肱骨近端骨折

Patients › Shoulder

Proximal humerus fractures — Neer classification, sling management, and surgical options.

Updated Jun 2026

一幅手绘插图，显示肩关节下方上臂骨骨折。 — X光片显示上臂骨顶部骨折，位于肩关节下方。 Kieran Hirpara 4.0

您的感受

您可能会在上臂和肩部区域感到疼痛。这种疼痛通常源于肩关节附近的骨骼骨折。如果您的骨折与骨质疏松症（即骨骼脆弱）有关，这种疼痛可能是更广泛的脆性骨折模式的一部分。无移位骨折（即骨块保持原位）在这一群体中很常见。即使骨骼没有移位，这些骨折仍可能导致严重的功能障碍，并降低您的整体健康感。

疼痛往往在活动时加重。您可能会发现难以抬起手臂或举过头顶。简单的日常任务变得具有挑战性。您可能难以将衬衫塞进裤子里，或伸手到背后扣上胸罩。提起物体，即使是轻物，也可能引发剧烈不适。由于肩部不稳定，任何使用手臂的努力都会加重损伤。

休息手臂通常有助于减轻疼痛。然而，您仍可能在夜间出现疼痛发作。许多患者报告说，侧卧在患侧睡觉会感到疼痛或不可能。醒来时肩部僵硬或酸痛很常见。您的外科医生将指导您如何调整姿势以在保护愈合骨骼的同时获得舒适。

如果您未满 65 岁，您的外科医生可能会讨论手术是否比非手术治疗具有明确的益处。对于这一年龄段的许多成年人来说，证据并未显示手术具有显著优势。大多数单部分骨折在没有手术的情况下也能良好愈合。老年人也经常接受非手术治疗。无论您的年龄如何，目标都是在骨骼愈合期间管理疼痛并保护骨骼。并发症可能在不同阶段发生，因此您的医疗团队将密切监测您。您并不孤单；您的护理团队将支持您的康复，并帮助您安全地恢复功能。

实际发生了什么

您的肩关节是一个球窝关节，由上臂骨与肩胛骨相接而成。上臂骨的顶部有两个称为结节的小突起。这些突起充当肩袖肌腱的锚定点。这些肌腱是由纤维组成的强韧绳索，负责抬起和旋转您的手臂。当上臂骨顶部发生骨折时，这些锚定点可能会移位。

如果结节向下移动，肌腱会失去适当的张力。这会导致关节力学失衡。即使只有15度的微小移位，也会改变关节的运动方式和承重能力。这种错位会引起疼痛并限制您的活动范围。它还会使关节难以在正确的位置愈合。

关节囊是包裹在肩关节周围的袖状结构。它将关节固定在一起，并产生液体以保持润滑。骨折后，关节囊可能会变得僵硬或形成瘢痕。这种僵硬加上任何肌腱损伤，会降低您的力量和活动范围。您的外科医生需要恢复解剖结构，以便这些组织能够重新协同工作。

对于许多人，尤其是老年人来说，骨碎片破碎得太严重，无法用钢板和螺钉进行固定。在这种情况下，您的外科医生可能会建议进行关节置换术。该手术用金属和塑料植入物替换受损的肱骨头。当重新活动手臂是首要任务时，通常会选择此选项。即使原始骨结构严重受损，它也能提供稳定的支撑，并帮助您恢复功能。

我们能采取的措施

大多数单部分骨折无需手术即可良好愈合。事实上，非手术治疗是绝大多数病例的标准方案。您的外科医生可能会建议一段固定期，以促进骨骼愈合。无论骨折类型如何，短期和长期的休息都能产生相似的效果。这种方法在老年人和儿童中尤为常见，因为他们的骨骼具有巨大的重塑潜力。

在此期间，物理治疗发挥着关键作用。您的治疗师将指导您进行轻柔的活动，以恢复关节活动度。目标是在保护愈合骨骼的同时防止僵硬。对于60岁或以上患者的移位性两部分骨折，研究表明，在两年时，手术与非手术治疗的结果无显著差异。因此，您的外科医生可能会建议您先尝试保守治疗，再考虑更具侵入性的方案。

疼痛管理对于您的舒适至关重要。您的外科医生可能会开具止痛药或抗炎药，以控制肿胀和不适。虽然证据强调了非手术治疗的成功，但并未详细说明针对此类骨折的具体注射方案，如可的松或富血小板血浆（PRP）。相反，应专注于遵守固定计划并参加物理治疗课程。在这些早期阶段持续的努力为康复奠定了基础。

仅当保守治疗达到极限或骨折类型复杂时，才会考虑手术。这通常涉及更严重的骨折，例如老年人中的三部分或四部分骨折，其中骨碎片明显移位。在这些情况下，您的外科医生可能会建议进行手术以稳定骨骼，例如使用髓内钉和钢板系统，或在某些情况下进行反式全肩关节置换术。这些方案旨在恢复功能，并在骨骼无法自行正常愈合时提供长期的耐用性。决策取决于您的年龄、具体的骨折类型以及整体健康状况。

预期情况

您的预后主要取决于您的年龄以及涉及的骨碎片数量。大多数单部分骨折无需手术即可良好愈合。对于老年患者，非手术治疗通常能带来良好的功能结果。然而，如果您超过六十岁，对于复杂的三部分或四部分骨折，您的外科医生可能会建议手术。在这些情况下，新的髓内钉和钢板系统或反向肩关节置换术可以提供比不处理骨折更好的长期功能。

恢复是一个渐进的过程。在非手术病例中，短期和长期的固定所产生的结果相似。您无需担心休息时间的长短会影响最终结果。如果进行手术，手术时间在五天之后不会影响最终结果。这为您的医疗团队提供了安全计划的灵活性。大多数接受手术治疗复杂骨折的患者实现了良好的长期结果，尽管并发症发生率较高。

请注意，受伤后您发生严重健康事件的风险更高。一年内的死亡风险为 9.8%。这一风险在五年内持续上升至 28.2%。无论其他健康因素如何，这种升高的死亡风险都存在。保持活跃并遵循外科医生的建议以在恢复期间维持整体健康非常重要。

如果您接受反向肩关节置换术，与保守治疗相比，您的功能可能会有显著改善。然而，一些患者随着时间的推移注意到功能和生活质量的下降。这种变化发生在两年后，但通常被认为在临床上不相关。大多数儿科患者恢复良好，并发症很少。对于六十五岁以下的成年人，手术并不总是比保守管理提供更明确的益处。您的外科医生将权衡这些因素，以选择最能支持您日常生活的治疗方案。

何时就医

如果休息后疼痛未改善，请咨询您的全科医生。如果您感到肩部无力或不稳，请要求专科医生进行评估。如果您的手臂出现锁定或脱位现象，请联系您的外科医生。如果症状影响您的睡眠或工作，请寻求医疗帮助。疼痛突然加重需要立即就医。大多数单部分骨折无需手术即可良好愈合。然而，并发症可能在任何阶段发生。老年骨质疏松性骨折的死亡风险较高。一年死亡率为9.8%。五年死亡率上升至28.2%。骨不连的风险高于以往认为的水平。不要忽视持续存在的症状。早期评估有助于您的外科医生选择正确的治疗方案。

Evidence & references

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 osteoporotic injuries with increasing incidence due to aging populations [5].
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].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
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].
Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade [3].
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

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 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

Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults [1].
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].
Most one-part proximal humerus fractures are amenable to non-operative treatment with positive outcomes reported in the vast majority of cases [8].
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].
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].
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

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].
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].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
Surviving patients with proximal humerus fractures 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].
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].
Guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin [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].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].

Recovery

Both age and gender are associated with the definitive treatment received for proximal humerus fractures in patients older than fifty years [3].
Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
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].
Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [27].
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].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
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].
Low arthroplasty survival is observed after treatment for proximal humerus fracture sequelae [9].
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].
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].
Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications [26].
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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