Treatment of Proximal Humerus Fracture in Older Patients or with High Anaesthesia Risk

The management of proximal humeral fractures depends on fracture fragment number, displacement, and patient factors — particularly age and operative risk. This protocol addresses three specific presentations where these factors shape the clinical decision.

Clinical Scenario

An undisplaced 2 or 3 fragment proximal humeral fracture in any age group
An undisplaced 2, 3, or 4 fragment proximal humeral fracture in the older age group
A mild to moderately displaced fracture where anaesthesia risk is high

Treatment Approach

Surgical stabilisation is indicated in selected cases — one approach involves a minimally invasive pinning technique to secure displaced fragments. The complete selection criteria, indications, and technique guidance are available in the full protocol.

Full regimen, decision algorithm, and fixation details available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jcot.2019.04.016

An undisplaced 2 or 3 fragment fracture, in any age group.
An undisplaced 2, 3 or 4 fragment fracture, in the older age group.
A mild to moderately displaced fracture, where the anesthesia risks are high.
A significant change of fragments position with conservative treatment, on serial radiographs.
A minimum of two Kirschner wires (K wires) must be placed to stabilize each displaced fragment.
Fractures of neck needing an ORIF are best fixed with locking plates and screws.

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