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Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

The ultimate goal of management of proximal humeral fractures in the elderly patient is to get the patient independently mobile. This article will review the current literature regarding this cohort of patient. Recent Cochrane reviews and a large multicentre randomised study question the role of surgical intervention. Implant design is evolving rapidly, and many elderly patients now behave more like the younger patient. There remains little compelling evidence to guide decision-making for the complex proximal humeral fracture in the elderly, and the decision needs to be made on a case-by-case basis taking into account the patient’s comorbidities, the fracture pattern and characteristics, the attending surgeon’s skill sets, and the availability of equipment.
Level of evidence: Level 5