Abstract
Fractures of the proximal humerus are common, especially in osteoporotic females. Despite this, there remains significant debate around their preferred treatment. The difficulties when considering treatment options is the wide array of fracture patterns and multiple patient factors which play an important role in the outcome of the management of these fractures. Fortunately, the vast majority of these fractures can be treated conservatively. The challenge, however, is the 15% of patients in which surgery may be required such as displaced three- and four-part fractures, and fractures in young and active patients. Although various recent studies and review papers show acceptable results with conservative treatment, especially in elderly patients, the decision on when to operate and when to consider conservative treatment remains challenging. The goal of this current concepts paper is to highlight important aspects of the conservative management of patients with proximal humerus fractures, from initial assessment through to treatment, including possible complications. Level of evidence: Level 5
Highlights
The results showed there was no difference in physical function as measured with the Constant-Murley score when comparing operative and non-operative treatment
It has been shown that a well-run screening and treatment programme can reduce the risk of a primary Proximal humerus fractures (PHFs) fragility fracture by 45%, and that anti-osteoporosis treatment started after a fragility fracture can decrease the age- and sex-adjusted risk of a subsequent fracture by 52% in patients with a PHF as the index fracture.[53,54]
An important question related to the treatment of PHFs is whether the results of a salvage arthroplasty procedure, a reverse shoulder replacement, are equivalent to a primary reverse arthroplasty at time of fracture
Summary
Proximal humerus fractures (PHFs) are common, accounting for 4–6%1-3 of all fractures, and more common in females over the age of 60 years due to the influence of osteoporosis.[4,5]. Many authors have suggested that up to 85% do not require surgery.[4,6,7,8] Despite this, there appears to be a trend towards increased surgical intervention which has been attributed to newer designs of plating systems, as well as the promotion of the reverse shoulder replacement as a treatment option.[6,7,9,10,11,12] The ideal outcome for a patient with a PHF is a pain-free shoulder with an acceptable range of motion according to the individual’s specific functional requirements. The goal of this review is to try and clarify some of the current aspects related to the conservative management of PHFs. A second current concepts review article exploring the surgical options will be published in a later issue of this journal
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