Controversies in the Management of Proximal Humerus Fractures

Proximal humerus fractures (PHFs) are frequently encountered by upper-extremity surgeons. Despite recent advances in both surgical techniques and implant designs, numerous management controversies exist that are primarily centered on indications for operative treatment as well as the decision to use fixation techniques or arthroplasty in the management of these injuries in older patients. The introduction and widespread adoption of reverse total shoulder arthroplasty in the management of three- and four-part PHFs represents a paradigm shift with respect to operative treatment options. This review discusses modern management controversies surrounding adult PHFs, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions for management by incorporating results of recent randomized controlled trials assessing treatment outcomes following management of PHFs.