Nonoperative treatment of proximal humerus fractures in the elderly

Proximal humerus fractures are common and occur in approximately 70% of the cases beyond the age of 60 with a peak incidence over the age of 80. A number of randomized studies and meta-analyses have so far failed to demonstrate the superiority of surgery over nonoperative treatment in the elderly. In addition, according to the latest systematic Cochrane Review, evidence still reveals that surgery might be associated with higher complication, and revision surgery rates. However, it remains unclear how exactly this evidence out of "controlled" trial conditions can be incorporated into a decision aid suitable for everyday clinical practice. The following review article aims to present a possible treatment algorithm that takes current best evidence into account, and provides guidance on how this steadily increasing type of injury might be successfully treated nonoperatively in the elderly in daily clinical practice.