Proximal humeral fractures-what is new?

The proximal humeral fracture (PHF) is the third most common fracture in older patients, and therefore new literature on it is dynamic and published on a regular basis. Especially the PROFHER study, which described similar outcomes between invasive and conservative treatments in PHF, was subject to controversial public discussion. The weak study design and its resulting low statistical power make it comparable to previous studies. Mentionable innovations of the past 2 years are polyaxial screw systems, cement augmentation through cannulated screws, carbon fibre reinforced PEEK, double-plate osteosynthesis in 4-part fractures, arthroscopy-assisted treatment of greater tuberosity fractures and arthroscopy-assisted arthrolysis and metal removal. "Fragility fractures of the elderly" tend to be treated with a total shoulder arthroplasty in case conservative treatment approaches fail. This is congruent with recent literature, which indicates a better outcome after primary implantation of an endoprosthesis. Reverse total shoulder arthroplasty is currently the most promising therapy. The increasing uses of tuberosity-refixation, as well as new refixation-enabled prosthesis models are innovative designs. However, the means of treatment remain to be an individual decision in which the patient, the type of fracture and the experience of the surgeon need to be taken into consideration.