Not all proximal humerus fractures require surgery. For a well-defined subset of patients, a conservative approach is supported by evidence — guided by fracture pattern, patient age, and anaesthetic risk.
This protocol applies to three overlapping situations: an undisplaced 2 or 3 fragment proximal humeral fracture in any age group; an undisplaced 2, 3 or 4 fragment fracture specifically in the older age group; or a mild to moderately displaced fracture in a patient for whom the risks of anaesthesia are high.
Management involves a structured period of arm immobilisation followed by the early introduction of passive shoulder mobilisation — the full sequence, specific intervals, and the required radiographic monitoring schedule are detailed in the complete protocol.
The primary clinical target is confirmed absence of proximal humeral fracture fragment displacement on serial radiographs through the first three weeks of treatment.