[Proximal humerus fracture: is fixed-angle plate osteosynthesis superior to conservative treatment?]

Despite the fact that proximal humerus fractures represent one of the most frequent types of all fractures, the quality of evidence is poor although it has improved in recent years. It is widely agreed in the literature that nondisplaced fractures can be treated conservatively with good outcome. Two recent prospective randomized studies have shown that this also applies to displaced three- and four-part fractures.The results of fixed-angle plate osteosynthesis are also not superior to conservative management in complex displaced fractures in the elderly and in many aspects are even worse. Fixed-angle plate osteosynthesis has not fulfilled expectations. High rates of complications and revision surgeries as well as moderate functional results have been demonstrated in numerous studies.Conventional fracture prostheses or inverse prostheses are solutions fo complex not reducible and/or retainable. Also for the dislocated 4-part fracture of the patient above 60 ears no general advantages of the joint replacement compared to conservative treatment could be shown in a recent scandinavian prospective randomized clinical trial.