Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2014; 5(5): 685-693
Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.685
Management of proximal humerus fractures in adults
Leonidas Vachtsevanos, Lydia Hayden, Aravind S Desai, Asterios Dramis
Leonidas Vachtsevanos, Lydia Hayden, Department of Trauma and Orthopaedics, Abertawe Bro Morgannwg University Health Board, Swansea SA6 6NL, United Kingdom
Aravind S Desai, Department of Trauma and Orthopaedics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, NE7 7DN, United Kingdom
Asterios Dramis, Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
Author contributions: Vachtsevanos L, Hayden L, Desai AS, Dramis A contributed to conception and design of the study, analysis and interpretation of data; Vachtsevanos L, Hayden L performed the literature review; Vachtsevanos L drafted the article; Dramis A, Desai AS revised the article; all the authors read and approved the final manuscript.
Correspondence to: Asterios Dramis, BM, MSc, MRCS, FEBOT, FRCS (Orth), Senior Trauma Fellow, Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
Telephone: +44-12-14403044 Fax: +44-29-20716310
Received: January 29, 2014
Revised: July 6, 2014
Accepted: July 15, 2014
Published online: November 18, 2014

The majority of proximal humerus fractures are low-energy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures. Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each individual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes.

Keywords: Proximal humerus fracture, Reconstruction, Non-operative management, Hemiarthroplasty, Reverse polarity total shoulder arthroplasty

Core tip: Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults. There is currently insufficient evidence to suggest superiority of one treatment option over the others. Any surgical intervention should have clear aims and indications and the appropriate technique should be selected for each individual patient. Decision-making should involve detailed fracture evaluation, careful patient selection with thorough consideration of individual patient characteristics, comorbidities and functional expectations and profound understanding of the benefits and limitations of each management option.