Retrospective case series evaluating standardized nonoperative management — Velpeau bandage, hanging cast when needed, then progressive rehabilitation — for Neer three- and four-part proximal humerus fractures in 18 patients (mean age 68) who were either high anesthesia risk (ASA IV) or refused surgery. Asks whether satisfactory function is achievable without operative intervention in this low-demand population.
When an elderly, low-demand patient with a Neer three- or four-part proximal humerus fracture is medically unfit for surgery, a structured nonoperative protocol (Velpeau immobilization, early pendulum exercises by week 2, progressive active motion by week 6) can achieve satisfactory function in the majority — radiographic malunion or osteonecrosis should not automatically trigger intervention if the patient is functioning adequately.
Retrospective case series evaluating standardized nonoperative management — Velpeau bandage, hanging cast when needed, then progressive rehabilitation — for Neer three- and four-part proximal humerus fractures in 18 patients (mean age 68) who were either high anesthesia risk (ASA IV) or refused surgery. Asks whether satisfactory function is achievable without operative intervention in this low-demand population.
When an elderly, low-demand patient with a Neer three- or four-part proximal humerus fracture is medically unfit for surgery, a structured nonoperative protocol (Velpeau immobilization, early pendulum exercises by week 2, progressive active motion by week 6) can achieve satisfactory function in the majority — radiographic malunion or osteonecrosis should not automatically trigger intervention if the patient is functioning adequately.