Proximal Humerus Fracture ORIF (Plate and Nail Fixation) Info Evidence Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. We usually try non-operative care first and consider surgery when that has not given enough improvement. For acute injuries, surgery may be recommended straight away.
This operation uses plates or nails to hold broken bone pieces together so they can heal in the correct position. It is typically offered when non-surgical treatment is unlikely to restore stability or function. We aim to relieve pain and restore movement. For displaced fractures, locking plates provide stable fixation. In patients over 60, there is a 44% complication rate and a 34% failure rate. However, for younger patients without brittle bones, outcomes remain favourable for at least 10 years. We discuss these figures with you to help decide if this shared path is right for your specific injury.
Before the operation
We ask that you fast for seven hours before your surgery. This allows us to bring your procedure forward if the list runs early. Please arrange a lift home and wear comfortable clothing. Bring a list of all current medications to your visit. Your surgeon will provide specific guidance on which medicines to stop. You will need clear X-ray images to plan the operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist. Most patients do not require these extra checks. We will confirm your specific preparation steps during your pre-admission visit.
On the day
You present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist. This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block — an injection that numbs the nerves supplying the arm before you wake up — provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.
You are then taken into the operating theatre. Your surgeon performs the procedure. You wake up in the recovery area. Nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home. This depends on the procedure and your recovery.
What the operation involves
Your surgeon makes a single cut over the area being operated on. This open approach allows clear access to the broken bone. Through this incision, your surgeon carefully realigns the fractured pieces of your upper arm bone. The goal is to restore the natural shape and position of the joint surface.
Once the bone fragments are in place, your surgeon secures them using metal plates and screws. These implants act like an internal splint, holding the bone steady while it heals. Your surgeon selects the specific plate and screw configuration based on the pattern of your fracture. The hardware is fixed directly to the bone surface to provide stable support.
After the fixation is complete, your surgeon checks the stability of the repair. The incision is then closed using sutures (stitches). A sterile dressing is applied to protect the wound. This process completes the surgical phase of your treatment.
After the operation
You will wake up in the recovery ward with your arm supported in a simple sling for comfort. We manage your pain with standard medication, and a nurse will check your wound dressing. Most patients stay one night in hospital after this operation, though some are able to go home the same day. Please ensure someone stays with you for the first 24 hours to help you. You must not drive for at least six weeks after any shoulder operation, regardless of which arm was operated on. You can drive once your surgeon clears you, typically at the six-week review. See our guide on Driving after upper-limb surgery. Your sling comes off for exercises and washing, but keep it on when resting.
Recovery
You will have a single cut over the area being operated on. Your arm rests in a simple sling for comfort. You take it off for exercises and washing. Swelling and pain are normal at first. They ease as the swelling settles. Your physiotherapist guides your rehabilitation. You do gentle movements to restore motion.
You cannot drive while in a sling. Your surgeon clears you to drive, typically at the six-week review. See our guide on Driving after upper-limb surgery. You return to daily tasks as movement returns. You sleep propped up for comfort. Your timeline may differ; your surgeon and physio will guide you.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Infection is a serious risk. You might notice increasing redness, warmth, or swelling around the wound. The area may feel tender or painful. You could develop a fever or chills. If you see these signs, contact the clinic immediately or go to the emergency department. Deep infections can be severe and may require further treatment.
Bone healing issues can occur. You might feel persistent pain that does not improve with rest or medication. The bone may not knit together properly, known as nonunion. This can lead to ongoing discomfort and limited movement. If pain worsens or fails to ease, bring it up at your next review.
The blood supply to the upper arm bone head can be affected. This is called avascular necrosis. You may experience deep, aching pain in the shoulder that does not go away. The joint might feel stiff or weak. If you notice new, unexplained pain, call the clinic for advice.
Reoperation may be needed. This is more common if the shoulder was dislocated along with the fracture. You might feel instability, clicking, or grinding in the joint. If the repair fails or causes new symptoms, your surgeon will discuss further options.
Overall, complications vary. Some treatments carry higher risks than others. Your surgeon will choose the safest approach for your specific fracture. The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you develop a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath, or if you lose sensation or cannot move your limb. These signs need urgent assessment. We are here to help you stay safe during your recovery.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Proximal Humerus Fracture page.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Proximal Humerus Fracture page.
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
- Modern proximal humeral nail designs and techniques demonstrate promising outcomes and provide stable fixation [1].
- Intramedullary nailing and locked plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults [2].
- Intramedullary nailing is superior to locking plates in reducing total complications, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rates [3].
- Both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures [6].
- There is unclear superiority of intramedullary nails versus locking plates for the treatment of displaced proximal humeral fractures [6].
- Limited evidence suggests that both locking plates and intramedullary nails are valuable options for the treatment of proximal humeral fractures [13].
- Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages [7].
- Reported outcomes for intramedullary fixation are comparable with other techniques [7].
- Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation [9].
- Augmentation of plate fixation for proximal humeral fractures mechanically increases construct stability and reduces complication rates while improving patient outcomes [18].
- Augmentation of plate fixation for proximal humeral fractures is a reliable and safe procedure [18].
- No single fixation method is a panacea for proximal humeral fractures [21].
- The choice of implant and method for proximal humeral fractures should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [21].
- Treatment for proximal humerus fractures remains controversial [5].
- Nonsurgical management of proximal humerus fractures demonstrates successful outcomes and union rates greater than 90% [5].
Anatomy & Pathophysiology
- Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy [29].
Classification
- Intramedullary nailing of the proximal humerus can provide stable fixation [1].
- Intramedullary nailing is superior to locking plate in reducing total complications, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
- There is unclear superiority of intramedullary nails versus locking plates for displaced proximal humeral fractures [6].
- Reported outcomes with intramedullary fixation are comparable with other techniques [7].
- Plate fixation was associated with a higher risk of avascular necrosis (AVN) development than conservative treatment in patients with proximal humeral fractures [11].
- Limited evidence suggests that locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures [13].
- No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures [14].
- Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics [16].
- Treatment options for displaced proximal humerus fractures range from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty [16].
- The choice of treatment for proximal humeral fractures depends on the fracture type and severity, surgeon expertise, patient age, and patient health status [25].
Clinical Presentation
- Intramedullary nailing is superior to locking plate in reducing total complication rate, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
- Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates [4].
- Both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method [6].
- Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages, including reported outcomes comparable with other techniques [7].
- Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [8].
- Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
- Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [15].
- Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics, with a general evolution toward humeral head preservation using options ranging from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty [16].
- Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging [17].
- Hemiarthroplasty for the treatment of complex proximal humerus fractures yields variable long-term clinical outcomes and high rates of failure, with the majority due to greater tuberosity malunion or nonunion [38].
- Optimal management of osteoporotic proximal humeral fractures has evolved to include the use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft [43].
Investigations
- Intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults [2].
- Intramedullary nailing is superior to locking plate in reducing total complication rates, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
- Modern proximal humeral nail designs and techniques have demonstrated promising outcomes and can provide stable fixation [1].
- Patients undergoing ORIF for proximal humerus fracture dislocations have relatively high avascular necrosis and reoperation rates [4].
- Preoperative CT is extremely valuable for careful analysis of fracture type, fragment displacement, and bone quality in the surgical treatment of three and four-part proximal humeral fractures [54].
- Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries [52].
Treatment
Non-Operative Management
- Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [15].
- Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes [27].
- Non-operative treatment is advocated for the majority of non-displaced and minimally displaced proximal humerus fractures, which generally yield good outcomes [41].
Operative Management: General Considerations
- No single fixation method is a panacea for proximal humerus fractures; the choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [21].
- Surgical management of proximal humeral fractures in younger patients is challenging due to high expectations and the lack of a single device providing reproducible results [19].
- Technical strategies to maximize the success of surgical treatment for proximal humerus fractures emphasize innovations in technique and implant design to mitigate high complication rates [39].
- Modern management controversies surrounding adult proximal humerus fractures include surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty [53].
Intramedullary Nailing vs. Locking Plate Fixation
- The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of proximal humerus fractures [3].
Augmentation Techniques
- Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure that mechanically increases construct stability and reduces complication rates while improving patient outcomes [18].
- Fixation of proximal humeral fractures in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone [26].
Specific Fracture Patterns and Populations
Anesthesia
- Regional anesthesia is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anesthesia alone [44].
Complications and Definitions
- Significant heterogeneity exists in the terminology and definitions used to describe complications following non-surgical management of proximal humeral fractures, calling for standardized definitions to improve evidence synthesis [20].
Complications
- Intramedullary fixation represents an alternative treatment option with reported outcomes comparable with other techniques [7].
- Fixation of proximal humeral fractures in elderly patients using locked plates with cement augmentation may have lesser implant failure and total complication rates than using a locked plate alone [26].
- Standard components and fracture-specific components in reverse shoulder arthroplasty (RSA) for proximal humerus fractures show no significant differences in complication rates [47].
- Venous thromboembolism (VTE) was the most frequently reported complication after shoulder arthroplasty (SA) compared to ORIF, with RSA having the highest VTE rate [50].
- Revision surgery for failed arthroplasty of proximal humerus fracture is complex with a high likelihood of inferior outcomes compared with primary arthroplasty [57].
- Locked humeral stems provide reliable diaphyseal fixation with a low incidence of screw-related complications in reverse total shoulder arthroplasty for complex proximal humerus fractures [58].
- Open fractures and 4-part proximal humerus fractures had the highest complication rates following intramedullary nailing [59].
- Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures [60].
- Proximal humerus fractures treated with a locking compression plate (LCP) augmented with a fibular allograft have decreased odds of a major complication when compared with patients treated with an LCP alone [61].
Recovery
- Modern proximal humeral nail designs and techniques can provide stable fixation [1].
- In most studies of proximal humerus fractures, only 1 or 2 patients experiencing an alternative outcome or lost to follow-up would change the conclusions for the dichotomous outcome studied [24].
- Patients 65 years of age with 3- or 4-part proximal humerus fractures achieve the most benefit in terms of ROM, postoperative functional outcomes, tuberosity union, and overall complication rate when undergoing reverse total shoulder arthroplasty (rTSA) with a noncemented stem and early postoperative ROM compared to rTSA with cemented stem and delayed rehabilitation [48].
- Published rehabilitation protocols for proximal humerus fractures vary considerably regardless of management [49].
Key Evidence
- [L5] Modern proximal humeral nail designs and techniques have demonstrated promising outcomes and can provide stable fixation. [1] (10.1016/j.jse.2015.11.016)
- [L1] Intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults. [2] (10.1016/j.jse.2026.02.016)
- [L1] The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of PHF. [3] (10.1186/s13018-019-1345-0)
- [L4] Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates. [4] (10.1016/j.jse.2022.04.018)
- [L5] Treatment for proximal humerus fractures remains controversial, with nonsurgical management demonstrating successful outcomes and union rates greater than 90%. [5] (10.5435/jaaos-d-24-01073)
- [L5] The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. [6] (10.1016/j.xrrt.2024.01.001)
- [L4] Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages, including reported outcomes comparable with other techniques. [7] (10.5435/jaaos-d-18-00360)
- [L5] Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes. [8] (10.2106/jbjs.l.01293)
- [L4] Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. [9] (10.1016/j.injury.2010.11.058)
- [L1] Plate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures. [11] (10.1186/1749-799x-9-31)
- [L5] Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent. [12] (10.5435/jaaos-d-14-00033)
- [L1] Limited evidence suggests that locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures. [13] (10.1186/s13018-015-0242-4)
- [L1] No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures. [14] (10.1007/s00264-017-3683-z)
- [L4] Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. [15] (10.1016/j.jseint.2021.08.006)
- [L5] Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics, with a general evolution toward humeral head preservation using options ranging from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty. [16] (10.5435/00124635-200701000-00003)
- [L4] Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging. [17] (10.1016/j.jse.2020.04.006)
- [L1] Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure that mechanically increases construct stability and reduces complication rates while improving patient outcomes. [18] (10.1007/s00402-019-03162-2)
- [L5] The paper concludes that surgical management of proximal humeral fractures in younger patients is challenging due to high expectations and the lack of a single device providing reproducible results. [19] (10.1016/j.jse.2010.12.006)
- [L1] This systematic review highlights significant heterogeneity in the terminology and definitions used to describe complications following non-surgical management of proximal humeral fractures, calling for standardized definitions to improve evidence synthesis. [20] (10.1186/s12891-019-2459-6)
- [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. [21] (10.1016/j.injury.2010.10.016)
- [L2] In most studies of proximal humeral fractures, only 1 or 2 patients experiencing an alternative outcome or lost to follow-up would change the conclusions for the dichotomous outcome studied. [24] (10.1016/j.jse.2022.01.141)
- [L4] The choice of treatment for proximal humeral fractures depends on the fracture type and severity, surgeon expertise, patient age, and patient health status. [25] (10.5435/jaaos-d-15-00240)
- [L1] Fixation of proximal humeral fractures in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. [26] (10.1186/s12891-024-07502-1)
- [L5] Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. [27] (10.2106/jbjs.20.00665)
- [L5] Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy, with biomechanical studies showing that locked plating provides stable fixation. [29] (10.5435/jaaos-d-20-00558)
- [L5] Hemiarthroplasty for the treatment of complex proximal humerus fractures yields variable long-term clinical outcomes and high rates of failure, with the majority due to greater tuberosity malunion or nonunion. [38] (10.1016/j.xrrt.2025.100616)
- [L5] This review highlights various technical strategies to maximize the success of surgical treatment for proximal humerus fractures, emphasizing innovations in technique and implant design to mitigate high complication rates. [39] (10.5435/jaaos-d-22-01211)
- [L4] Non-operative treatment is advocated for the majority of non-displaced and minimally displaced fractures with generally good outcomes, while displaced fractures may require arthroscopically assisted fixation or open/percutaneous reduction and internal fixation depending on fracture type and patient factors. [41] (10.1016/j.injury.2007.09.022)
- [L4] Optimal management of osteoporotic proximal humeral fractures has evolved to include the use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft. [43] (10.1016/j.jse.2012.04.003)
- [L1] This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. [44] (10.1007/s00402-019-03253-0)
- [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. [47] (10.1302/0301-620x.107b9.bjj-2024-1508.r2)
- [L1] Patients 65 years of age with 3- or 4-part proximal humerus fractures achieve the most benefit in terms of ROM, postoperative functional outcomes, tuberosity union, and overall complication rate when undergoing rTSA with a noncemented stem and early postoperative ROM compared to rTSA with cemented stem and delayed rehabilitation. [48] (10.1016/j.jse.2024.03.040)
- [L4] Published rehabilitation protocols for proximal humerus fractures vary considerably regardless of management. [49] (10.1177/17585732231182374)
- [L4] Among the various procedures, VTE was the most frequently reported after SA when compared to ORIF, with RSA having the highest VTE rate. [50] (10.1016/j.xrrt.2023.06.003)
- [L5] Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries. [52] (10.1530/eor-2026-0043)
- [L5] This review discusses modern management controversies surrounding adult proximal humerus fractures, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions. [53] (10.1016/j.jhsa.2025.07.009)
- [L4] All available ORIF techniques require careful analysis of fracture type, fragment displacement, and bone quality, making preoperative CT extremely valuable. [54] (10.1016/j.otsr.2012.12.006)
- [L5] Revision surgery for failed arthroplasty of proximal humerus fracture is complex with a high likelihood of inferior outcomes compared with primary arthroplasty. [57] (10.5435/jaaos-d-17-00051)
- [L4] Locked humeral stems provide reliable diaphyseal fixation with a low incidence of screw-related complications in reverse total shoulder arthroplasty for complex proximal humerus fractures. [58] (10.1016/j.xrrt.2025.100625)
- [L4] Open fractures and 4-part proximal humerus fractures had the highest complication rates. [59] (10.1016/j.jse.2024.07.049)
- [L1] Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures. [60] (10.1016/j.jse.2020.09.044)
- [L1] The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. [61] (10.1016/j.jse.2021.11.004)
References
[1] Intramedullary nailing of the proximal humerus: evolution, technique, and results. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.11.016
[2] Effectiveness of intramedullary nailing vs. locked plating (open reduction and internal fixation) in adult displaced proximal humerus fractures: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.016
[3] Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1345-0
[4] Fracture dislocations of the proximal humerus treated with open reduction and internal fixation: a systematic review. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.04.018
[5] Contemporary Management of Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01073
[6] Intramedullary versus locking plate fixation for proximal humerus fractures: indications and technical considerations. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.01.001
[7] Intramedullary Fixation for Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-18-00360
[8] Proximal Humeral Fracture Treatment in Adults. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01293
[9] A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011. DOI: 10.1016/j.injury.2010.11.058
[11] Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2014. DOI: 10.1186/1749-799x-9-31
[12] Evaluation and Management of Pediatric Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00033
[13] Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0242-4
[14] Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. International Orthopaedics. 2017. DOI: 10.1007/s00264-017-3683-z
[15] Trending a decade of proximal humerus fracture management in older adults. JSES International. 2022. DOI: 10.1016/j.jseint.2021.08.006
[16] Innovations in the Management of Displaced Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200701000-00003
[17] Outcome measures reported for the management of proximal humeral fractures: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.006
[18] Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03162-2
[19] Proximal humeral fractures in younger patients: fixation techniques and arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.12.006
[20] Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2459-6
[21] New trends in fixation of proximal humeral fractures: A review. Injury. 2011. DOI: 10.1016/j.injury.2010.10.016
[24] Fragility of randomized controlled trials on treatment of proximal humeral fracture. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.141
[25] Management of Acute Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-15-00240
[26] Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07502-1
[27] Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.00665
[29] Principles of Locking Plate Fixation of Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00558
[38] Long-term outcomes of hemiarthroplasty for complex proximal humerus fractures: a systematic review of clinical studies with minimum 10-year follow-up. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100616
[39] Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-01211
[41] Isolated tuberosity fractures of the proximal humerus: Current concepts. Injury. 2008. DOI: 10.1016/j.injury.2007.09.022
[43] Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.04.003
[44] Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03253-0
[47] Standard compared with fracture-specific components in reverse shoulder arthroplasty for proximal humerus fractures. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b9.bjj-2024-1508.r2
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