Proximal humeral fracture. A commentary on systematic reviews of surgical versus non-surgical management in older adults

Abstract

Background
Proximal humeral fractures (PHFs) are common fractures in older adults and their prevalence is on the rise. Recovery following this fracture can be complex and disabling. Treatment varies from non-surgical management such as immobilisation to surgical procedures, with choice dependent on type and severity of fracture and patient health.

Objective
Several systematic reviews have considered the evidence for non-surgical versus surgical management of PHF in older adults. This commentary considers these findings for clinical practice and further research.

Methods
Three systematic reviews exploring non-surgical versus surgical management were selected based on the quality of their included evidence, and individually critically appraised. Findings from the reviews were reported for each outcome, and the implications considered for clinical practice and future research.

Results
Findings from the three reviews suggest that surgical management of PHF in older adults does not result in better functional outcomes or quality of life and non-surgical management should achieve acceptable upper limb function while decreasing the risks of surgery. More complex three-part fractures may also be managed non-surgically with fair to good functional results relative to fracture severity.

Conclusion
The findings align with current guidance to offer non-surgical management to uncomplicated cases of PHF in adults and older adults. More complex three-part PHFs may also be managed well non-surgically. There is however a lack of evidence and guidance on the specifics of rehabilitation for this type of management and further research is needed to evaluate the factors that contribute to the effectiveness of non-surgical interventions.