Clinicians who advocate nonoperative treatment for displaced PHF accept that they are relying on the patients’ tolerance of malunion at the completion of healing. For any displaced fracture treated nonoperatively, the outcome will be defined by the original displacement: the patient will inevitably heal with a malunion, and the functional value of the shoulder will reflect this. Management of PHF, as for all fractures, combines an assessment of the mechanical and biological factors affecting fracture healing with a judgement about the likely prognosis for healing and function based on a multiplicity of intrinsic (shoulder) and extrinsic (comorbid) factors. The functional outcome of a proximal humeral fracture (PHF) is never that of a completely normal shoulder, however treated.
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