Concept of neutral rotation sling for non-operative treatment of proximal humerus fractures

Abstract

Proximal humerus fractures (PHFs) are common injuries and are most frequently treated nonoperatively. Non-operative management has shown adequate results in the majority of PHF with appropriate patient selection. However, a uniformly agreed upon protocol for non-operative treatment of PHFs does not currently exist. A review of the literature demonstrates a wide range of immobilization devices, immobilization time, and physical therapy protocols. Non-operatively treated PHFs are frequently treated in a commercially available sling that holds the humeral shaft in a relatively internally rotated position in relation to the humeral head, potentially displacing the fracture. Surgical neck fractures may heal in a position with the humeral shaft relatively internally rotated in reference to the humeral head. Additionally, greater tuberosity fractures may heal with more posterior displacement in reference to the humeral head when the arm is immobilized in internal rotation. Placing patients in a neutral rotation shoulder immobilizer better maintains alignment in PHFs, thus reducing the risk of potential malunion. Justification for immobilization in a neutral rotation sling for non-operative treatment of PHFs is proposed in this review. Furthermore, this article reviews immobilization and physical therapy treatments in order to suggest a standardized, evidence-based protocol for non-operative management of PHFs.