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Proximal Humerus Fracture ORIF (Plate and Nail Fixation)

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Updated Aug 2026
Illustration of a fracture of the upper arm bone near the shoulder.
A fracture of the upper end of the arm bone, near the shoulder. Kieran Hirpara 4.0

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For acute injuries, surgery may be recommended straight away. For long-standing problems, we usually try non-operative care first and consider surgery when that has not given enough improvement.

Your surgeon may suggest this operation to restore stability and function to your shoulder. The procedure uses a plate and screws or a nail inside the bone to hold the broken pieces in place while they heal. Most fractures in older adults heal well without surgery, but displaced fractures often need support to prevent long-term stiffness or pain. This approach aims to help you regain movement and reduce discomfort.

Before the operation

Please fast for seven hours before your surgery. This allows us to bring you forward if the theatre list runs early. You must arrange a lift home and wear comfortable clothing. Bring a list of your current medications. Your surgeon will give specific advice on stopping certain medicines. We use X-rays, MRI, or ultrasound to plan your operation carefully. Most patients do not need blood tests or an anaesthetic review. If you have other medical conditions, you may need these checks. We aim to make your preparation simple and clear so you can focus on recovery.

On the day

You will present to the surgical admissions unit for check-in and preparation. You will meet the anaesthetist who discusses your care. This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block — an injection that numbs the nerves supplying the arm before you wake up — provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.

You are then taken into the operating theatre where your surgeon performs the procedure. You wake up in the recovery area while nurses monitor you as the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

Your surgeon makes a single cut over the shoulder area to reach the broken bone. This open approach allows direct access to the fracture site. The surgeon carefully realigns the bone fragments to restore their natural position. This step is crucial for proper healing and future movement.

Once the bone is in place, your surgeon secures it using either a metal plate with screws or an intramedullary nail. A plate sits on the surface of the bone, while a nail is inserted down the centre of the bone shaft. Both methods provide stable fixation to hold the pieces together while they heal. The choice between these options depends on your specific fracture pattern and bone quality, as determined by your surgeon.

After the fixation is complete, your surgeon closes the wound using sutures (stitches). No staples or skin glue are used for this closure. The area is then dressed to protect the incision as it begins to heal. This procedure focuses on stabilising the fracture to allow your shoulder to recover its function over time.

After the operation

You will wake up in the recovery ward with your arm supported in a simple sling for comfort. This sling comes off for exercises and washing. We provide pain control to keep you comfortable. A single cut is made over the area being operated on, covered with dressings. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours. You must not drive for at least six weeks after any shoulder operation, regardless of which arm was operated on. Please see our guide on Driving after upper-limb surgery for more details.

Recovery

You will wear a simple sling for comfort after your operation. It keeps your arm supported while the tissues heal. You can remove the sling for your exercises and for washing. We do not use complex braces or pillows. Your physiotherapist will guide you through gentle movements to restore mobility.

In the first few days, pain and swelling are normal. Your surgeon may recommend regional anaesthesia to help manage discomfort and support a smoother early recovery. Resting with your arm slightly elevated can ease the swelling. As the swelling settles, you will notice more movement returning to your shoulder.

Daily activities will feel limited at first. You cannot drive while in the sling. Our policy requires no driving for at least six weeks after any shoulder operation, regardless of which arm was treated. You can return to driving once your surgeon clears you, typically at the six-week review. For more details, see Driving after upper-limb surgery.

Recovery varies between individuals. Your timeline may differ; your surgeon and physio will guide you.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Infection You might notice increasing redness, warmth, or swelling around the shoulder. The area may feel tender or look like it is draining fluid. You could also develop a fever. Contact the clinic immediately if you see these signs so we can start treatment right away.

Blood Clots A blood clot in the leg (venous thromboembolism) is a known risk after shoulder surgery. You might feel sudden swelling, pain, or tenderness in your calf or thigh. The skin may look red or feel warm to the touch. This is serious. Go to the emergency department or call for help straight away if you notice these symptoms in your leg.

Bone Death (Avascular Necrosis) Sometimes the blood supply to the head of your upper arm bone is damaged. You may not feel this happening at first. Later, you might notice deep, aching pain that does not go away with rest or simple painkillers. Your shoulder may feel stiff or weak. Bring this up at your next review so we can check the bone health.

Non-Union or Malunion The bone might take longer than expected to heal, or it might heal in a slightly different position. You may notice persistent pain when you move your arm. Your shoulder might feel unstable or click when you lift it. Tell your surgeon if your pain does not ease over time or if your arm feels weak.

Hardware Issues The plate, screws, or nail used to hold your bone in place can sometimes cause irritation. You might feel a sharp pain or a clicking sensation under the skin. The hardware could potentially loosen or break. If you feel something shifting or hear grinding noises, let us know. We can check if the implant is still holding the bone correctly.

Need for Further Surgery In some cases, the initial fixation may not hold, or complications like infection or bone death may occur. This could mean you need another operation to fix the problem or to replace the joint. If your pain worsens significantly or your shoulder function declines, we will discuss further options with you.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath, which could signal a blood clot. Seek urgent care if you lose sensation in your arm or cannot move your limb. We are here to help if any of these symptoms occur.

Where to read more

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Proximal Humerus Fracture page.

Where to read more about the condition

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Proximal Humerus Fracture page.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Modern proximal humeral nail designs and techniques demonstrate promising outcomes and provide stable fixation [1].
  • Intramedullary nailing and locked plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults [2].
  • Intramedullary nailing is superior to locking plates in reducing total complications, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rates [3].
  • Both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures [6].
  • There is unclear superiority of intramedullary nails versus locking plates for the treatment of displaced proximal humeral fractures [6].
  • Limited evidence suggests that both locking plates and intramedullary nails are valuable options for the treatment of proximal humeral fractures [13].
  • Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages [7].
  • Reported outcomes for intramedullary fixation are comparable with other techniques [7].
  • Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation [9].
  • Augmentation of plate fixation for proximal humeral fractures mechanically increases construct stability and reduces complication rates while improving patient outcomes [18].
  • Augmentation of plate fixation for proximal humeral fractures is a reliable and safe procedure [18].
  • No single fixation method is a panacea for proximal humeral fractures [21].
  • The choice of implant and method for proximal humeral fractures should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [21].
  • Treatment for proximal humerus fractures remains controversial [5].
  • Nonsurgical management of proximal humerus fractures demonstrates successful outcomes and union rates greater than 90% [5].

Anatomy & Pathophysiology

  • Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy [29].

Classification

  • Intramedullary nailing of the proximal humerus can provide stable fixation [1].
  • Intramedullary nailing is superior to locking plate in reducing total complications, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
  • There is unclear superiority of intramedullary nails versus locking plates for displaced proximal humeral fractures [6].
  • Reported outcomes with intramedullary fixation are comparable with other techniques [7].
  • Plate fixation was associated with a higher risk of avascular necrosis (AVN) development than conservative treatment in patients with proximal humeral fractures [11].
  • Limited evidence suggests that locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures [13].
  • No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures [14].
  • Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics [16].
  • Treatment options for displaced proximal humerus fractures range from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty [16].
  • The choice of treatment for proximal humeral fractures depends on the fracture type and severity, surgeon expertise, patient age, and patient health status [25].

Clinical Presentation

  • Intramedullary nailing is superior to locking plate in reducing total complication rate, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
  • Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates [4].
  • Both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method [6].
  • Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages, including reported outcomes comparable with other techniques [7].
  • Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes [8].
  • Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent [12].
  • Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [15].
  • Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics, with a general evolution toward humeral head preservation using options ranging from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty [16].
  • Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging [17].
  • Hemiarthroplasty for the treatment of complex proximal humerus fractures yields variable long-term clinical outcomes and high rates of failure, with the majority due to greater tuberosity malunion or nonunion [38].
  • Optimal management of osteoporotic proximal humeral fractures has evolved to include the use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft [43].

Investigations

  • Intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults [2].
  • Intramedullary nailing is superior to locking plate in reducing total complication rates, intraoperative blood loss, operative time, postoperative fracture healing time, and postoperative humeral head necrosis rate [3].
  • Modern proximal humeral nail designs and techniques have demonstrated promising outcomes and can provide stable fixation [1].
  • Patients undergoing ORIF for proximal humerus fracture dislocations have relatively high avascular necrosis and reoperation rates [4].
  • Preoperative CT is extremely valuable for careful analysis of fracture type, fragment displacement, and bone quality in the surgical treatment of three and four-part proximal humeral fractures [54].
  • Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries [52].

Treatment

Non-Operative Management

  • Most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment [15].
  • Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes [27].
  • Non-operative treatment is advocated for the majority of non-displaced and minimally displaced proximal humerus fractures, which generally yield good outcomes [41].

Operative Management: General Considerations

  • No single fixation method is a panacea for proximal humerus fractures; the choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications [21].
  • Surgical management of proximal humeral fractures in younger patients is challenging due to high expectations and the lack of a single device providing reproducible results [19].
  • Technical strategies to maximize the success of surgical treatment for proximal humerus fractures emphasize innovations in technique and implant design to mitigate high complication rates [39].
  • Modern management controversies surrounding adult proximal humerus fractures include surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty [53].

Intramedullary Nailing vs. Locking Plate Fixation

  • The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of proximal humerus fractures [3].

Augmentation Techniques

  • Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure that mechanically increases construct stability and reduces complication rates while improving patient outcomes [18].
  • Fixation of proximal humeral fractures in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone [26].

Specific Fracture Patterns and Populations

Anesthesia

  • Regional anesthesia is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anesthesia alone [44].

Complications and Definitions

  • Significant heterogeneity exists in the terminology and definitions used to describe complications following non-surgical management of proximal humeral fractures, calling for standardized definitions to improve evidence synthesis [20].

Complications

  • Intramedullary fixation represents an alternative treatment option with reported outcomes comparable with other techniques [7].
  • Fixation of proximal humeral fractures in elderly patients using locked plates with cement augmentation may have lesser implant failure and total complication rates than using a locked plate alone [26].
  • Standard components and fracture-specific components in reverse shoulder arthroplasty (RSA) for proximal humerus fractures show no significant differences in complication rates [47].
  • Venous thromboembolism (VTE) was the most frequently reported complication after shoulder arthroplasty (SA) compared to ORIF, with RSA having the highest VTE rate [50].
  • Revision surgery for failed arthroplasty of proximal humerus fracture is complex with a high likelihood of inferior outcomes compared with primary arthroplasty [57].
  • Locked humeral stems provide reliable diaphyseal fixation with a low incidence of screw-related complications in reverse total shoulder arthroplasty for complex proximal humerus fractures [58].
  • Open fractures and 4-part proximal humerus fractures had the highest complication rates following intramedullary nailing [59].
  • Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures [60].
  • Proximal humerus fractures treated with a locking compression plate (LCP) augmented with a fibular allograft have decreased odds of a major complication when compared with patients treated with an LCP alone [61].

Recovery

  • Modern proximal humeral nail designs and techniques can provide stable fixation [1].
  • In most studies of proximal humerus fractures, only 1 or 2 patients experiencing an alternative outcome or lost to follow-up would change the conclusions for the dichotomous outcome studied [24].
  • Patients 65 years of age with 3- or 4-part proximal humerus fractures achieve the most benefit in terms of ROM, postoperative functional outcomes, tuberosity union, and overall complication rate when undergoing reverse total shoulder arthroplasty (rTSA) with a noncemented stem and early postoperative ROM compared to rTSA with cemented stem and delayed rehabilitation [48].
  • Published rehabilitation protocols for proximal humerus fractures vary considerably regardless of management [49].

Key Evidence

  • [L5] Modern proximal humeral nail designs and techniques have demonstrated promising outcomes and can provide stable fixation. [1] (10.1016/j.jse.2015.11.016)
  • [L1] Intramedullary nailing and plating demonstrate equivalent clinical outcomes for the surgical management of displaced proximal humerus fractures in adults. [2] (10.1016/j.jse.2026.02.016)
  • [L1] The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of PHF. [3] (10.1186/s13018-019-1345-0)
  • [L4] Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates. [4] (10.1016/j.jse.2022.04.018)
  • [L5] Treatment for proximal humerus fractures remains controversial, with nonsurgical management demonstrating successful outcomes and union rates greater than 90%. [5] (10.5435/jaaos-d-24-01073)
  • [L5] The available evidence suggests that both intramedullary nails and locking plates can effectively restore shoulder function in the treatment of displaced proximal humeral fractures, with unclear superiority of either method. [6] (10.1016/j.xrrt.2024.01.001)
  • [L4] Intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages, including reported outcomes comparable with other techniques. [7] (10.5435/jaaos-d-18-00360)
  • [L5] Most proximal humeral fractures in elderly patients can be treated nonoperatively with good functional outcomes. [8] (10.2106/jbjs.l.01293)
  • [L4] Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. [9] (10.1016/j.injury.2010.11.058)
  • [L1] Plate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures. [11] (10.1186/1749-799x-9-31)
  • [L5] Most pediatric patients with proximal humerus fractures have favorable results, and complications are infrequent. [12] (10.5435/jaaos-d-14-00033)
  • [L1] Limited evidence suggests that locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures. [13] (10.1186/s13018-015-0242-4)
  • [L1] No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures. [14] (10.1007/s00264-017-3683-z)
  • [L4] Over the past decade, most older adults who sustain proximal humerus fractures continue to receive nonoperative treatment. [15] (10.1016/j.jseint.2021.08.006)
  • [L5] Treatment of displaced proximal humerus fractures must be individualized based on patient and fracture characteristics, with a general evolution toward humeral head preservation using options ranging from nonsurgical immobilization to various surgical techniques including locking plate fixation and hemiarthroplasty. [16] (10.5435/00124635-200701000-00003)
  • [L4] Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging. [17] (10.1016/j.jse.2020.04.006)
  • [L1] Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure that mechanically increases construct stability and reduces complication rates while improving patient outcomes. [18] (10.1007/s00402-019-03162-2)
  • [L5] The paper concludes that surgical management of proximal humeral fractures in younger patients is challenging due to high expectations and the lack of a single device providing reproducible results. [19] (10.1016/j.jse.2010.12.006)
  • [L1] This systematic review highlights significant heterogeneity in the terminology and definitions used to describe complications following non-surgical management of proximal humeral fractures, calling for standardized definitions to improve evidence synthesis. [20] (10.1186/s12891-019-2459-6)
  • [L4] No single fixation method is a panacea for proximal humeral fractures; choice of implant and method should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications. [21] (10.1016/j.injury.2010.10.016)
  • [L2] In most studies of proximal humeral fractures, only 1 or 2 patients experiencing an alternative outcome or lost to follow-up would change the conclusions for the dichotomous outcome studied. [24] (10.1016/j.jse.2022.01.141)
  • [L4] The choice of treatment for proximal humeral fractures depends on the fracture type and severity, surgeon expertise, patient age, and patient health status. [25] (10.5435/jaaos-d-15-00240)
  • [L1] Fixation of proximal humeral fractures in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. [26] (10.1186/s12891-024-07502-1)
  • [L5] Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. [27] (10.2106/jbjs.20.00665)
  • [L5] Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy, with biomechanical studies showing that locked plating provides stable fixation. [29] (10.5435/jaaos-d-20-00558)
  • [L5] Hemiarthroplasty for the treatment of complex proximal humerus fractures yields variable long-term clinical outcomes and high rates of failure, with the majority due to greater tuberosity malunion or nonunion. [38] (10.1016/j.xrrt.2025.100616)
  • [L5] This review highlights various technical strategies to maximize the success of surgical treatment for proximal humerus fractures, emphasizing innovations in technique and implant design to mitigate high complication rates. [39] (10.5435/jaaos-d-22-01211)
  • [L4] Non-operative treatment is advocated for the majority of non-displaced and minimally displaced fractures with generally good outcomes, while displaced fractures may require arthroscopically assisted fixation or open/percutaneous reduction and internal fixation depending on fracture type and patient factors. [41] (10.1016/j.injury.2007.09.022)
  • [L4] Optimal management of osteoporotic proximal humeral fractures has evolved to include the use of locking plates and augmentation with intramedullary fibular grafts, calcium phosphate or sulfate cement, and iliac crest bone graft. [43] (10.1016/j.jse.2012.04.003)
  • [L1] This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. [44] (10.1007/s00402-019-03253-0)
  • [L1] This meta-analysis demonstrates no significant differences in clinical outcomes or complication rates between standard components and fracture-specific components in RSA, suggesting comparable performance in the treatment of proximal humerus fractures. [47] (10.1302/0301-620x.107b9.bjj-2024-1508.r2)
  • [L1] Patients 65 years of age with 3- or 4-part proximal humerus fractures achieve the most benefit in terms of ROM, postoperative functional outcomes, tuberosity union, and overall complication rate when undergoing rTSA with a noncemented stem and early postoperative ROM compared to rTSA with cemented stem and delayed rehabilitation. [48] (10.1016/j.jse.2024.03.040)
  • [L4] Published rehabilitation protocols for proximal humerus fractures vary considerably regardless of management. [49] (10.1177/17585732231182374)
  • [L4] Among the various procedures, VTE was the most frequently reported after SA when compared to ORIF, with RSA having the highest VTE rate. [50] (10.1016/j.xrrt.2023.06.003)
  • [L5] Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries. [52] (10.1530/eor-2026-0043)
  • [L5] This review discusses modern management controversies surrounding adult proximal humerus fractures, 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. [53] (10.1016/j.jhsa.2025.07.009)
  • [L4] All available ORIF techniques require careful analysis of fracture type, fragment displacement, and bone quality, making preoperative CT extremely valuable. [54] (10.1016/j.otsr.2012.12.006)
  • [L5] Revision surgery for failed arthroplasty of proximal humerus fracture is complex with a high likelihood of inferior outcomes compared with primary arthroplasty. [57] (10.5435/jaaos-d-17-00051)
  • [L4] Locked humeral stems provide reliable diaphyseal fixation with a low incidence of screw-related complications in reverse total shoulder arthroplasty for complex proximal humerus fractures. [58] (10.1016/j.xrrt.2025.100625)
  • [L4] Open fractures and 4-part proximal humerus fractures had the highest complication rates. [59] (10.1016/j.jse.2024.07.049)
  • [L1] Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures. [60] (10.1016/j.jse.2020.09.044)
  • [L1] The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. [61] (10.1016/j.jse.2021.11.004)

References

[1] Intramedullary nailing of the proximal humerus: evolution, technique, and results. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.11.016

[2] Effectiveness of intramedullary nailing vs. locked plating (open reduction and internal fixation) in adult displaced proximal humerus fractures: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.016

[3] Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1345-0

[4] Fracture dislocations of the proximal humerus treated with open reduction and internal fixation: a systematic review. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.04.018

[5] Contemporary Management of Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01073

[6] Intramedullary versus locking plate fixation for proximal humerus fractures: indications and technical considerations. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.01.001

[7] Intramedullary Fixation for Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-18-00360

[8] Proximal Humeral Fracture Treatment in Adults. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01293

[9] A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011. DOI: 10.1016/j.injury.2010.11.058

[11] Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: a meta-analysis. Journal of Orthopaedic Surgery and Research. 2014. DOI: 10.1186/1749-799x-9-31

[12] Evaluation and Management of Pediatric Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00033

[13] Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0242-4

[14] Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. International Orthopaedics. 2017. DOI: 10.1007/s00264-017-3683-z

[15] Trending a decade of proximal humerus fracture management in older adults. JSES International. 2022. DOI: 10.1016/j.jseint.2021.08.006

[16] Innovations in the Management of Displaced Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200701000-00003

[17] Outcome measures reported for the management of proximal humeral fractures: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.006

[18] Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03162-2

[19] Proximal humeral fractures in younger patients: fixation techniques and arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.12.006

[20] Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2459-6

[21] New trends in fixation of proximal humeral fractures: A review. Injury. 2011. DOI: 10.1016/j.injury.2010.10.016

[24] Fragility of randomized controlled trials on treatment of proximal humeral fracture. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.01.141

[25] Management of Acute Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-15-00240

[26] Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07502-1

[27] Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.00665

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[38] Long-term outcomes of hemiarthroplasty for complex proximal humerus fractures: a systematic review of clinical studies with minimum 10-year follow-up. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100616

[39] Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-01211

[41] Isolated tuberosity fractures of the proximal humerus: Current concepts. Injury. 2008. DOI: 10.1016/j.injury.2007.09.022

[43] Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.04.003

[44] Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03253-0

[47] Standard compared with fracture-specific components in reverse shoulder arthroplasty for proximal humerus fractures. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b9.bjj-2024-1508.r2

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