Few studies have compared different types of shoulder immobilizers. The method of shoulder immobilization in PHFs may influence fracture healing and ultimately shoulder function. Furthermore, we offer a comprehensive review of non-operative protocols used in the literature, and propose a standardized protocol for non-operative treatment of these injuries. In this article, we introduce the concept of immobilization of PHFs in neutral rotation. The potential exists for malreduction of the PHF from remaining in this position. When assessing the type of immobilization used, most commonly it is a routine sling with the arm resting in an internally rotated position. The duration, frequency, and type of physical therapy also varies significantly in the literature. A wide range of timeframes for immobilization exist. Furthermore, two recent Cochrane systematic review showed no evidence of improved functional or quality of life scores in operatively treated displaced PHFs ( 8, 9).Ī uniform protocol for suggested non-operative treatment of PHFs does not currently exist. The study found no difference in function outcomes, quality of life scores, complication rates, or mortality at two and five years post-injury ( 6, 7). The Proximal Fracture of the Humerus Evaluation by Randomization (PROFHER) study was a multi-center randomized study conducted in the United Kingdom comparing surgical and non-surgical treatment in 250 patients with displaced surgical neck fractures of the proximal humerus. Although the rate at which PHFs are being treated with surgery has not changed, there has been recent literature supporting non-operative treatment in displaced PHFs. Surgery has traditionally been reserved for displaced two, three, and four-part PHFs based on the classic Neer criteria ( 5). Shoulder replacement procedures are another surgical option, with recent emphasis on reverse shoulder arthroplasty (RSA), which has largely replaced hemiarthroplasty (HA) ( 4). In that same timeframe, open reduction and internal fixation (ORIF) was the most common type of surgery for PHFs. The proportion of PHF being treated conservatively has remained relatively unchanged in the past decade. While extremely common, up to 84% of PHFs are treated conservatively without surgery ( 3). These fractures are more common in females (84%) and elderly patients with an average age of 71 years ( 2). PHFs most commonly occur from a low energy mechanism such as a fall from standing height. It is the third most common fracture diagnosed in elderly patients after hip and distal forearm fractures ( 1). Proximal humerus fractures (PHFs) are a common source of morbidity in patients, especially in the elderly population. Received: 11 December 2019 Accepted: Published: 15 April 2021. Keywords: Proximal humerus fracture (PHF) sling neutral rotation non-operative Furthermore, this article reviews immobilization and physical therapy treatments in order to suggest a standardized, evidence-based protocol for non-operative management of PHFs. Justification for immobilization in a neutral rotation sling for non-operative treatment of PHFs is proposed in this review. Placing patients in a neutral rotation shoulder immobilizer better maintains alignment in PHFs, thus reducing the risk of potential malunion. Additionally, greater tuberosity fractures may heal with more posterior displacement in reference to the humeral head when the arm is immobilized in internal rotation. Surgical neck fractures may heal in a position with the humeral shaft relatively internally rotated in reference to the humeral head. Non-operatively treated PHFs are frequently treated in a commercially available sling that holds the humeral shaft in a relatively internally rotated position in relation to the humeral head, potentially displacing the fracture. A review of the literature demonstrates a wide range of immobilization devices, immobilization time, and physical therapy protocols. However, a uniformly agreed upon protocol for non-operative treatment of PHFs does not currently exist. Non-operative management has shown adequate results in the majority of PHF with appropriate patient selection. Policy of Dealing with Allegations of Research MisconductĪbstract: Proximal humerus fractures (PHFs) are common injuries and are most frequently treated non-operatively.Policy of Screening for Plagiarism Process.
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