| Abstract [eng] |
Proximal humerus fractures are among the most common fragility fractures in elderly patients and represent a growing clinical challenge due to increasing life expectancy, reduced bone quality, and frequent comorbidities. Although there have been great advancements in surgical technique, it remains controversial which treatment approach is most appropriate. The evidence concerning functional outcomes, complication rates, and the relative benefits of operative compared to non- operative treatment strategies is inconsistent. The aim of this literature review was to compare and evaluate conservative and surgical treatment options for proximal humerus fractures in elderly patients by analysing clinical evidence published between 2010 and 2025. Using major medical databases, a structured literature search was carried out that included PubMed, Embase, and Google Scholar. Randomized controlled trials, systematic reviews, meta-analyses, and large cohort studies focusing on patients aged 60 years and older were incorporated. Particularly important outcomes which have been used to evaluate treatment success included functional recovery, complications, reintervention rates, and patient-centred measures such as pain control and independence. The objectives included summarising the epidemiology and classification of PHFs, comparing conservative and surgical treatment modalities, evaluating outcomes and complications, and identifying crucial factors for clinical decision-making. The findings indicated that conservative management provides acceptable functional outcomes for a significant proportion of elderly patients, especially in cases with minimally displaced or stable fracture patterns. The same applies for patients with low functional demands. Surgical management should be guided by fracture complexity, bone quality, and rehabilitation potential since it is very context-dependent. One of the key findings from this review is the importance of tailoring surgical interventions according to individual patient characteristics. Since every intervention has benefits and risks it is important to evaluate all details. Head-preserving fixation techniques are associated with high complication and revision rates, especially in osteoporotic bone. Despite the long recovery period reverse shoulder arthroplasty offers more predictable functional outcomes in patients with complex or unstable fractures. Since there is no single treatment modality demonstrating universal superiority, it remains one of the main tasks for clinicians to choose the treatment approach most beneficial for every individual. Overall, the evidence supports a shift from fracture-centred treatment algorithms towards biologically informed decision-making. Optimal management of proximal humerus fractures in elderly patients requires individualized strategies that balance mechanical feasibility, physiological reserve, functional goals, and postoperative care capacity to achieve meaningful clinical outcomes. |
