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Abstract
A proximal humeral fracture is an osteoporotic fracture that often occurs in elderly women. Approximately 80% of all proximal humeral fractures are non-displaced fractures, which can be treated with conservative treatment to achieve stable union. The treatment plan for fractures involving displaced and comminuted fractures is controversial. Malunion, avascular necrosis of the humeral head, and shoulder stiffness due to conservative treatment can occur but the functional deterioration is low and the patient satisfaction is high. The indications for the conservative management of proximal humeral fractures include a non-displaced fracture and a 2-part fracture, low-functional demanded 3-part fracture, and operative-limited 4-part fracture. Recently, the surgical indications have expanded as technological advances in surgical fixation methods and functional needs of elderly patients are increasing. Current treatment policy decisions tend to be determined by the personal preference and expert opinion rather than by evidence-based decision-making.
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Fig. 1.
A 68-year-old woman with a displaced 2-part fracture of the proximal humerus on the right shoulder. After informed consent from the patient, we used a picture of the patient. (A) Initial simple radiograph. (B) Coronal cut of the initial computed tomography (CT) image. (C) Axial cut of the initial CT image. (D) Follow-up at 3 months. The range of motion of the shoulder measured after 3 months of conservative treatment. (E) Forward flexion. (F) External rotation. (G) Internal rotation.
Fig. 2.
A 54-year-old man with a 2-part fracture of the proximal humerus on the left shoulder. After informed consent from the patient, we used a picture of the patient. (A) Initial simple radiograph. (B) Three-dimensional reconstruction of initial computed tomography image. (C) Partial union at 15 months after conservative treatment. The range of motion of the shoulder was measured after 15 months of conservative treatment. (D) Forward flexion. (E) External rotation. (F) Internal rotation.
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