Most proximal humerus fractures will heal without surgery, and many recover satisfactory function.
Outcome of nonoperative treatment depends upon the type of fracture, the degree of fragment displacement, and intrinsic fracture stability. Assessment of stability with image intensification is helpful according to the author’s experience.
Without fixation, displaced proximal humerus fractures are rarely improved with closed fracture reduction.
Nonoperative treatment should provide mechanical support until the patient is sufficiently comfortable to begin shoulder use, and the fracture is sufficiently consolidated that displacement is unlikely. The intrinsic stability provided by the periosteum may guide the type of immobilization.
In fractures of the greater tuberosity and/or the surgical neck, the fracture may rest in better reduction if the arm is immobilized in abduction with a cushion.
Once these goals have been achieved, rehabilitative exercises can begin to restore range of motion, followed by strength, and function.
The three phases of nonoperative treatment are thus
Passive/assisted range of motion
Progressive resistance exercises
Duration of Immobilization should be as short as possible, and as long as necessary. Typically, immobilization is recommended for 2-3 weeks, followed by gentle range of motion exercises. Resistance exercises can generally begin at 6 weeks. Isometric exercises may help maintain strength during the first 6 weeks.