OUTCOMES OF OPEN REDUCTION AND INTERNAL FIXATION FOR PROXIMAL HUMERUS FRACTURES: A RETROSPECTIVE AUDIT

Proximal humerus fractures account for approximately 6% of all fractures and their incidence is increasing with an ageing population. These injuries often result in pain, stiffness, and loss of independence, particularly in previously active individuals. While conservative management is common for minimally displaced fractures, surgical intervention is frequently considered for displaced or unstable injuries. The PROFHER study has provided insight, but its findings remain debated in clinical application. We aimed to assess outcomes of open reduction and internal fixation (ORIF) for proximal humerus fractures, focusing on complication rates and identifying associated risk factors such as comorbidities, lifestyle factors and the operating surgeon’s subspecialty. A retrospective audit was conducted of 100 patients who underwent ORIF between 2022 and 2023 at a single centre. Data collected included age, sex, Neer classification, time from injury to operation, surgeon type, and postoperative outcomes. In cases with complications, we examined associations with smoking, diabetes and alcohol use. 83% of procedures were performed by upper limb surgeons. Eight patients (8%) experienced complications: five required hardware removal, two had non-union or malposition, and one developed an infection. In cases performed by upper limb surgeon there was a 6% rate of complication, in cases performed by non-specialists there was a 17% rate of complication. Of the complications 87.5% were smokers. Our findings suggest a substantially lower complication rate for ORIF than previously reported in PROFHER, particularly when performed by an upper limb surgeon. This may challenge its generalisability and support the continued use of surgery in selected patients.