CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

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WHO AND HOW: CONSERVATIVE MANAGEMENT APPROACHES FOR PROXIMAL HUMERAL FRACTURES

Nuri Koray Ülgen

Ankara Sincan Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Ülgen NK. Who and How: Conservative Management Approaches for Proximal Humeral Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.33-38.

ABSTRACT

Proximal humerus fractures are the third most common fractures in the elderly. Its incidence is increasing day by day with the prolongation of life expectancy. 85% of patients are over the age of 50. It is more than twice as common in women. While young and active patients are treated with surgical methods, 85% of elderly patients are treated conservatively. With the development of implant technologies in the 2000s, surgical fixation and shoulder arthroplasty options began to increase in the treatment of proximal humerus fractures in the elderly. Recent studies have shown that surgical treatment in elderly patients is associated with a high level of complications. In addition, since the effectiveness of conservative treatment has been demonstrated in studies, its popularity has increased again. Conservative treatment is applied to patients who are functionally immobile and have poor bone quality. Two important factors in deciding on conservative treatment are bone quality and the individual’s degree of social independence. The patient’s degree of social independence is more important than chronological age in decision making. Tingart index and Deltoid tuberosity index are used to determine bone structure. The presence of poor bone quality increases complications in patients treated surgically. Plain radiographs and computed tomography are used in fracture evaluation. To decide on treatment, the number of fractured fragments, the amount of displacement, and defective areas should be determined in imaging. Determining the stability of the fracture is important in deciding on conservative treatment. Minimal comminution, less than 3 fracture fragments, minimal displacement of the greater tubercle, adequate cortical contact, impaction of the head to the diaphysis, and no history of dislocation are effective in choosing conservative treatment. In studies comparing conservative and surgical treatment for proximal humerus fractures, shoulder functional scores were found to be similar between both treatment methods. Surgical treatment has been shown to have more complications in patients over 60 years of age. When evaluated in terms of cost, conservative treatment was found to be superior to surgical treatment. Conservative follow-up is a very effective treatment method in the treatment of proximal humerus fractures. Although it is primarily recommended for functionally inactive elderly and osteoporotic patients, studies have shown that it can be an effective treatment in larger patient groups with the right patient selection.

Keywords: Shoulder fractures; Conservative treatment; Frail elderly; Geriatrics

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