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Objectives: Proximal humeral fractures are common fractures in elderly patients. In some cases, operative treatment is difficult in elderly patients because of severe osteoporosis. An external rotation shoulder brace can maintain the arm in neutral rotation for conservative treatment, which has prompted its use for treatment of proximal humeral fractures in patients aged ≥65 years. We sought to confirm the efficacy of the neutral rotation position. Methods: Eleven patients with a proximal humeral fracture were clinically and radiographically reviewed. Their mean age was 75 years, and the fracture type was classified according to the Neer group classification system. The duration of brace use prior to achieving bone union and the observation period were analyzed. The shoulder range of motion (ROM) was examined during the final follow-up. Results: Displacement was not observed during the course of treatment. The patients stopped using the brace at 40 days, bone union was confirmed at 46 days, and the mean follow up period was 4 months. The mean active shoulder ROM for elevation, abduction, external rotation, and internal rotation was 148°, 146°, 50°, and L3, respectively. Conclusion: We obtained good results during treatment of proximal humeral fractures by maintaining neutral rotation of the arm in elderly patients. Neutral rotation of the arm facilitated by use of an external rotation shoulder brace is an appropriate treatment for proximal humeral fractures in the elderly.

Objectives: Trochanteric fractures with a detached greater trochanter are often encountered during routine medical examinations. We analyzed cases of stable reconstruction following surgery for these fractures. Methods: Forty-two patients who sustained a trochanteric fracture with a detached greater trochanter from 2015 to 2016 were clinically and radiographically reviewed. Fracture fixation was performed with 135° free-sliding plates. On postoperative day 14, the patients were classified into two groups based on their computed tomography findings: those in whom a lag screw could be inserted in the anterolateral part that continues to the diaphysis and those in whom the screw could not be inserted in this position. Outcome measures included the quality of reduction (postoperative neck–shaft angle on the lateral view, postoperative ratio of subtype A or subtype N according to Ikuta's classification), postoperative placement of the tip of the lag screw in the femoral head on the lateral view, and sliding distance of the lag screw on postoperative day 14. Results: The mean neck–shaft angle on the lateral view and the mean sliding distance of the lag screw were significantly shorter in the group in which the lag screw could be inserted in the anterolateral part that continues to the diaphysis. Conclusions: For trochanteric fractures with a detached greater trochanter, insertion of the lag screw in the anterolateral part that continues to the diaphysis is important and can achieve stable reconstruction. Moreover, caution should be employed with respect to the neck–shaft angle on the lateral view.