Proximal Humeral Fracture

The majority of proximal humerus fractures occur in older people, secondary to a simple fall. However, in younger people, these are higher-energy injuries, with a proportion of these fractures occurring secondary to a sports event. Anterior glenohumeral dislocations are a common sports injury, and approximately 15% are complicated by a greater tuberosity fracture. We discuss the anatomy and biomechanics of the shoulder joint, including blood supply, with implications for fracture management. Neer’s classification provides a simple method for describing the fracture with regards to the number of parts, although multiple other more detailed classification systems are available. There are many treatment options available for management of proximal humerus fractures, reflecting the controversy regarding the optimal treatment. Recently, the ProFHER trial has shed some light on this, with a follow-up ProFHER-2 trial in progress to provide further evidence. However, in younger, active patients who hope to promptly return to their sporting activities, surgical management of displaced fractures may be more appropriate.