Severe proximal humeral fracture often occurs in the high energy trauma, many of which are accompanied with osteoporosis. The humeral head often has serious displacement and less bone mass, which is difficult to fix. It is also often accompanied with rotator cuff injury, resulting in different degrees of postoperative shoulder joint dysfunction. The concept of fast track surgery (FTS) is of great significance to the postoperative curative effect and functional reconstruction of proximal humeral fracture.

To retrospectively analyze and study the significance of fast track surgery in the treatment of severe proximal humeral fractures.

From January 2017 to January 2020, 37 cases of proximal humeral fractures classified by Neer part-3 or 4 fractures were treated with FTS. Among them, 29 cases were treated with open reduction and internal fixation (internal fixation group) , and 8 cases were treated with artificial humeral head replacement (arthroplasty group) . The operation time, intraoperative hemorrhage, operation difficulty, bone healing and shoulder joint function were compared and analyzed. The therapeutic effect of operation was evaluated and the experience of operation and FTS was summarized.

There was no significant difference in the mean operation time, mean bleeding volume, mean hospitalization time and mean tube placement time between the internal fixation group and the joint replacement group. The concept of FTS runs through the whole treatment process, such as preoperative condition evaluation, intraoperative detail treatment, and postoperative functional exercise. In the internal fixation group, 27 cases achieved bone union at 3 months after operation, 1 case underwent revision operation due to the second fracture at 2 months after operation, 1 case had delayed fracture union, and achieved bone union at 5 months after the limb suspension. In the arthroplasty group, 8 patients achieved postoperative bone union within 3 to 4 months without acromial fracture or scapular fracture. There was no significant difference in VAS score of postoperative pain between the two groups. The shoulder function score in the internal fixation group was significantly better than that in the arthroplasty group at 3 months, 6 months and 1 year after operation (P<0.05) .

For severe proximal humeral fracture, the operation plan should be selected according to different fracture types. The concept of FTS should be valued throughout the process of diagnosis and treatment of proximal humeral fractures, and it has a significant impact on the postoperative effect. Neer part-3 fractures are recommended to be treated with open reduction and internal fixation, while Neer part- 4 fractures, especially severely comminuted humeral head fracture, humeral head dislocation and cartilage damage of humeral head, can be treated with shoulder arthroplasty. Spitted or comminuted humeral head fractures are the major indications of shoulder replacement. The classification of split-type humeral head fracture is not perfect, and the operation plan and prognosis were not effectively evaluated. Animal experiments or clinical experimental studies are further required.