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Conservative Treatment of Proximal Humerus Fractures: When, How, and What to Expect

  • Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The key question to answer during the decision-making process for proximal humerus fractures (PHF) is whether the amount of displacement of a specific fracture pattern will be acceptable taking into account the anticipated demands on the patient. The aim of this review article was to provide some clarity regarding the features that contribute to poor clinical outcomes when PHF are treated non-operatively and to review the reported outcomes of conservative treatment.

Recent Findings

Conservative treatment for non-displaced or minimally displaced fractures leads to good outcomes in 80% to 90% of patients. However, with increasing fracture complexity and displacement, functional outcomes tend to diminish. In active patients with significant functional demands, the challenge is to predict which fractures will do poorly when treated non-operatively.

Summary

A better understanding of fracture patterns and fragment displacement may improve treatment indications. To avoid complications related to conservative treatment, surgery should be considered (1) in fractures in which the humeral head is severely compromised (due to fracture-dislocation, severe impaction, or a split of the head itself), (2) in non-impacted fractures with gross instability between the humeral shaft and humeral head, and (3) in those cases in which displacement of the tuberosities or the final shape of the proximal humerus after healing will lead to symptomatic malunion.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hospital Fundación Jimenez Diaz, Avenida de los Reyes Catolicos 2, 28040, Madrid, Spain

    Natalia Martinez-Catalan

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Correspondence to Natalia Martinez-Catalan.

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Martinez-Catalan, N. Conservative Treatment of Proximal Humerus Fractures: When, How, and What to Expect. Curr Rev Musculoskelet Med 16, 75–84 (2023). https://doi.org/10.1007/s12178-022-09817-9

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