiographs and computed tomography. [45] (10.1016/j.jse.2023.02.035)
[L5] These findings suggest that positioning the arm in abduction and internal rotation may help mitigate deforming muscular forces in proximal humerus fractures. [46] (10.5397/cise.2022.00885)
[L3] Nonsurgical treatment should have a more prominent role in the treatment of proximal humeral fractures. [48] (10.1016/j.jse.2011.01.025)
[L4] MIPO is a safe and effective option for the treatment of proximal humerus fractures, with good functional recovery and fewer complications, which are typically technique dependent. [49] (10.1016/j.aott.2016.10.003)
[L2] Morphologic classification of proximal humerus fractures as the sole basis for treatment algorithms and surgical success should be scrutinized. [50] (10.1016/j.jseint.2022.02.006)
[L1] This meta-analysis demonstrates no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in RSA, suggesting comparable performance in the treatment of proximal humerus fractures. [51] (10.1302/0301-620x.107b9.bjj-2024-1508.r2)
[L3] ORIF of nonosteoporotic proximal humeral fractures with locking plates led to favorable functional and radiologic outcomes at a minimum of 10 years of follow-up. [52] (10.1097/corr.0000000000002895)
[L2] However, the changed position of the humeral head on coronal plane does not affect the final functional results. [54] (10.4103/0973-6042.118911)
[L3] Holistic assessment of outcomes with both subjective and objective outcomes are necessary, as shoulder flexion, extension, and abduction are only moderately correlated with PROMs. [57] (10.1016/j.jseint.2024.02.003)
[L4] The paper reviews the biology and biomechanics of osteosynthesis for proximal humerus fractures, emphasizing that bone quality significantly impacts implant anchorage. [58] (10.1007/s00068-007-7089-2)
[L3] Predictive models constructed using ML techniques demonstrated favorable discrimination and satisfactory-to-excellent performance in forecasting prolonged LOS and serious adverse complications occurring within 30 days of surgical intervention for proximal humerus fracture. [59] (10.1016/j.jseint.2024.02.005)
[Paper] Rotator cuff tears are a detrimental factor and a major cause of painful shoulders. [63] (10.1007/s00264-004-0552-3)
[L5] The double plate strategy can increase the stability of the medial column of the proximal humerus, and enhance the overall biomechanical property of the repaired proximal humerus. [64] (10.1186/s12891-024-08216-0)
[L4] Evidence-based recommendations to guide treatment of proximal humerus fractures are lacking, and no good evidence exists whether surgery is clearly superior to nonoperative treatment. [65] (10.1016/j.ocl.2008.06.003)
[Abstract] Patients with a proximal humerus fracture undergoing reverse total shoulder arthroplasty have significantly worse perioperative outcomes, including higher rates of complications, longer hospital stays, and higher costs, compared to patients with other indications. [67] (10.1016/j.jse.2015.05.005)
[L4] There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third. [69] (10.1016/j.injury.2013.10.030)
[L3] Therefore, reverse shoulder arthroplasty could be considered primary treatment, especially when optimal range of motion is of great importance to the patient. [72] (10.1177/17585732231190038)
[L4] Glenoid loosening and severe scapular notching are related to poor positioning and/or incorrect orientation of the glenosphere. [74] (10.1016/j.otsr.2018.06.008)
[L3] Current diagnosis coding practices do not adequately capture the fracture complexity needed to conduct subgroup analysis for proximal humerus fractures. [75] (10.1016/j.jse.2023.08.022)
[L3] CNNs proficiently rule out proximal humerus fractures on plain radiographs. [76] (10.1302/0301-620x.106b11.bjj-2024-0264.r1)
[L5] The routine use of 3D-printed models may not be beneficial for classifying proximal humeral fracture patterns beyond the information gained from currently available imaging modalities, and their use as the sole determinant for recommending surgical intervention should be avoided at this time. [79] (10.1097/corr.0000000000002017)
[L5] In addition to palpation and anteroposterior and lateral humeral x-ray, we suggest adding bilateral anteroposterior shoulders xray routinely to confirm the shoulder location. [83] (10.1097/md.0000000000008977)
[L3] Timing of surgery did not impact outcomes of patients who underwent ORIF for proximal humerus fractures. [84] (10.1016/j.jse.2025.02.019)

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