This JAAOS review covers the full management spectrum for acute proximal humeral fractures — the third most common fracture type — from nonsurgical immobilization through reverse shoulder arthroplasty. It synthesizes evidence across classification systems, fixation strategies, and arthroplasty options to guide treatment selection based on fracture pattern, patient age, and bone quality.
When you see a three- or four-part proximal humeral fracture in a patient over 65 with poor bone quality or comminuted tuberosities, RSA is increasingly favored over HA because functional results are more predictable and do not depend on tuberosity healing — but counsel every patient preoperatively that permanent functional limitations are possible regardless of implant choice.
This JAAOS review covers the full management spectrum for acute proximal humeral fractures — the third most common fracture type — from nonsurgical immobilization through reverse shoulder arthroplasty. It synthesizes evidence across classification systems, fixation strategies, and arthroplasty options to guide treatment selection based on fracture pattern, patient age, and bone quality.
When you see a three- or four-part proximal humeral fracture in a patient over 65 with poor bone quality or comminuted tuberosities, RSA is increasingly favored over HA because functional results are more predictable and do not depend on tuberosity healing — but counsel every patient preoperatively that permanent functional limitations are possible regardless of implant choice.