Patients › Shoulder

Fraktura ng Proksimal Humerus

Proximal humerus fractures — Neer classification, sling management, and surgical options.

Updated Jun 2026

Isang guhit-kamay na ilustrasyon ng isang nabasag na buto ng itaas na braso, kaagad sa ilalim ng balikat. — X-ray na nagpapakita ng fracture sa itaas na bahagi ng upper arm bone, kaagad sa ilalim ng shoulder joint. Kieran Hirpara 4.0

Ano ang nararamdaman mo¶

Maaaring mararamdaman mo ang sakit sa iyong itaas na braso at lugar ng balikat. Karaniwang nagmumula ang sakit na ito sa pagbasag ng buto malapit sa joint ng balikat. Kung ang iyong fracture ay may kaugnayan sa mahinang buto, na kilala bilang osteoporosis, ang sakit ay maaaring bahagi ng mas malawak na pattern ng mga sugat na dulot ng kahinaan. Ang mga nondisplaced fractures, kung saan nananatili sa lugar ang mga piraso ng buto, ay karaniwan sa grupong ito. Kahit na hindi lumilipat ang buto, ang mga basag na ito ay maaari pa ring magdulot ng malaking kapansanan at bawasan ang iyong pangkalahatang pakiramdam ng kalusugan.

Ang sakit ay karaniwang lumalala kapag gumagalaw. Maaaring mahirapan kang itaas ang iyong braso o umabot pataas. Nagiging hamon ang mga simpleng gawain sa araw-araw. Maaaring mahirapan kang ipasok ang iyong kamiseta o umabot sa likod ng iyong likod upang isara ang bra. Ang pag-angat ng mga bagay, kahit magaan, ay maaaring mag-trigger ng matulis na hindi komportableng pakiramdam. Dahil hindi matatag ang balikat, ang anumang pagsisikap na gamitin ang braso ay maaaring magpalala sa sugat.

Ang pagpapahinga ng braso ay karaniwang tumutulong upang bawasan ang sakit. Gayunpaman, maaari pa ring maranasan mo ang mga flare-up sa gabi. Maraming pasyente ang nag-uulat na masakit o imposible ang pagtulog sa apektadong gilid. Karaniwan ang paggising na may stiff o masakit na balikat. Gabay ng iyong surgeon ang iyong posisyon para sa komportableng pakiramdam habang pinoprotektahan ang nagpapagaling na buto.

Kung ikaw ay nasa ilalim ng 65 taong gulang, maaaring talakayin ng iyong surgeon kung ang operasyon ay nag-aalok ng malinaw na benepisyo kumpara sa non-surgical na paggamot. Para sa maraming matatanda sa grupong ito, ang ebidensya ay hindi nagpapakita ng malakas na advantage para sa operasyon. Ang karamihan ng one-part fractures ay gumagaling nang maayos nang walang operasyon. Ang mga mas matandang matatanda ay madalas din na tumatanggap ng nonoperative na paggamot. Anuman ang iyong edad, ang layunin ay pamahalaan ang iyong sakit at protektahan ang buto habang ito ay nagpapagaling. Maaaring mangyari ang mga komplikasyon sa iba't ibang yugto, kaya ang iyong team ay magm-monitor sa iyo nang mahigpit. Hindi ka mag-isa sa prosesong ito; ang iyong care team ay nandoon upang suportahan ang iyong paggaling at tulungan kang muling makuha ang function nang ligtas.

Ano ang nangyayari talaga¶

Ang iyong balikat ay isang ball-and-socket joint kung saan ang itaas na bahagi ng buto ng braso ay nagtatagpo sa iyong shoulder blade. Ang itaas na bahagi ng iyong buto ng braso ay may dalawang maliit na bubong na tinatawag na tuberosities. Ang mga bubong na ito ay nagsisilbing mga anchor point para sa mga tendon ng rotator cuff. Ang mga tendon na ito ay matibay na tali ng mga hibla na nagpapataas at nagpapaliko sa iyong braso. Kapag nabasag ang itaas na bahagi ng iyong buto ng braso, ang mga anchor point na ito ay maaaring lumipat sa hindi tamang posisyon.

Kung ang mga tuberosities ay gumalaw pababa, ang mga tendon ay mawawalan ng tamang tensyon. Ito ay humihila sa mekanika ng joint at nagdudulot ng hindi pagkakasunod-sunod. Kahit isang maliit na paglipat ng 15 degrees ay maaaring magbago ng paraan ng paggalaw ng joint at pagdala ng bigat. Ang hindi pagkakasunod-sunod na ito ay nagdudulot ng sakit at nagbabawas ng iyong galaw. Nagiging mas mahirap din para sa joint na gumaling sa tamang posisyon.

Ang joint capsule ay ang sleeve sa paligid ng balikat. Ito ay nagpapanatili ng joint na magkasama at gumagawa ng likido upang panatilihin ang mga bagay na madulas. Pagkatapos ng fracture, ang capsule na ito ay maaaring maging matigas o magkaroon ng scar. Ang katigasan na ito, kasama ang anumang pinsala sa mga tendon, ay nagbabawas ng iyong lakas at range of motion. Kailangan ng iyong surgeon na ibalik ang anatomy upang ang mga tissue na ito ay muling magtrabaho nang sama-sama.

Para sa maraming tao, lalo na ang mga nakatatanda, ang mga fragment ng buto ay masyadong basag upang ayusin gamit ang mga plate at screw. Sa mga kaso na ito, ang iyong surgeon ay maaaring magrekomenda ng joint replacement. Ang prosedurong ito ay nagpapalit sa nasirang ball ng isang metal at plastic implant. Ang opsyong ito ay madalas pinipili kapag ang paggaling ng iyong braso ay ang pinakamahalagang prioridad. Ito ay nagbibigay ng matibay na suporta at nagpapahintulot sa iyo na muling makuha ang function kahit ang orihinal na istruktura ng buto ay malubhang nasira.

Ano ang maaari naming gawin dito¶

Karamihan sa mga one-part fractures ay gumagaling nang maayos nang walang operasyon. Sa totoo lang, ang non-surgical na pamamahala ang karaniwang pamantayan para sa karamihan ng mga kaso. Posibleng irekomenda ng iyong surgeon ang isang panahon ng immobilization upang payagan ang buto na mag-ugnay. Maaari kang mag-expect na parehong maganda ang resulta ng maikli at mahabang panahon ng pahinga, anuman ang pattern ng fracture. Ang pamamaraang ito ay lalo nang karaniwan para sa mga matatanda at bata, na may napakalaking potensyal ang kanilang mga buto para sa remodeling.

Sa panahong ito, may mahalagang papel ang physiotherapy. Gabay ng iyong therapist ang iyong mga banayad na galaw upang maibalik ang range of motion. Ang layunin ay pigilan ang stiffness habang pinoprotektahan ang gumagaling na buto. Para sa mga displaced na two-part fractures sa mga pasyenteng nasa edad 60 pataas, ipinapakita ng mga pag-aaral na walang makabuluhang pagkakaiba sa mga resulta pagkatapos ng dalawang taon sa pagitan ng operasyon at non-operative na paggamot. Kaya, posibleng payuhan ka ng iyong surgeon na bigyan ng patas na pagkakataon ang conservative na pag-aalaga bago isaalang-alang ang mas invasive na mga opsyon.

Mahalaga ang pamamahala ng sakit para sa iyong kaginhawaan. Posibleng magreseta ng gamot pang-sakit o anti-inflammatories ang iyong surgeon upang kontrolin ang pamamaga at hindi kagustuhan. Habang binibigyang-diin ng ebidensya ang tagumpay ng non-operative na pag-aalaga, hindi nito inilalarawan ang mga partikular na protocol ng injection tulad ng cortisone o PRP para sa uri ng fracture na ito. Sa halip, magtuon sa pagsunod sa iyong schedule ng immobilization at pagdalo sa mga sesyon ng physiotherapy. Ang patuloy na pagsisikap sa mga unang linggong ito ang nagtatag ng pundasyon para sa iyong paggaling.

Ang operasyon ay isinasaalang-alang lamang kapag naabot na ng conservative na pag-aalaga ang hangganan nito o kapag ang pattern ng fracture ay kumplikado. Karaniwang ito ay tumutukoy sa mas malalang mga basag, tulad ng three- o four-part fractures sa mga matatandang pasyente, kung saan ang mga fragmento ng buto ay malaki ang displacement. Sa mga kasing ito, posibleng irekomenda ng iyong surgeon ang isang prosedura upang istabilize ang buto, tulad ng paggamit ng nail at plate system o, sa ilang mga kaso, isang reverse total shoulder replacement. Layunin ng mga opsyong ito na maibalik ang function at magbigay ng long-term na tibay kapag hindi na gumagaling nang maayos ang buto sa sarili nito. Ang desisyon ay nakadepende sa iyong edad, ang partikular na pattern ng fracture, at sa iyong pangkalahatang kalusugan.

Ano ang inaasahan¶

Ang iyong prognosis ay nakadepende sa malaking bahagi sa iyong edad at sa bilang ng mga fragment ng buto na kasangkot. Karamihan sa mga fracture na may iisang bahagi ay gumagaling nang maayos nang walang operasyon. Para sa mga matatanda, ang nonoperative na paggamot ay madalas na nagdudulot ng magandang resulta sa pagganap. Gayunpaman, kung ikaw ay higit sa animnapung taong gulang, maaaring irekomenda ng iyong surgeon ang operasyon para sa mga komplikadong fracture na may tatlo o apat na bahagi. Sa mga kaso na ito, ang isang bagong sistema ng kuko at plate o ang reverse shoulder replacement ay maaaring magbigay ng mas mahusay na pangmatagalang pagganap kumpara sa pag-iiwan ng fracture na walang gamot.

Ang paggaling ay isang unti-unting proseso. Para sa mga kaso na nonoperative, ang maikli at mahabang panahon ng immobilization ay nagdudulot ng katulad na resulta. Hindi mo kailangang mag-alala na ang eksaktong haba ng pahinga ay magbabago sa iyong huling resulta. Kung ikaw ay magkakaroon ng operasyon, ang pagkakasunod-sunod ng operasyon pagkatapos ng limang araw ay hindi nakakaapekto sa iyong huling resulta. Ibinibigay nito ang flexibility sa iyong care team na magplano nang ligtas. Karamihan sa mga pasyente na may komplikadong fracture na ginamutan sa pamamagitan ng operasyon ay nakakamit ng magandang pangmatagalang resulta, kahit na mataas ang rates ng komplikasyon.

Mag-ingat na ang iyong risk para sa seryosong mga pangyayari sa kalusugan ay mas mataas pagkatapos ng pinsalang ito. Ang risk ng kamatayan sa loob ng isang taon ay 9.8%. Ang risk na ito ay patuloy na tumataas hanggang 28.2% sa limang taon. Ang elevated na risk ng mortality na ito ay umiiral anuman ang ibang mga salik sa kalusugan. Mahalagang manatiling aktibo at sundin ang payo ng iyong surgeon upang mapanatili ang iyong pangkalahatang kalusugan sa panahon ng paggaling.

Kung ikaw ay magkakaroon ng reverse shoulder replacement, ang iyong pagganap ay maaaring umusbong nang malaki kumpara sa nonoperative na paggamot. Gayunpaman, may ilang mga pasyente na nakakaramdam ng pagbaba sa functionality at kalidad ng buhay sa paglipas ng panahon. Ang pagbabagong ito ay nangyayari pagkatapos ng dalawang taon ngunit karaniwang hindi itinuturing na clinically relevant. Karamihan sa mga pediatric na pasyente ay gumagaling nang buo na may kaunting komplikasyon. Para sa mga adult na nasa ilalim ng animnapu't limang taong gulang, ang operasyon ay hindi laging nag-aalok ng malinaw na benepisyo kumpara sa nonoperative na pamamahala. Timbangin ng iyong surgeon ang mga salik na ito upang pumili ng daan na pinakamabuti na sumusuporta sa iyong pang-araw-araw na buhay.

Kailan pumunta sa doktor¶

Pumunta sa iyong GP kung hindi umuunlad ang sakit kahit may pahinga. Humingi ng review ng espesyalista kung nararamdaman mo ang kahinaan o kawalan ng katatagan sa iyong balikat. Kontakin ang iyong surgeon kung ang iyong braso ay nakakulong o biglang bumabagsak. Humingi ng pag-aalaga kung ang mga sintomas ay nakakaapekto sa iyong tulog o trabaho. Ang biglang paglala ng sakit ay nangangailangan ng agad na atensyon. Karamihan sa mga one-part fractures ay gumagaling nang maayos nang walang operasyon. Gayunpaman, ang mga komplikasyon ay maaaring mangyari sa anumang yugto. Mataas ang risk ng kamatayan para sa mga fragility fractures sa mga matatanda. Ang mortality rate sa loob ng isang taon ay 9.8%. Ang mortality rate sa loob ng limang taon ay tumataas sa 28.2%. Mas mataas ang risk ng nonunion kaysa sa dati nating iniisip. Huwag balewalain ang mga persistent na sintomas. Ang maagang evaluasyon ay tumutulong sa iyong surgeon na pumili ng tamang landas.

Evidence & references

Overview¶

Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults [1].
Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
Most one-part proximal humerus fractures are amenable to non-operative treatment with positive outcomes reported in the vast majority of cases [8].
The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years [15].
Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade [3].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
Patients with pathologic humerus fractures had significantly higher complication rates compared with native humerus fractures after surgical treatment [29].
Guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin [29].
The selection of reverse total shoulder arthroplasty (RTSA) over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients [25].
Patients with a proximal humerus fracture undergoing reverse total shoulder arthroplasty have significantly worse perioperative outcomes, including higher rates of complications, longer hospital stays, and higher costs, compared to patients with other indications [67].
Prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures [17].
Besides age, most randomized controlled trials on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria [16].

Anatomy & Pathophysiology¶

Inferior tuberosity displacement after prosthetic reconstruction of shoulder fractures is associated with diminished functional results [33].
Inferior tuberosity positioning after hemiarthroplasty for proximal humerus fractures is associated with diminished function [40].
Range of motion and strength thresholds can identify subjects with normal shoulder function [36].
Shoulder flexion, extension, and abduction are only moderately correlated with patient-reported outcome measures (PROMs) [57].
Holistic assessment of outcomes requires both subjective and objective outcomes [57].
The changed position of the humeral head on the coronal plane does not affect final functional results in conservatively treated displaced proximal humerus fractures in the elderly [54].
Bone quality significantly impacts implant anchorage in osteosynthesis for proximal humerus fractures [58].
Positioning the arm in abduction and internal rotation may help mitigate deforming muscular forces in proximal humerus fractures [46].
Rotator cuff tears are a detrimental factor and a major cause of painful shoulders in proximal humeral fractures with minimal displacement treated conservatively [63].
The double plate strategy can increase the stability of the medial column of the proximal humerus and enhance the overall biomechanical property of the repaired proximal humerus [64].
Reverse shoulder arthroplasty could be considered primary treatment for proximal humerus fractures, especially when optimal range of motion is of great importance to the patient [72].
Glenoid loosening and severe scapular notching in reverse shoulder arthroplasty for proximal humerus fractures are related to poor positioning and/or incorrect orientation of the glenosphere [74].

Classification¶

Proximal humerus fractures are osteoporotic injuries with increasing incidence due to aging populations [5].
Accurate clinical evaluation, imaging, and classification are paramount for informed treatment decisions [5].
Evaluation of classification systems for fractures of the proximal humerus with plain radiographs has yielded low interobserver reliability [32].
The Mayo-FJD classification system for proximal humerus fractures allows high intraobserver and interobserver agreement using both radiographs and computed tomography [45].
The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs [28].
Morphologic classification of proximal humerus fractures as the sole basis for treatment algorithms and surgical success should be scrutinized [50].
Current diagnosis coding practices (ICD-10) do not adequately capture the fracture complexity needed to conduct subgroup analysis for proximal humerus fractures [75].
There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third [69].

Clinical Presentation¶

Proximal humerus fractures are osteoporotic injuries with increasing incidence due to aging populations [5].
Proximal humerus fractures are now typically osteoporotic fractures in women over 70, with prevalence increasing due to an aging population in poor general condition [19].
There is a substantial mortality in patients with a proximal humerus fracture [6].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
Surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year [6].
Complications associated with proximal humerus fractures are varied and can be categorized as occurring at the time of initial injury, during operative management, or as delayed sequelae [11].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
Treatment algorithms and outcomes following proximal humerus fractures in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population [13].
Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade [3].
Surgical treatment of proximal humerus fractures remains far from straightforward, with unpredictable outcomes where factors associated with poor results include being a woman, four-part fracture dislocation, and absence of metaphyseal head extension [37].
Computed tomography improves the diagnostic accuracy but not the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography scan was more specific than radiographs in the assessment of proximal humerus fracture sequelae [18].

Investigations¶

Proximal humerus fractures are osteoporotic injuries with increasing incidence due to aging populations [5].
Accurate clinical evaluation, imaging, and classification are paramount for informed treatment decisions in proximal humerus fractures [5].
Computed tomography improves the diagnostic accuracy of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography does not improve the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae [18].
Computed tomography scan is more specific than radiographs in the assessment of proximal humerus fracture sequelae [18].
Artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs [28].
Convolutional neural networks proficiently rule out proximal humerus fractures on plain radiographs [76].
The routine use of 3D-printed models may not be beneficial for classifying proximal humeral fracture patterns beyond the information gained from currently available imaging modalities [79].
The routine use of 3D-printed models should be avoided as the sole determinant for recommending surgical intervention in proximal humeral fractures [79].
In children with shoulder dislocation combined with proximal humerus fracture, bilateral anteroposterior shoulders x-ray is suggested routinely to confirm shoulder location in addition to palpation and anteroposterior and lateral humeral x-ray [83].

Treatment¶

Non-Operative Management¶

Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults [1].
In the vast majority of cases, proximal humerus fractures may be treated nonoperatively [2].
Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
Most one-part proximal humerus fractures are amenable to non-operative treatment with positive outcomes reported in the vast majority of cases [8].
Non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention [24].
There is little utility to the routine use of postoperative radiographs in follow-up of pediatric proximal humerus fractures [24].
Proximal humerus fractures in children have tremendous potential for remodeling, making non-operative management the treatment of choice for most fractures [56].
Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [27].
A majority of patients with proximal humeral fractures underwent non-operative treatment [41].
Nonsurgical management of proximal humerus fractures decreased during the study period [35].
Nonsurgical treatment should have a more prominent role in the treatment of proximal humeral fractures [48].
Nonsurgical treatment provides better midterm outcomes compared to locking plate fixation for proximal humeral fractures [48].
There is no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus [39].
The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years [15].
Evidence-based recommendations to guide treatment of proximal humerus fractures are lacking, and no good evidence exists whether surgery is clearly superior to nonoperative treatment [65].

Operative Management¶

Treatment algorithms and outcomes following proximal humerus fractures in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population [13].
Consensus when managing proximal humerus fractures is limited to specific scenarios, whereas lack of consensus still exists in others [7].
Most RCTs on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria [16].
Hemiarthroplasty and reverse prosthesis are indicated for complex proximal humerus fractures in patients no younger than 70 years of age [21].
Reverse total shoulder replacement is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome [22].
The selection of RTSA over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients [25].
Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications [26].
No single fixation method is a panacea for proximal humeral fractures; choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [38].
Minimally invasive plate osteosynthesis (MIPO) with PHILOS plate is a safe and effective option for the treatment of proximal humerus fractures, with good functional recovery and fewer complications, which are typically technique dependent [49].
There are no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in reverse shoulder arthroplasty (RSA) for proximal humerus fractures [51].

Complications¶

Proximal humerus fractures are associated with substantial mortality [6].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
Surviving patients with proximal humerus fractures frequently have persistent symptoms that can be predicted as early as after 1 year [6].
Complications associated with proximal humerus fractures are varied and can be categorized as occurring at the time of initial injury, during operative management, or as delayed sequelae [11].
Low arthroplasty survival is observed after treatment for proximal humerus fracture sequelae [9].
Patients with pathologic humerus fractures have significantly higher complication rates compared with native humerus fractures after surgical treatment [29].
Guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin [29].
Predictive models using machine learning techniques demonstrate favorable discrimination and satisfactory-to-excellent performance in forecasting prolonged length of stay and serious adverse complications occurring within 30 days of surgical intervention for proximal humerus fracture [59].
Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].

Recovery¶

Both age and gender are associated with the definitive treatment received for proximal humerus fractures in patients older than fifty years [3].
Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [4].
Treatment algorithms and outcomes for proximal humerus fractures in patients aged 60 years or younger are distinctly different from those in a more elderly population [13].
Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [27].
Long-term treatment with reverse shoulder arthroplasty (RSA) for displaced 3- or 4-part proximal humerus fractures provides better functional outcomes compared to nonoperative treatment, a difference attributed to the deterioration of functional outcomes of the nonoperative treatment over time [44].
There is substantial mortality in patients with a proximal humerus fracture, and surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year [6].
Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors [14].
Complications associated with proximal humerus fractures are varied and can be categorized as occurring at the time of initial injury, during operative management, or as delayed sequelae [11].
Low arthroplasty survival is observed after treatment for proximal humerus fracture sequelae [9].
Prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures [17].
After one year, long-term follow-up of fixed proximal humerus fractures may be unnecessary for those without symptoms [20].
Reverse shoulder arthroplasty is used for the treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old) [30].
It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome [22].
The locking plate provides satisfactory functional outcomes after a mid-term follow-up in patients with displaced proximal humerus fractures [23].
ORIF of nonosteoporotic proximal humeral fractures with locking plates led to favorable functional and radiologic outcomes at a minimum of 10 years of follow-up [52].
Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications [26].
Minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock yields good midterm clinical and radiological results [31].
Timing of surgery does not impact outcomes of patients who underwent ORIF for proximal humerus fractures, with delays beyond 5 days not affecting outcome [84].

Key Evidence¶

[L4] Non-operative management is associated with good outcomes in the majority of proximal humerus fractures in adults. [1] (10.5312/wjo.v5.i5.685)
[L4] In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. [2] (10.1155/2012/861598)
[L3] Both age and gender have an association with the definitive treatment patients received for proximal humerus fractures over the last decade. [3] (10.1016/j.jseint.2021.11.007)
[L4] Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. [4] (10.1016/j.jseint.2021.08.006)
[L3] Our results suggest that there is a substantial mortality in patients with a proximal humerus fracture, as we have previously reported, and that surviving patients frequently have persistent symptoms that can be predicted as early as after 1 year. [6] (10.1080/17453670510041295)
[L5] Consensus when managing proximal humerus fractures is limited to specific scenarios, whereas lack of consensus still exists in others. [7] (10.1016/j.jse.2024.12.005)
[L3] These results are pertinent when deciding on the treatment of proximal humerus fracture sequelae. [9] (10.1080/17453674.2020.1793548)
[L5] Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent. [12] (10.5435/jaaos-d-14-00033)
[L4] Treatment algorithms and outcomes following proximal humerus fractures in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population. [13] (10.1016/j.xrrt.2023.01.002)
[L3] Mortality at 1 year for fragility proximal humerus fractures is universally high regardless of risk factors. [14] (10.1016/j.jse.2022.03.006)
[L1] The available literature does not demonstrate a clear clinical benefit of operative treatment over nonoperative management of proximal humeral fractures in adult patients younger than 65 years. [15] (10.1016/j.xrrt.2021.04.014)
[L2] Besides age, most RCTs on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria. [16] (10.1016/j.xrrt.2025.07.023)
[L3] However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures. [17] (10.1016/j.injury.2013.08.024)
[L2] Computed tomography scan was more specific than radiographs in the assessment of proximal humerus fracture sequelae. [18] (10.1177/17585732221150785)
[L2] Proximal humerus fractures are now typically osteoporotic fractures in women over 70, with prevalence increasing due to an aging population in poor general condition. [19] (10.1016/j.otsr.2012.05.013)
[L3] After one-year, long-term follow-up of fixed proximal humerus fractures may be unnecessary for those without symptoms. [20] (10.1007/s00590-021-03099-6)
[L4] They are indicated for complex proximal humerus fractures in patients no younger than 70 years of age. [21] (10.1016/j.otsr.2008.09.002)
[L3] It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome. [22] (10.1186/s12891-023-06669-3)
[L4] The locking plate provides satisfactory functional outcomes after a mid-term follow-up in patients with displaced proximal humerus fractures. [23] (10.1007/s00590-010-0655-z)
[Paper] Non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention, and there is little utility to the routine use of postoperative radiographs in follow-up of these patients. [24] (10.1016/j.otsr.2016.09.022)
[L5] The selection of RTSA over other surgical options is a current, reasonable, and safe option to treat proximal humerus fractures, particularly in those with higher Neer grades and/or in older patients. [25] (10.1097/corr.0000000000002430)
[L4] Percutaneous treatment of selected proximal humeral fractures results in predictable union and good clinical results with a low rate of complications. [26] (10.1016/j.jse.2006.09.006)
[L5] Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes. [27] (10.2106/jbjs.l.01293)
[L4] The use of artificial intelligence can accurately detect and classify proximal humerus fractures on plain shoulder AP radiographs. [28] (10.1080/17453674.2018.1453714)
[L3] After surgical treatment, patients with pathologic humerus fractures had significantly higher complication rates compared with native humerus fractures, suggesting that guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin. [29] (10.1016/j.jse.2020.10.024)
[L4] We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals ( ≥ 65 years old). [30] (10.1007/s12178-020-09597-0)
[L4] Minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock yields good midterm clinical and radiological results. [31] (10.1016/j.injury.2015.05.017)
[L5] Evaluation of the classification systems for fractures of the proximal humerus with plain radiographs has yielded low interobserver reliability. [32] (10.1016/j.ocl.2008.05.002)
[L5] These biomechanical observations may explain diminished functional results observed in patients treated with inferior tuberosity displacement after prosthetic reconstruction of shoulder fractures. [33] (10.1016/j.jse.2007.02.110)
[L4] Nonsurgical management of proximal humerus fractures decreased during the study period. [35] (10.1016/j.jhsa.2020.03.022)
[L3] Range of motion and strength thresholds can identify subjects with normal shoulder function. [36] (10.1016/j.jse.2010.06.005)
[L5] Surgical treatment of proximal humerus fractures remains far from straightforward, with unpredictable outcomes where factors associated with poor results include being a woman, four-part fracture dislocation, and absence of metaphyseal head extension. [37] (10.1097/corr.0000000000002242)
[L4] No single fixation method is a panacea for proximal humeral fractures; choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications. [38] (10.1016/j.injury.2010.10.016)
[L1] This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. [39] (10.1371/journal.pmed.1002855)
[Abstract] These biomechanical changes may explain diminished function in patients with inferior tuberosity positioning after hemiarthroplasty for proximal humerus fractures. [40] (10.1016/j.jse.2007.02.027)
[L3] A majority of patients with proximal humeral fractures underwent non-operative treatment. [41] (10.1186/s12891-019-2812-9)
[L1] Long-term treatment with RSA for displaced 3- or 4-part proximal humerus fractures provides better functional outcomes compared to nonoperative treatment, a difference attributed to the deterioration of functional outcomes of the nonoperative treatment over time. [44] (10.1016/j.jse.2024.09.032)
[L4] The Mayo-FJD classification system for proximal humerus fractures seems to allow high intraobserver and interobserver agreement using both radiographs and computed tomography. [45] (10.1016/j.jse.2023.02.035)
[L5] These findings suggest that positioning the arm in abduction and internal rotation may help mitigate deforming muscular forces in proximal humerus fractures. [46] (10.5397/cise.2022.00885)
[L3] Nonsurgical treatment should have a more prominent role in the treatment of proximal humeral fractures. [48] (10.1016/j.jse.2011.01.025)
[L4] MIPO is a safe and effective option for the treatment of proximal humerus fractures, with good functional recovery and fewer complications, which are typically technique dependent. [49] (10.1016/j.aott.2016.10.003)
[L2] Morphologic classification of proximal humerus fractures as the sole basis for treatment algorithms and surgical success should be scrutinized. [50] (10.1016/j.jseint.2022.02.006)
[L1] This meta-analysis demonstrates no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in RSA, suggesting comparable performance in the treatment of proximal humerus fractures. [51] (10.1302/0301-620x.107b9.bjj-2024-1508.r2)
[L3] ORIF of nonosteoporotic proximal humeral fractures with locking plates led to favorable functional and radiologic outcomes at a minimum of 10 years of follow-up. [52] (10.1097/corr.0000000000002895)
[L2] However, the changed position of the humeral head on coronal plane does not affect the final functional results. [54] (10.4103/0973-6042.118911)
[L3] Holistic assessment of outcomes with both subjective and objective outcomes are necessary, as shoulder flexion, extension, and abduction are only moderately correlated with PROMs. [57] (10.1016/j.jseint.2024.02.003)
[L4] The paper reviews the biology and biomechanics of osteosynthesis for proximal humerus fractures, emphasizing that bone quality significantly impacts implant anchorage. [58] (10.1007/s00068-007-7089-2)
[L3] Predictive models constructed using ML techniques demonstrated favorable discrimination and satisfactory-to-excellent performance in forecasting prolonged LOS and serious adverse complications occurring within 30 days of surgical intervention for proximal humerus fracture. [59] (10.1016/j.jseint.2024.02.005)
[Paper] Rotator cuff tears are a detrimental factor and a major cause of painful shoulders. [63] (10.1007/s00264-004-0552-3)
[L5] The double plate strategy can increase the stability of the medial column of the proximal humerus, and enhance the overall biomechanical property of the repaired proximal humerus. [64] (10.1186/s12891-024-08216-0)
[L4] Evidence-based recommendations to guide treatment of proximal humerus fractures are lacking, and no good evidence exists whether surgery is clearly superior to nonoperative treatment. [65] (10.1016/j.ocl.2008.06.003)
[Abstract] Patients with a proximal humerus fracture undergoing reverse total shoulder arthroplasty have significantly worse perioperative outcomes, including higher rates of complications, longer hospital stays, and higher costs, compared to patients with other indications. [67] (10.1016/j.jse.2015.05.005)
[L4] There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third. [69] (10.1016/j.injury.2013.10.030)
[L3] Therefore, reverse shoulder arthroplasty could be considered primary treatment, especially when optimal range of motion is of great importance to the patient. [72] (10.1177/17585732231190038)
[L4] Glenoid loosening and severe scapular notching are related to poor positioning and/or incorrect orientation of the glenosphere. [74] (10.1016/j.otsr.2018.06.008)
[L3] Current diagnosis coding practices do not adequately capture the fracture complexity needed to conduct subgroup analysis for proximal humerus fractures. [75] (10.1016/j.jse.2023.08.022)
[L3] CNNs proficiently rule out proximal humerus fractures on plain radiographs. [76] (10.1302/0301-620x.106b11.bjj-2024-0264.r1)
[L5] The routine use of 3D-printed models may not be beneficial for classifying proximal humeral fracture patterns beyond the information gained from currently available imaging modalities, and their use as the sole determinant for recommending surgical intervention should be avoided at this time. [79] (10.1097/corr.0000000000002017)
[L5] In addition to palpation and anteroposterior and lateral humeral x-ray, we suggest adding bilateral anteroposterior shoulders xray routinely to confirm the shoulder location. [83] (10.1097/md.0000000000008977)
[L3] Timing of surgery did not impact outcomes of patients who underwent ORIF for proximal humerus fractures. [84] (10.1016/j.jse.2025.02.019)

References¶

[1] Management of proximal humerus fractures in adults. World Journal of Orthopedics. 2014. DOI: 10.5312/wjo.v5.i5.685 [2] Evaluation and Management of Proximal Humerus Fractures. Advances in Orthopedics. 2012. DOI: 10.1155/2012/861598 [3] How age and gender influence proximal humerus fracture management in patients older than fifty years. JSES International. 2022. DOI: 10.1016/j.jseint.2021.11.007 [4] Trending a decade of proximal humerus fracture management in older adults. JSES International. 2022. DOI: 10.1016/j.jseint.2021.08.006 [5] 1. Clinical Evaluation, Imaging, and Classification of Proximal Humerus Fractures. n.d.. [6] Long-term outcome of a proximal humerus fracture predicted after 1 year. Acta Orthopaedica. 2005. DOI: 10.1080/17453670510041295 [7] Consensus statement on the treatment of proximal humerus fractures: a Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.005 [8] 2. Non-operative Management of Proximal Humerus Fractures: Indications, Protocols, and Outcomes. n.d.. [9] Low arthroplasty survival after treatment for proximal humerus fracture sequelae: 3,245 shoulder replacements from the Nordic Arthroplasty Register Association. Acta Orthopaedica. 2020. DOI: 10.1080/17453674.2020.1793548 [11] 6. Complications of Proximal Humerus Fractures: Evaluation and Management. n.d.. [12] Evaluation and Management of Pediatric Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00033 [13] Proximal humerus fracture management and outcomes are distinctly different for individuals 60 years of age or younger: a systematic review. JSES Reviews, Reports, and Techniques. 2023. DOI: 10.1016/j.xrrt.2023.01.002 [14] Morbidity and mortality of fragility proximal humerus fractures: a retrospective cohort study of patients presenting to a level one trauma center. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.03.006 [15] Analyzing outcomes after proximal humerus fractures in patients <65 years: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2021.04.014 [16] Randomized controlled trials investigating proximal humerus fractures lack consensus in inclusion criteria. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.07.023 [17] A comprehensive update on current fixation options for two-part proximal humerus fractures. Injury. 2014. DOI: 10.1016/j.injury.2013.08.024 [18] Computed tomography improves the diagnostic accuracy but not the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae. Shoulder & Elbow. 2023. DOI: 10.1177/17585732221150785 [19] Epidemiology of proximal humerus fractures managed in a trauma center. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2012.05.013 [20] No change in outcome ten years following locking plate repair of displaced proximal humerus fractures. European Journal of Orthopaedic Surgery & Traumatology. 2021. DOI: 10.1007/s00590-021-03099-6 [21] Three or four parts complex proximal humerus fractures: Hemiarthroplasty versus reverse prosthesis: A comparative study of 40 cases. Orthopaedics & Traumatology: Surgery & Research. 2009. DOI: 10.1016/j.otsr.2008.09.002 [22] Rehabilitation progress following reverse total shoulder replacement and internal fixation for geriatric three and four-part proximal humerus fractures – a propensity score matched comparison. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06669-3 [23] Results of 131 consecutive operated patients with a displaced proximal humerus fracture: an analysis with more than two years follow-up. European Journal of Orthopaedic Surgery & Traumatology. 2010. DOI: 10.1007/s00590-010-0655-z [24] Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2016.09.022 [25] CORR Insights®: Short-term Complications for Proximal Humerus Fracture Surgery Have Decreased: An Analysis of the National Surgical Quality Improvement Program Database. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002430 [26] Outcomes after percutaneous reduction and fixation of proximal humeral fractures. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.006 [27] Proximal Humeral Fracture Treatment in Adults. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01293 [28] Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthopaedica. 2018. DOI: 10.1080/17453674.2018.1453714 [29] Morbidity and mortality of surgically treated pathologic humerus fractures compared to native humerus fractures. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.10.024 [30] Reverse Shoulder Arthroplasty for Proximal Humerus Fracture. Current Reviews in Musculoskeletal Medicine. 2020. DOI: 10.1007/s12178-020-09597-0 [31] Midterm outcome and complications after minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock. Injury. 2015. DOI: 10.1016/j.injury.2015.05.017 [32] Classification and Imaging of Proximal Humerus Fractures. Orthopedic Clinics of North America. 2008. DOI: 10.1016/j.ocl.2008.05.002 [33] Biomechanical Assessment Of Inferior Tuberosity Placement During Hemiarthroplasty For 4-Part Proximal Humerus Fractures G.. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.110 [35] Cost-Minimization Analysis and Treatment Trends of Surgical and Nonsurgical Treatment of Proximal Humerus Fractures. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.03.022 [36] Does objective shoulder impairment explain patient-reported functional outcome? A study of proximal humerus fractures. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.06.005 [37] CORR Insights®: What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?. Clinical Orthopaedics & Related Research. 2022. DOI: 10.1097/corr.0000000000002242 [38] New trends in fixation of proximal humeral fractures: A review. Injury. 2011. DOI: 10.1016/j.injury.2010.10.016 [39] Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. PLOS Medicine. 2019. DOI: 10.1371/journal.pmed.1002855 [40] Biomechanical Assessment Of Inferior Tuberosity Placement During Hemiarthroplasty For 4-Part Proximal Humerus Fractures. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.027 [41] Readmissions, revisions, and mortality after treatment for proximal humeral fractures in three large states. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2812-9 [44] Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.09.032 [45] The Mayo-FJD Classification System For Proximal Humerus Fractures: Intra And Interobserver Agreement. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.035 [46] Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2022.00885 [48] Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.01.025 [49] Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures. Acta Orthopaedica et Traumatologica Turcica. 2020. DOI: 10.1016/j.aott.2016.10.003 [50] The reliability of the Neer classification for proximal humerus fractures: a survey of orthopedic shoulder surgeons. JSES International. 2022. DOI: 10.1016/j.jseint.2022.02.006 [51] Standard compared with fracture-specific components in reverse shoulder arthroplasty for proximal humerus fractures. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b9.bjj-2024-1508.r2 [52] What Are the Long-term Outcomes of Locking Plates for Nonosteoporotic Three-part and Four-part Proximal Humeral Fractures With a Minimum 10-year Follow-up Period?. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002895 [54] Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study. International Journal of Shoulder Surgery. 2013. DOI: 10.4103/0973-6042.118911 [56] 24. Proximal Humerus Fractures in the Adolescent Patient: Diagnosis, Management, and Complications. n.d.. [57] Achieving satisfactory functional outcomes in conservatively treated proximal humerus fractures: relationship between shoulder range of motion and patient-reported clinical outcome scores. JSES International. 2024. DOI: 10.1016/j.jseint.2024.02.003 [58] Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures. European Journal of Trauma and Emergency Surgery. 2007. DOI: 10.1007/s00068-007-7089-2 [59] Preoperative factors predict prolonged length of stay, serious adverse complications, and readmission following operative intervention of proximal humerus fractures: a machine learning analysis of a national database. JSES International. 2024. DOI: 10.1016/j.jseint.2024.02.005 [63] Proximal humeral fractures with minimal displacement treated conservatively. International Orthopaedics. 2004. DOI: 10.1007/s00264-004-0552-3 [64] Biomechanical study of two different fixation methods for the treatment of Neer III proximal humerus fractures. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08216-0 [65] Open Reduction and Internal Fixation of Proximal Humerus Fractures. Orthopedic Clinics of North America. 2008. DOI: 10.1016/j.ocl.2008.06.003 [67] Reverse Total Shoulder Arthroplasty Patients with a Proximal Humerus Fracture Have Significantly Worse Perioperative Outcomes than Other Indications: An Analysis of 5644 Cases. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.005 [69] Proximal third humeral shaft fractures—A fracture entity not fully characterized by conventional AO classification. Injury. 2014. DOI: 10.1016/j.injury.2013.10.030 [72] Does primary treatment of proximal humerus fractures show favourable functional outcomes over secondary treatment with reverse shoulder arthroplasty?. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231190038 [74] Reverse shoulder arthroplasty for proximal humerus fractures: Is the glenoid implant problematic?. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2018.06.008 [75] ICD-10 diagnosis codes in electronic health records do not adequately capture fracture complexity for proximal humerus fractures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.08.022 [76] Detection, classification, and characterization of proximal humerus fractures on plain radiographs. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0264.r1 [79] CORR Insights®: 3D-printed Handheld Models Do Not Improve Recognition of Specific Characteristics and Patterns of Three-part and Four-part Proximal Humerus Fractures. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000002017 [83] Shoulder dislocation combined with proximal humerus fracture in children. Medicine. 2017. DOI: 10.1097/md.0000000000008977 [84] Delays beyond 5 days to surgery does not affect outcome following plate and screw fixation of proximal humerus fractures. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.019

	CC Creative Commons licence
	BY Attribution — you must credit the source
	NC NonCommercial — not for commercial use