High rate of maintaining self-dependence and low complication rate with a new treatment algorithm for proximal humeral fractures in the elderly population

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

“…Barbary macaques seem to have inferior inter-rater reliability compared with the experts for choice of treatment (non-surgical v surgical), but they performed similarly to the experts for the geriatric age group most frequently affected by proximal humeral fractures, in their choices of treatment and choice of surgical procedure. These findings highlight the continuing controversy and lack of expert consensus on the optimal treatment of these fractures even outside the human species 4621…”

“…Surgical treatment of proximal humeral fractures has been associated with complication rates as high as 49% and reoperation rates of 14%. Growing evidence from randomised controlled trials and meta-analyses showing similar outcomes between surgical and non-surgical management of proximal humeral fractures has called into question surgical treatment of such fractures for patients older than 65 562122. In addition to prospective trials, pooled data of previous studies in a recent Cochrane review showed no clinically important difference in functional outcomes and quality of life between surgical and non-surgical treatment of proximal humerus fractures at one to two year follow-up 816…”

“…4 The rates of surgically treated patients are higher than 25% in some institutions, leading to substantial variation worldwide in the management of this common injury. 6 In a review of a large sample of US Medicare data, Bell and coauthors found a significant increase in the number of surgical procedures for proximal humeral fractures without a corresponding increase in their incidence in the study period, and moreover, with significant regional variation in the rates of surgery, ranging from 0% to 68%. 7 This heterogeneity of treatment is in the setting of a lack of scientific consensus on the optimal treatment for these fractures.…”

“…Although it is well known that most proximal humeral fractures (nearly 75%) can be treated non-operatively with acceptable functional results, surgery became popular with advancements in the field of osteosynthetic implants, such as locking nails, plates, and prosthetic shoulder joint replacements 4. The rates of surgically treated patients are higher than 25% in some institutions, leading to substantial variation worldwide in the management of this common injury 6…”

Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

“…Despite an increase in publications on conservative approaches to proximal humerus treatment 6 , 7 , 8 , the literature continues to describe an upward tendency in surgical therapies 9 .…”