Proximal humeral fractures are the third most common osteoporotic fractures in the elderly population, which can lead to severe shoulder pain, functional impairment, and a decline in quality of life. The incidence rate is significantly related to age. With the increase in age, bone mass decreases and osteoporosis develops, and its incidence rate gradually increases. The prevalence of rotator cuff tears in the general population also increases with age. Therefore, there may be a significant overlap between the two patient groups. The recovery of shoulder joint function in patients with proximal humeral fractures is significantly correlated with rotator cuff injury, and rotator cuff tears affect the selection of treatment plans for patients with proximal humeral fractures. Undetected rotator cuff tears in patients with proximal humeral fractures may be an important reason for poor therapeutic effect. Not only full-thickness tears, but also simple partial rotator cuff tears have a significant impact on functional prognosis. Compared with patients without rotator cuff injury, even the functional prognosis of patients with partially torn proximal humeral fractures at one-year follow-up is impaired.

To investigate the prevalence of rotator cuff tears in proximal humerus fractures via Meta-analysis.

Meta-analysis was used to summarize and statistically analyze the previously published literature on proximal humeral fractures combined with rotator cuff tears. The search period is from the establishment of the database to March 1, 2025. The data in the literature were extracted, summarized, and analyzed using Stata 17.0 software.

A total of 15 studies were included. A total of 1 787 samples of the population with proximal humeral fractures were extracted, involving 1 791 cases of proximal humeral fractures. The incidence of rotator cuff tears was 26.7% (95% CI: 20.1-33.2), among which the incidence was 22.6% in males and 27.4% in females (comparison between males and females, P> 0.05). Based on the Neer classification of proximal humeral fractures, the incidence of rotator cuff tears in patients with Neer 2 partial fractures was 21.4%, 34.8%, and 9.1%. The incidence of supraspinatus tendon tears and (supraspinatus + infraspinatus) tendon tears was analyzed based on the tendon sites involved in rotator cuff tears. The incidence of patients with proximal humeral fractures combined with supraspinatus tendon tears was 9.4%, and the incidence of patients with (supraspinatus + infraspinatus) tendon tears was 3.7% (P< 0.05 for comparison between the two). Taking every 10 years as one age group, it is divided into five age groups. The overall trend shows that after the age of 50, the incidence of proximal humeral fractures combined with rotator cuff tears increases with age.

Rotator cuff tears are relatively common in patients with proximal humeral fractures. There is no significant gender difference in patients with rotator cuff tears. Patients with Neer's three-part fractures are more prone to rotator cuff tears. Supraspinatus tendons are more likely to tear in patients with rotator cuff tears. The incidence of proximal humeral fractures combined with rotator cuff tears in patients over 50 years old increases with age.