Management of Non-Displaced Proximal Humerus Fractures
Non-displaced or minimally displaced proximal humerus fractures should be managed conservatively with immobilization in a sling or orthosis for approximately 3 weeks, followed by early rehabilitation, as this approach leads to good outcomes in 80-90% of patients 1.
Initial Diagnostic Approach
Start with standard shoulder radiographs including three views: anterior-posterior (AP) in internal and external rotation, plus an axillary or scapula-Y view 2. These radiographs are sufficient to confirm the non-displaced nature of the fracture and guide treatment decisions 2.
Consider CT without IV contrast if radiographs are indeterminate or you suspect subtle displacement, as CT can change clinical management in up to 41% of proximal humeral fractures by better characterizing fracture morphology 2.
Conservative Treatment Protocol
For confirmed non-displaced fractures:
- Immobilize in a sling or shoulder orthosis for 3 weeks 3
- Begin early range-of-motion exercises after the initial immobilization period
- This approach avoids the complications of surgery while achieving satisfactory functional outcomes in the vast majority of cases 1
When to Reconsider Surgical Management
You must consider surgery instead of conservative treatment if any of these features are present 1:
- Severe compromise of the humeral head (fracture-dislocation, severe impaction, or head split)
- Gross instability between humeral shaft and head in non-impacted fractures
- Tuberosity displacement that will lead to symptomatic malunion
Critical Pitfall to Avoid
The main risk with conservative management is missing occult displacement or instability that becomes apparent only after initial treatment. If the patient has significant functional demands or is active, obtain follow-up radiographs at 1-2 weeks to ensure the fracture remains non-displaced during the early healing phase. Any secondary displacement warrants reassessment for surgical intervention 1.
Expected Outcomes
With appropriate conservative management of truly non-displaced fractures, expect:
- 80-90% good functional outcomes 1
- Some degree of malunion is well-tolerated, especially in elderly patients 4
- Faster return to activities compared to surgical intervention
- Lower complication rates than operative management
The key is accurate initial assessment: if there is any doubt about displacement, stability, or fracture complexity on plain radiographs, obtain CT imaging before committing to conservative treatment 2.