Proximal humerus fractures in the elderly are we operating on too many?

Proximal humerus fractures in the elderly are a relatively rare injury, the treatment of which remains controversial, especially regarding Neer displaced two-part, and three-part and four-part fractures. Operative indications for most displaced proximal humerus fractures in the elderly remain poorly defined, but recent literature is actually supporting less aggressive approaches except for the most severe fractures. Recent epidemiological and larger scale retrospective studies fail to show a significant functional difference between operative and non-operative treatment of displaced two-part and three-part fractures in the elderly. Most four-part fractures appear to be best treated with hemiarthroplasty. Recent meta-analyses show a need for well-executed, randomized, prospective studies that can be used to provide evidence-based templates for appropriate management of displaced proximal humerus fractures in the elderly.