Outcomes of Non-Operative and Operative Treatment of Proximal Humerus Fractures: Current Concepts

Proximal Humerus Fractures (PHF) account for 5-6% of all adult fractures and have a bimodal distribution involving young patients with high-energy trauma or, more commonly, older patients with low-energy falls. Whenever possible, particularly with non- or minimally displaced fractures, PHFs can be treated non-operatively. Many recent studies have demonstrated no outcome difference between non-operative treatment and any common operative option. Operative treatment options for PHFs include percutaneous pinning, open reduction and internal fixation (ORIF), intramedullary nails (IMN), hemiarthroplasty (HA), and reverse shoulder arthroplasty (rTSA). Generally displaced three or four-part fractures are indicated for operative fixation. However, the ProFHER (Proximal Fracture of the Humerus: Evaluation by Randomization) trial demonstrated satisfactory results may be achieved when PHFs are managed non-operatively. This review will focus on the latest evidence and outcomes following non-operative and operative treatment of proximal humerus fractures (PHF).