{"title":"Controversies in the Management of Proximal Humerus Fractures.","authors":"Nicholas Brule, Yagiz Ozdag, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.07.009","DOIUrl":null,"url":null,"abstract":"<p><p>Proximal humerus fractures (PHFs) are frequently encountered by upper-extremity surgeons. Despite recent advances in both surgical techniques and implant designs, numerous management controversies exist that are primarily centered on indications for operative treatment as well as the decision to use fixation techniques or arthroplasty in the management of these injuries in older patients. The introduction and widespread adoption of reverse total shoulder arthroplasty in the management of three- and four-part PHFs represents a paradigm shift with respect to operative treatment options. This review discusses modern management controversies surrounding adult PHFs, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions for management by incorporating results of recent randomized controlled trials assessing treatment outcomes following management of PHFs.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jhsa.2025.07.009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Proximal humerus fractures (PHFs) are frequently encountered by upper-extremity surgeons. Despite recent advances in both surgical techniques and implant designs, numerous management controversies exist that are primarily centered on indications for operative treatment as well as the decision to use fixation techniques or arthroplasty in the management of these injuries in older patients. The introduction and widespread adoption of reverse total shoulder arthroplasty in the management of three- and four-part PHFs represents a paradigm shift with respect to operative treatment options. This review discusses modern management controversies surrounding adult PHFs, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions for management by incorporating results of recent randomized controlled trials assessing treatment outcomes following management of PHFs.
期刊介绍:
The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.