AIMS A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals to evaluate the clinical effectiveness and cost effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults. METHODS A cost utility analysis from the NHS perspective wa...

Limited evidence is available on the optimal treatment of complex fractures of the proximal humerus. No randomized prospective studies have compared hemiarthroplasty, open reduction internal fixation and/or conservative treatment. Two systematic reviews are available but they do not include angle-stable plate osteosynthesis or third-generation prosthetic designs. We conducted a systematic revie...

BACKGROUND Several studies have reported that diabetic persons have an increased risk for fractures than non-diabetes patients. The association between proximal humerus fractures and type 2 diabetes (T2DM) is unclear and some studies point to insulin treatment, hypoglycaemic episodes consequently to inadequate control of diabetes or, more recently, to an alteration of trabecular bone. We examin...

Proximal humerus fractures are the third most common fracture type in individuals older than 65 years, after distal radius and proximal femur fractures [8]. In 1970, Charles Neer described his four-segment classification system [18]. He believed the existing classifications were inadequate for research purposes, as they did not differentiate between injuries of varied severity nor did they grou...

P roximal humerus fractures are common, and about 80% are well managed nonsurgically. The remaining 20% present a therapeutic challenge because surgical stabilization is necessary to ensure healing and to optimize function. The priorities in surgical stabilization of proximal humerus fractures are (1) restoring the anatomic relationship between the tuberosities and the articular head fragment a...

Orthopaedic surgeons frequently have to deal with osteoporotic fractures of the distal radius, hip and proximal humerus. Low bone mineral density is not only associated with an increased fracture risk but also with more fracture displacement and reduction loss. The specific problems and main treatment options for these fragility fractures are reviewed.

A single antegrade Rush nail was used to treat 37 fractures of the distal humerus extending to the olecranon fossa and up to 6.5 cm proximal to it. In order to stabilise the fracture, the bent tip of the Rush nail was directed into the lateral epicondylar ridge. This gave immediate stability. All the fractures united without residual stiffness of the shoulder or elbow.