Clinical outcomes following surgical fixation of proximal humerus fractures in skiers and snowboarders.

Downhill skiing and snowboarding are popular winter sports, yet limited data describe outcomes after surgical fixation of proximal humerus fractures in these patients. The purpose of this study was to evaluate clinical outcomes and return to sport (RTS) after surgical fixation of proximal humerus fractures sustained while skiing or snowboarding, and to determine the influence of age, sex, sport, injury severity (Neer classification), and fixation type (open reduction internal fixation vs. closed reduction percutaneous pinning) on these outcomes. A retrospective cohort study of patients who underwent surgical fixation of proximal humerus fractures sustained while skiing or snowboarding between 2005 and 2022 by a fellowship-trained surgeon (P.J.M) was performed. Inclusion criteria were age ≥18 years, acute fracture sustained during downhill snow sports, and ≥12 months of follow-up. Exclusion criteria included prior fixation, pathologic fracture, polytrauma, arthroplasty, or incomplete records. Patient-reported outcome measures (PROMs) included 12-Item Short-Form Physical Component Summary (SF-12 PCS)/12-Item Short-Form Mental Component Summary, American Shoulder and Elbow Surgeons, Quick Disabilities of the Arm, Shoulder and Hand, Single Assessment Numeric Evaluation, visual analog scale pain, satisfaction, and RTS. Sub-group analyses compared outcomes by age (<65 vs. ≥ 65 years), sex, sport (skiing vs. snowboarding), Neer classification (2- vs. 3-4-part), and fixation type (open reduction and internal fixation vs. closed reduction and percutaneous pinning). Forty-eight patients (26 females, 22 males; median age 55.8 years; 38 skiing, 10 snowboarding) were analyzed at a mean 83.9-month follow-up (minimum 12 months). Neer classification included 17 (35%) 2-part and 31 (65%) 3-4-part fractures. Median PROMs were SF-12 PCS (55.5), 12-Item Short-Form Mental Component Summary (56.0), American Shoulder and Elbow Surgeons (94.9), Quick Disabilities of the Arm, Shoulder and Hand (4.5), Single Assessment Numeric Evaluation (95.0), and visual analog scale pain (0.0). Overall, 77% (37/48) returned to sport, with 55% returning at or near preinjury level; median satisfaction was 10/10, and the revision rate was 4%. Younger patients (<65 years) had higher SF-12 PCS scores (P = .004), and snowboarders were younger (P = .003) and reported higher satisfaction (P = .048) than skiers; no other significant differences in PROMs or RTS were observed by age, sex, sport, fracture severity, or fixation type. Operative fixation of proximal humerus fractures sustained during skiing or snowboarding yields excellent long-term clinical outcomes, with 77% (37/48) of patients returning to sport at a mean follow-up of 83.9 months, high patient satisfaction (median 10/10), and a low revision rate (4%, 2/50 operative cases). Clinical outcomes were largely comparable across age, sex, sport, fracture severity, and fixation type, underscoring the reliability of surgical management for proximal humerus fractures in active snow sport populations.