Related Experiment Video
Updated: Jun 30, 2025

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Position statement: management of proximal humerus fractures
Peter Lapner1, Ujash Sheth2, Diane Nam2
1From the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Lapner); Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre (Sheth, Nam, Richards); Department of Surgery, University of Toronto, Toronto, Ont. (Sheth, Nam, Richards); Department of Surgery, University Hospital, Western University, London, Ont. (Schemitsch); and Department of Orthopaedics, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Guy) plapner@toh.ca.
This study compares surgical treatments for proximal humerus fractures in adults over 60, evaluating functional outcomes and reoperation rates. Findings aim to improve patient counseling and surgeon knowledge on surgical options for better decision-making.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Geriatric Medicine
Background:
- Proximal humerus fractures are common in older adults.
- Optimal surgical management remains debated, impacting patient outcomes.
Purpose of the Study:
- To compare functional outcomes and reoperation rates for surgical treatments of proximal humerus fractures in patients over 60.
- To provide evidence-based guidance for surgical decision-making.
Main Methods:
- Systematic review of English-language randomized controlled trials (RCTs) up to February 2022.
- Searched MEDLINE, Embase, and Cochrane databases.
- Included comparisons: operative vs. nonoperative, ORIF (locking plate vs. intramedullary nail), arthroplasty vs. ORIF, and reverse shoulder arthroplasty vs. hemiarthroplasty.
- Assessed evidence quality using the GRADE approach.
Main Results:
- Evaluated functional outcomes (e.g., Constant score), pain (VAS), and reoperation rates.
- Synthesized data from RCTs to inform treatment recommendations.
- Quality of evidence and strength of recommendations were assessed.
Conclusions:
- The guideline aims to enhance patient counseling regarding surgical options and outcomes for proximal humerus fractures.
- It seeks to improve surgeons' knowledge of various surgical approaches.
- Data can support shared decision-making tools for patients and providers.
Related Concept Videos
Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
Bones of the Upper Limb: Humerus
Bones of the Upper Limb: Ulna
Bones of the Upper Limb: Radius
The radius has a nail-shaped head, and a...
Muscles that Move the Forearm
Forearm Flexors
The biceps brachii, brachialis, and brachioradialis are forearm flexors. The biceps brachii is made up of two heads. Its long head originates at the supraglenoid tubercle of the scapula, whereas that of the short head is...

