Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant–Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.

Objectives: Distal ulna plate fixation for ulnar neck and head fractures (excluding ulnar styloid fractures) aims to anatomically reduce the distal ulna fracture (DUF) by open reduction and internal fixation, while obtaining a stable construct allowing functional rehabilitation without need for cast immobilization. Indications: Severe displacement, angulation or translation, as well as unstable or intra-articular fractures. Furthermore, multiple trauma or young patients in need of quick functional rehabilitation. Contraindications: Inability to surgically address concomitant ipsilateral extremity fractures, thus, limiting early active rehabilitation. Stable, nondisplaced fractures. Need for bridging plate or external fixator of distal radiocarpal joint. Surgical technique: An ulnar approach, with a straight incision between the extensor and flexor carpi ulnaris. Preservation of the dorsal branch of the ulnar nerve. Reduction and plate fixation with avoidance of plate impingement in the articular zone. Postoperative management: Postoperatively, an elastic bandage is applied for the first 24–48 h. In isolated DUF with stable fixation, a postoperative splint is often unnecessary and should be avoided. For the first four weeks, only light weightbearing of everyday activities is allowed to protect the osteosynthesis. Thereafter, heavier weightbearing and activities are allowed and can be increased as tolerated. Results: The best available evidence likely shows that for younger patients with a DUF, with or without concomitant distal radius fractures, open reduction and internal fixation can be safely achieved with good functional outcome and acceptable union and complication rates as long as proper technique is ensured.

Background: Trauma care is inherently complex due to wide variability in patients, injury patterns, possible treatment strategies, and achievable outcomes that dynamically interact and influence the risk of complications and long-term functional recovery. Mortality-focused research insufficiently reflects this complexity and the evolving goals of trauma care. A Learning Healthcare System offers an opportunity to learn from routine clinical care by integrating data and translating findings into feedback. Objective: This paper proposes a comprehensive framework for continuous evaluation and improvement of trauma care that integrates patient and injury characteristics with care processes, complications, and outcomes beyond mortality, and describes an institutional data infrastructure that can support this framework. Approach: A conceptual framework based on routine care data is described, together with an institutional example combining the Dutch National Trauma Registry, the Utrecht Patient-Oriented Database, and a specialty complication registry. No new patient-level data were created or analyzed, and the effectiveness of the integrated infrastructure was not evaluated. Maintaining these databases requires dedicated professionals, data managers, structured documentation, multidisciplinary collaboration, and continuous quality control. Conclusions: Linking complementary registries provides a foundation for a Learning Healthcare System in complex trauma care. Combining established mortality and morbidity reviews with the opportunities offered by large, integrated databases may facilitate the implementation of a Learning Healthcare System in trauma care.