Critical analysis review synthesizing evidence on proximal humeral fracture management, evaluating when to operate, which procedure to choose, and how fracture pattern and physiological age — rather than chronological age alone — should drive decision-making across the full spectrum from nonoperative care to reverse arthroplasty.
When you see a proximal humerus fracture in a patient over 60, the default should be nonoperative — four RCTs support this for three- and four-part patterns without dislocation.
When arthroplasty is indicated in patients over 70 with irreconstructable fractures, choose reverse over hemi: expect ~40° more forward elevation and superior functional scores.
Critical analysis review synthesizing evidence on proximal humeral fracture management, evaluating when to operate, which procedure to choose, and how fracture pattern and physiological age — rather than chronological age alone — should drive decision-making across the full spectrum from nonoperative care to reverse arthroplasty.
When you see a proximal humerus fracture in a patient over 60, the default should be nonoperative — four RCTs support this for three- and four-part patterns without dislocation.
When arthroplasty is indicated in patients over 70 with irreconstructable fractures, choose reverse over hemi: expect ~40° more forward elevation and superior functional scores.