Proximal Humeral Fractures: Nonoperative Versus Operative Treatment

Authors

1 Research Fellow, Sint Lucas Andreas Ziekenhuis Amsterdam, PhD Research Fellow Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA

2 Research Fellow, Department of Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, The Netherlands

3 Resident, Academic Medical Center Amsterdam, University of Amsterdam Orthopedic Residency Program, PhD Research Fellow, Orthotrauma Research Center Amsterdam, The Netherlands

4 Associate Professor of Orthopedic Surgery, Harvard Medical School, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA

5 Resident, Sint Lucas Andreas Ziekenhuis Amsterdam, University of Amsterdam Orthopedic Residency Program, Postdoc Research Fellow, Orthotrauma Research Center Amsterdam, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands

6 Chief Department of General Surgery, Sint Lucas Andreas Ziekenhuis Amsterdam, Secretariaat C4, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands

Abstract

Background
Management of displaced proximal humeral fractures is subject of ongoing debate.


Objectives
We aimed to review our results of operative treatment of proximal humeral fractures compared to age-, sex, and fracture-type controlled conservative treatment. We hypothesized that there is no significant difference in upper-extremity specific disability between patients treated with operative fixation and patients treated nonoperatively after displaced proximal humeral fracture. Our secondary null hypotheses were that there were no differences in pain intensity, satisfaction and physical function.


Methods
Thirty-three patients treated with operative fixation were enrolled and randomly matched with 33 patients treated nonoperatively according to age (within 5 years), sex, ASA-score, Neer fracture type and mechanism of injury. The patients were evaluated using the disabilities of the arm, shoulder and hand (DASH) scale, the constant score, short form (SF)-36 health survey, CESD, the pain catastrophizing scale (PCS) and pain intensity and satisfaction questionnaires.


Results
At follow-up, the nonoperatively treated patients had better functional outcomes than the operatively treated patients. Nonoperatively treated patients also scored better on pain intensity and satisfaction. There were no significant differences in CESD, PCS, and SF-36 physical- and mental health summary scores between cohorts.


Conclusions
The results of this study suggest that operative treatment might, on average, be detrimental to patients with proximal humeral fractures compared to natural healing. It will be a key to identify patients who will benefit from surgery.

Keywords


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