➢ Percutaneous pinning, while technically demanding, provides a minimally invasive approach to the treatment of select displaced two, three, and four-part fractures, with reliable results.
➢ The advent of locked plate fixation has expanded the indications for open reduction and internal fixation of displaced proximal humeral fractures but still requires anatomic reduction and appropriate implant placement in order to avoid complications. The incorporation of tension band rotator cuff sutures into the plate construct may augment tuberosity and fracture fixation.
➢ Anatomic tuberosity position and healing, along with the use of a dedicated fracture implant, are key factors for the successful treatment of proximal humeral fractures with use of hemiarthroplasty.
➢ Reverse shoulder replacement is an alternative to hemiarthroplasty for the treatment of severe fractures for which arthroplasty is indicated, especially in elderly patients (those over the age of seventy-five years), but it requires tuberosity healing for optimum function.
Proximal humeral fractures are common in the elderly population, and the societal burden is expected to increase. These fractures represent 4% to 5% of all fractures and one-third of fractures among patients over the age of sixty years1,2. Epidemiological studies have indicated that the number of such fractures in women who are eighty years of age or older may nearly double within the next twenty years3.
In his original description of proximal humeral fractures, Neer affirmed that most fractures are nondisplaced or minimally displaced and therefore can be treated nonoperatively4. Displaced fractures represent only 15% to 20% of all proximal humeral fractures4. Decision-making is influenced by many factors, including fracture pattern, comminution, bone quality, surgeon preferences, and the age and activity level of the patient5. Numerous options are currently available to the surgeon for the treatment of displaced fractures, including …