The proximal humeral fracture accounts for 4% to 5% of all the types of body fracture, and its incidence was only second to hip fracture and distal radius fracture. With the aging of population, the incidence of proximal humeral fracture shows an increasing tendency. Currently, the treatments of proximal humeral fracture mainly include plate fixation, intramedullary nailing and shoulder arthroplasty. The proximal humerus fractures of Neer type 2 and type 3 are generally treated with locking plate or intramedullary nail. In the Neer type 4 fracture where the humeral head is split or the articular surface collapses over 50%, the humeral head blood supply is destroyed especially in patients with severe osteoporosis. Thus, shoulder arthroplasty shoulder be considered. The surgical treatment of proximal humeral fracture is widely recognized. This study analyzed 3 internal fixation methods for the treatment of proximal humeral fracture: (1) plate screw system; (2) proximal humeral nail; (3) shoulder arthroplasty. Through bibliometric analysis of the published literatures of the SCI database from 2008 to 2017, the research hotspots and article directions of proximal humerus fracture are presented as well as the development tendency of surgical treatment, which provide the directional guidance for clinical practice and academic research of domestic scholars.

1. General information: (1) Database: The officially published literatures in the Web of Science database by the Institute for Scientific Information (ISI) . (2) Time range: January 2008 to December 2017. (3) Subject term: proximal humeral fracture, proximal humerus fracture or humeral neck fracture; plate fixation, PHILOS or locking plate or LPHP; intramedullary nail or PHN; shoulder arthroplasty or shoulder replacement or humeral head prosthesis or humeral head replacement.2. Methods: (1) Selection criteria: (a) Inclusive criteria: Original article; meeting abstract; review; correspondence; proceeding paper; editorial material; research note; corrigenda. (b) Exclusive criteria: Literature that was not related to this study or not yet published. (2) Analysis indicators: The literature results retrieved from the Web of Science database were exported and analyzed, and the analysis indexes included the number of published literatures, the number of references cited, the source journals, the national and regional distributions, the popular research institutions and the popular authors.

1. Keywords for the search of literature in the Web of Science database from 2008 to 2017: A total of 1900 literatures were retrieved from the SCI database using different keywords, and the total cited time was 20135. Among them, 724 literatures were related to the treatment of proximal humerus fracture with plate fixation; 165 literatures were related to the treatment with proximal humerus nail; 473 literatures were related to the treatment with shoulder arthroplasty. 2. Analysis of literature publication year: The number proximal humeral fractures retrieved from SCI database increased year by year from 2008 to 2017. Since 2009, the number of published literatures had increased dramatically. Since 2014, the overall development was steady. 3. National and regional distribution of published literatures: According to the rank of national and regional distributions of published literatures on proximal humerus fracture retrieved from the SCI database, the United States had the most published literatures with the number of 534, which accounted for 28.105%. China had a total of 113 literatures, accounting for 5.947% and ranking 4th. From 2010, the literatures published by Chinese scholar showed an increasing tendency year by year, but there was still a certain gap with those by American scholar. 4. Analysis of source journals: Among the top 10 journals that included the most literatures of proximal humeral fracture in the SCI database from 2008 to 2017, Journal of Shoulder and Elbow Surgery, the best journal in this field, had the largest publication number of 247, which accounted for 13%. Injury (131 literatures) and Journal of Orthopaedic Trauma (113 literatures) were ranked behind. 5. Popular authors: Voigt C, a scholar from the Department of Orthopedics and Traumatology of Freiburg University, Germany, published the largest number of literature (25) and ranked 1st in the list. Lil H (23 literatures) from the Department of Orthopaedics of Friederikenstift Hospital, Hannover Germany, and Ring D (22 articles) from the Department of Orthopaedics of Massachusetts General Hospital, Medical School of Harvard University ranked behind. 6. Popular research institutions: The top 3 US research institutions with the most published literatures of proximal humeral fracture in the SCI database from 2008 to 2017 were Mayo Medical Center (43 literatures) , Hospital for Special Surgery (28 literatures) and Massachusetts General Hospital (27 literatures) . The number of published literatures in Shanghai Jiao Tong University was 20 and ranked 8th. 7. Highly cited literatures of proximal humerus fractures: From 2008 to 2017, 14 literatures of proximal humeral fracture included in the SCI database were cited over 100 times respectively. 8. Development tendency of the 3 methods for the surgical treatment of proximal humeral fracture:The treatment of proximal humeral fracture with plate internal fixation was favored by orthopedic surgeons and was widely used, which accounted for most of the related literatures. From 2012, shoulder arthroplasty had been gradually accepted, and the number of published literatures had increased year by year. However, the number of literatures on intramedullary nailing for proximal humeral fracture developed steadily.

Through bibliometric analysis, it is possible to find popular national region, journal, high-reference literature and research institution in the field of proximal humerus fracture research and to provide the tendency in the application of plate fixation, intramedullary nailing and shoulder arthroplasty, which provide the directional guidance for clinical practice and academic research of domestic scholars.