Fractures of the proximal humerus

Fractures of the proximal humerus encompass a broad spectrum of injuries. They are often the result of a fall in an osteoporotic patient, but can also occur in high-energy trauma. The incidence of this fracture is expected to increase dramatically in the next 30 years. Accurate classification is important in selecting the appropriate treatment. Additional factors such as patient activity level, bone quality, and ability to participate in rehabilitation must also be considered in developing a treatment plan. The indications and methods for both operative and nonoperative treatment of proximal humerus fractures are reviewed in this article. The current recommendations for percutaneous pinning, tension band wiring, plating, intramedullary fixation, and humeral head replacement are discussed. Also reviewed is the surgical treatment of proximal humeral nonunions.