Conservative Treatment of 3- and 4-part Proximal Humeral Fractures: Can Poor Outcomes Be Predicted?

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2024 Mar 22

PMID 38517527

Authors

George Matheron

Melissa Mahoney

Peter Domos

Affiliations

Soon will be listed here.

Abstract

Purpose: 3- and 4-part proximal humeral fractures are frequently treated conservatively. This study aims to combine radiographic, and patient reported outcome data to identify factors leading to poor outcomes following conservative treatment.

Methods: A retrospective local database analysis identified 3- and 4-part fractures. Radiographic and functional outcomes including Oxford Shoulder Score (OSS), QuickDash (QD), Subjective Shoulder Score (SSV) and VAS pain scores were collected.

Results: 104 patients were included at mean follow-up of 55 months. Analysis highlighted significant OSS differences in 3- versus 4-part (p = 0.027), dominant arm injury (p = 0.046), age > 65 (p = 0.006), varus coronal neck-shaft angle < 115 versus 115-155 degrees (p = 0.008), posterior head tilt > 155 degrees (p = 0.005), greater tuberosity (GT) displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.032). According to QD scores; age > 65 (p = 0.012), varus neck-shaft angle (p = 0.01), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.006). SSV varied significantly with 3- versus 4-part fractures (p = 0.005), age > 65 (p = 0.04), varus neck-shaft angle (p = 0.001), posterior head tilt (p = 0.005), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.003), and medial calcar hinge displacement > 2 mm (p = 0.001).

Conclusion: We highlight risk factors for unfavourable outcomes following conservative management, aiding surgeons in shared decision-making and patient expectation management.

Citing Articles

Evaluating the association of radiographic parameters of proximal humerus fractures managed conservatively with functional outcomes.

Song J, Joo L, Jonathan L, Ho S, Chua I, Kwek E Arch Orthop Trauma Surg. 2024; 144(8):3461-3468.

PMID: 39105844 DOI: 10.1007/s00402-024-05467-3.

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