Court-Brown and McQueen identified risk factors for nonunion of a fracture involving the proximal humerus. These can help identify a patient who may benefit from more aggressive management. The authors are from the Royal Infirmary of Edinburgh in Scotland.


Patient selection: fracture of the proximal humerus with nonoperative management


Risk factors for nonunion:

(1) older age

(2) metaphyseal comminution

(3) fracture displacement


Nonunion of a fracture of the proximal humerus results in:

(1) loss of overall glenohumeral function

(2) slow return to routine activities of daily living


If surgery is required to repair fracture nonunion:

(1) it should be performed as soon as possible once nonunion has been diagnosed

(2) it should not be delayed beyond 6 months after the fracture


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