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Proximal Humeral Fractures

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Textbook of Shoulder Surgery

Abstract

Proximal humeral fractures continue to pose challenges on many fronts. From fracture characterisation to treatment choices and personalised treatment decisions, there is limited guidance from the literature. The PROFHER Trial, being the largest randomised trial to date on these fractures, has provided high quality evidence to justify non-surgical treatment for the majority of low energy injuries. Understandably, this trial has divided opinion and stimulated a debate, with some proponents of surgery criticising the trial as mentioned in this chapter. These criticisms have been about the pragmatic design of the trial, but the difficulties with fracture characterisation and standardisation of interventions explained in this chapter; and the need to avoid clustering of outcomes by surgeon and centre confirm that a pragmatic trial was clearly justified to make the findings more generalisable. The findings of PROFHER therefore cannot be ignored, and whilst we await further evidence on aspects not covered by this trial (e.g., Reverse Shoulder Arthroplasty) to guide clinical practice, it would be useful to provide an overview of some current concepts in assessment and management of proximal humeral fractures. We thank the experienced authors in this field the experienced authors in this field for constructing this chapter, which provides an overview of the authors’ own algorithm for management of proximal humeral fractures.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    C. Spross & B. Jost

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  1. C. Spross
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  1. Wrightington Hospital, Wigan, Lancashire, UK

    Ian A. Trail

  2. Wrightington Hospital, Wigan, Lancashire, UK

    Lennard Funk

  3. Orthopaedic Surgery Department, The James Cook University Hospital, Middlesbrough, North Yorkshire, UK

    Amar Rangan

  4. Trauma & Orthopaedics Department, Countess of Chester Hospital, Chester, Cheshire, UK

    Matthew Nixon

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Spross, C., Jost, B. (2019). Proximal Humeral Fractures. In: Trail, I., Funk, L., Rangan, A., Nixon, M. (eds) Textbook of Shoulder Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-70099-1_5

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