Proximal Humerus Fracture — Does the Type of Immobilisation Matter?

In non-operative treatment of proximal humerus fractures, considerable attention is often paid to how restrictive the immobilisation should be. A randomized trial suggests that choosing between a Velpeau-type bandage, a standard shoulder-arm sling and a sling with additional support does not lead to meaningful differences in functional or radiographic outcomes.

Polish version: Złamanie bliższego końca kości ramiennej — czy rodzaj unieruchomienia ma znaczenie?

Why is this study clinically relevant?

Immobilisation is almost routine when a proximal humerus fracture is selected for conservative management, but the exact device used is often influenced more by local practice than by strong comparative evidence. The practical question is therefore not only whether to immobilise the shoulder, but whether a more elaborate brace produces a real patient benefit.

The study was published online on 21 August 2026 in the Journal of Shoulder and Elbow Surgery.

Study question and methodology

This prospective randomized study included patients with proximal humerus fractures treated non-operatively. Three immobilisation methods were compared:

• a Velpeau-type bandage,
• a standard shoulder-arm sling/brace,
• a shoulder-arm sling with additional support.

The clinical outcome analysis included 34, 39 and 32 patients in the respective groups, for a total of 105. Mean age was 60.6 years and 63.8% of participants were women. Baseline characteristics, including fracture severity according to the Neer classification, were comparable between groups.

Outcomes included pain, range of motion and several measures of shoulder and upper-limb function: SSV, ASES, DASH and Constant score.

Key results

No statistically significant differences were found between the three groups in pain, range of motion or functional scores. Radiographic outcomes likewise did not show an advantage for one immobilisation method over the others.

The authors reported nonunion in 5 of 120 patients (4.1%). Malunion was reported in 22 of 105 patients (21%), with comparable rates across the study groups.

Clinical interpretation for an orthopaedic surgeon

The most practical conclusion is straightforward: once a fracture has appropriately been selected for non-operative management, a more elaborate immobilisation device does not necessarily produce a better result. Choice of device may therefore reasonably take greater account of patient comfort, the ability to use the brace correctly and cost.

This may be particularly relevant in older patients, for whom complex immobilisation devices can be harder to apply, interfere with hygiene and reduce treatment tolerance.

Limitations

The findings need to be interpreted within the population studied. They do not mean that every proximal humerus fracture can be treated with any sling, or that immobilisation method is irrelevant when fracture alignment is unstable, surgery is indicated, or adherence to treatment presents particular problems.

Importantly, the absence of a statistically significant difference is not the same as formally proving equivalence between all three methods. The publicly available abstract does not indicate that the study was designed as an equivalence or non-inferiority trial.

There is also a numerical inconsistency in the abstract: the nonunion denominator is 120 patients, whereas the analysis of the other reported outcomes includes 105. This limits full interpretation without access to the detailed data in the complete article.

What might change in practice — and what does the study not prove?

The trial supports moving away from the assumption that a more restrictive or more expensive immobilisation device inherently improves the outcome of conservative treatment. When fracture stability and the patient’s condition allow, a simple, well-tolerated device that can be used correctly may be a reasonable choice.

The study does not answer which proximal humerus fractures should be treated non-operatively, when exercises should begin, or whether earlier mobilisation is better than longer immobilisation. Those are separate clinical decisions.

Reference

1. Sarıkas M, Kapıcıoğlu M, Şahin K, Bilsel K. Does Immobilization Method Make a Difference in Conservative Management of Proximal Humeral Fractures? A Prospective Randomized Trial. Journal of Shoulder and Elbow Surgery. 2026 Aug 21. DOI: 10.1016/j.jse.2026.08.004. PubMed PMID: 42628626.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.