(i) Fractures of the proximal humerus: general considerations and nonoperative management

Fractures of the proximal humerus are common, accounting for 6% of all fractures, and tend to affect elderly patients after a fall from standing height. Patterns of fracture are predictable from the anatomy of the proximal humerus, the insertions of the rotator cuff on the tuberosities causing displacements of these segments and impacting on functional outcome. Fractures also impair blood supply to the head segment, particularly if the anatomical neck is involved and especially if the head is dislocated. Overall, nonoperative management gives results that are sufficiently good that it is exceptionally difficult to set up a trial that has sufficient power to prove any method of treatment better than rehabilitation alone.