Proximal humerus fractures (PHFs) most commonly affect elderly, osteoporotic women, although younger patients sustain them through high-energy trauma. Both incidence and the associated healthcare burden continue to rise with demographic ageing. Non-operative management is preferred for undisplaced fractures and for many elderly patients, whereas a range of internal fixation methods and arthroplasty options are available for more complex injuries. Patient age, comorbidities, functional demands and fracture pattern are the primary determinants of treatment selection, implant choice and expected outcome. Absolute indications for surgery include acute fracture-dislocations, open fractures and injuries with vascular or neurological compromise. Relative indications are based on the degree of displacement and the predicted failure of non-operative treatment, and include head-splitting fractures, severe varus, valgus or posterior tilt of the humeral head, anatomical neck fractures, calcar comminution, complete displacement of the humeral head from the shaft, significant displacement of the lesser or greater tuberosity, displaced three- and four-part fractures, and large impaction defects of the humeral head, particularly when associated with instability. It is important to recognise that the displacement thresholds in routine use are pragmatic and consensus-derived rather than validated, and that expert panels do not agree on a maximum acceptable deviation. Surgery is technically demanding, requiring anatomical reduction, calcar restoration, avoidance of varus, secure fixation of the tuberosities and correct patient and implant selection. Locked plating has been the most common operation, but is associated with high complication rates and has failed to show superiority over non-operative treatment in several large randomised controlled trials. Augmentation of fixation and intramedullary nailing may address calcar comminution, metaphyseal voids and varus collapse. Arthroplasty is increasingly used in elderly patients, with reverse shoulder arthroplasty now dominating over hemiarthroplasty. Results appear better than hemiarthroplasty and plate fixation in the single trial that has compared them directly, but the evidence remains limited. To support this narrative review a systematic search was undertaken to identify every randomised controlled trial of PHF management. This review synthesises and compares current evidence on the management options for PHFs and provides practical guidance on contemporary surgical strategies.

Supracondylar humerus fractures (SHFs) are commonly treated with closed reduction and percutaneous pinning (CRPP); however, open reduction is required in selected cases. To compare early functional and operative outcomes of anterior, lateral, and posterior open reduction techniques, using CRPP as a reference standard. This retrospective study included 60 pediatric patients with Gartland type III SHFs (CRPP, n = 15; anterior, n = 15; lateral, n = 15; posterior, n = 15). Outcomes included operative time, fluoroscopy use, union time, joint range of motion, Flynn functional and cosmetic scores, and complication rates. Compared with open techniques, CRPP demonstrated shorter operative time (30.5 ± 5.4 vs. 55.4 ± 7.2 min, P < 0.001), earlier union (28.6 ± 2.7 vs. 39.0 ± 5.9 days, P < 0.001), and superior cosmetic outcomes (P < 0.001). Flexion limitation was greater in the open surgery group (P = 0.030), while extension limitation was similar between groups (P = 0.068). Functional Flynn scores did not differ significantly (P = 0.151). Complication rates were low and comparable (P = 1.000). Among open approaches, the posterior technique was associated with longer operative time, delayed union, greater motion limitation, and poorer functional and cosmetic outcomes (P < 0.05 for all). Among open approaches, the anterior technique demonstrated more favorable early outcomes; however, these findings should be interpreted in the context of potential differences in fracture complexity between groups. CRPP remains the standard treatment and provides superior perioperative and cosmetic outcomes.

Cubitus varus is the most common long-term complication following supracondylar humeral fractures. Although traditional step-cut osteotomy yields reliable clinical outcomes, the intraoperative osteotomy direction and angle remain largely dependent on the surgeon's experience, resulting in suboptimal precision. Although digital three-dimensional (3D) planning and 3D-printed patient-specific guides have been shown to improve osteotomy accuracy, their application in adolescent patients with long-standing cubitus varus deformity has rarely been reported. We report an 18-year-old male patient who developed progressive cubitus varus deformity 13 years after conservative treatment of a right supracondylar humeral fracture. Preoperatively, the carrying angle was -19°, with mildly restricted elbow motion and no ulnar nerve symptoms. Using mirror-image-based 3D digital planning, we designed and 3D-printed a patient-specific step-cut osteotomy guide and performed corrective osteotomy with lateral locking plate fixation. Intraoperatively, the guide was stably apposed to the bone surface, enabling precise execution of the osteotomy without displacement or interference. At 12-month follow-up, both the carrying angle and humeral-elbow-wrist angle had improved from -19° to 6.5°, elbow flexion-extension range improved from 5°-120° to 0°-135°, and the Mayo Elbow Performance Score was 95. No complications such as nonunion or nerve injury occurred, and the patient was satisfied with the surgical outcome. The combination of digital 3D planning and 3D-printed guide-assisted step-cut osteotomy may significantly enhance osteotomy accuracy and surgical safety, offering an effective approach for treating long-standing cubitus varus in adolescents. Nevertheless, given that this is a single-case report, broader studies are warranted to confirm its advantages.

Introduction and aim The distal end of the humerus consists of the trochlea and capitulum, which articulate with the ulna and radius to form the elbow joint. Fractures of the distal humerus are common and often require surgical fixation, while inflammatory arthropathies may necessitate elbow arthroplasty. Morphometric measurements of the humerus are useful in forensic anthropology for estimating humeral length and stature. Detailed knowledge of distal humeral morphology is also crucial for implant design and population-specific anatomical reference standards. This study aimed to determine the correlation between the total length of the humerus and its distal segmental dimensions, while emphasizing the morphometric significance of these segments in applied anatomy. To achieve this, the maximum length of the humerus, the epicondylar breadth, and maximum breadth of the articular surfaces at the distal end were measured and correlated with the total bone length. Materials and methods This study was conducted on 90 dry adult humeri (49 right and 41 left) with intact distal morphology obtained from the department of anatomy. Total humeral length was measured using an osteometric board. The maximum breadth of the distal end, as well as the individual widths of the capitulum and trochlea, were measured using a digital Vernier caliper. Descriptive tests, such as mean and standard deviation, along with inferential statistics, such as linear regression and the unpaired t-test, were used to derive the findings. Descriptive statistics and linear regression analysis were employed to evaluate the relationship between distal humeral dimensions and total humeral length. Results The mean maximum length of the right and left humeri was 273.23±43.57 mm and 262.95±46.49 mm, respectively. Linear regression analysis demonstrated a moderately positive relationship between total humeral length and all measured distal humeral segments. Regression equations were derived separately for right and left humeri, indicating that distal segment dimensions can reliably be used to estimate total humeral length. Conclusion Distal humeral measurements show a positive correlation with total humeral length and may aid in the estimation of stature when only fragmentary skeletal remains are available. These morphometric data may also contribute to the selection and design of prostheses for elbow replacement surgeries and provide population-specific anatomical reference values.