Comparison of Surgical and Non-Surgical Treatments for Proximal Humerus Fractures: A Cross-Sectional Study
,
Abstract
Background: The proximal humerus fracture (PHF) is one of the most common fractures of the upper limbs. PHF is more common in older people, usually following a fall, whereas in younger people this form of fracture is typically caused by high-energy trauma. There are several treatment options for PHFs, including surgical and non-surgical procedures. Our aim was to compare the outcomes of surgical and non-surgical treatment methods in Iranian patients with PHFs.
Methods: Sixty patients with PHFs participated in this single-center cross-sectional study. Medical records were reviewed and evaluated according to demographic characteristics, underlying diseases, type of treatment, complications, need for reintervention, and Constant score.
Results: The mean age of the patients was 45.65 years. Among those older than 50 years, women significantly outnumbered men (66.7%, P = 0.009). Thirty-one patients received surgical treatment, while 29 patients received non-surgical care. The Constant scores of patients who underwent surgery were considerably higher than those of non-surgical patients [mean ± standard deviation (SD): 80.41 ± 1.89 versus 69.82 ± 1.82, P = 0.009]. This significant relationship was observed only in the age group of 18 to 49 years.
Conclusion: Overall, the complications arising from both surgical and nonsurgical treatments were not statistically significant; however, patients under the age of 50 and men had higher Constant scores, indicating better clinical outcomes.
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10. Chivot M, Lami D, Bizzozero P, Galland A, Argenson JN. Three- and four-part displaced proximal humeral fractures in patients older than 70 years: Reverse shoulder arthroplasty or nonsurgical treatment? J Shoulder Elbow Surg. 2019;28(2):252- 9. doi: 10.1016/j.jse.2018.07.019. [PubMed: 30348542].
11. Marongiu G, Leinardi L, Congia S, Frigau L, Mola F, Capone A. Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: A comparison of three different classification systems. J Orthop Traumatol. 2020;21(1):4. doi: 10.1186/s10195-020-0543-1. [PubMed: 32166457]. [PubMed Central: PMC7067934].
12. Matsumura N, Furuhata R, Seto T, Takada Y, Shirasawa H, Oki Set al. Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures. J Orthop Surg Res. 2020;15(1):438. doi: 10.1186/s13018-020-01966-2. [PubMed: 32967709]. [PubMed Central: PMC7509915].
13.Iglesias-Rodriguez S, Dominguez-Prado DM, Garcia-Reza A, Fernandez-Fernandez D, Perez-Alfonso E, Garcia-Pineiro J, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402. doi: 10.1186/s13018-021-02551-x. [PubMed: 34158100]. [PubMed Central: PMC8220679].
14. Cheung EV, Sperling JW. Management of proximal humeral nonunions and malunions. Orthop Clin North Am. 2008;39(4): 475-82, vii. doi: 10.1016/j.ocl.2008.06.002. [PubMed: 18803977].
15. Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg. 2016;25(2):330-40. doi: 10.1016/j.jse.2015.08.030. [PubMed: 26644230].
16. Handoll H, Brealey S, Rangan A, Keding A, Corbacho B, Jefferson L, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial - a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015;19(24):1- 280. doi: 10.3310/hta19240. [PubMed: 25822598]. [PubMed Central: PMC4781052].
17. Mao Z, Zhang L, Zhang L, Zeng X, Chen S, Liu D, et al. Operative versus nonoperative treatment in complex proximal humeral fractures. Orthopedics. 2014;37(5):e410-e419. doi: 10.3928/01477447-20140430-50. [PubMed: 24810816].
18. Richard GJ, Denard PJ, Kaar SG, Bohsali KI, Horneff JG, Carpenter S, et al. Outcome measures reported for the management of proximal humeral fractures: a systematic review. J Shoulder Elbow Surg. 2020;29(10):2175-84. doi: 10.1016/j.jse.2020.04.006. [PubMed: 32951643].
19. Soler-Peiro M, Garcia-Martinez L, Aguilella L, Perez-Bermejo M. Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review. J Orthop Surg Res. 2020;15(1):347. doi: 10.1186/s13018-020-01880-7. [PubMed: 32831119]. [PubMed Central: PMC7444241].
20. Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res. 2016;5(10):470-80. doi: 10.1302/2046-3758.510.2000638. [PubMed: 27756738]. [PubMed Central: PMC5086838].
21. Mao F, Zhang DH, Peng XC, Liao Y. Comparison of surgical versus non-surgical treatment of displaced 3- and 4-part fractures of the proximal humerus: A meta-analysis. J Invest Surg. 2015;28(4):215-24. doi: 10.3109/08941939.2015.1005781. [PubMed: 26268421].
22. Boileau P, Pennington SD, Alami G. Proximal humeral fractures in younger patients: Fixation techniques and arthroplasty. J Shoulder Elbow Surg. 2011;20(2 Suppl):S47-S60. doi: 10.1016/j.jse.2010.12.006. [PubMed: 21281922].
23. Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohe K, Hoffmann R. Trends in surgical management of proximal humeral fractures in adults: A nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019;139(12):1713-21. doi: 10.1007/s00402-019-03252-1. [PubMed: 31375915].
24. Davey MS, Hurley ET, Anil U, Condren S, Kearney J, O'Tuile C, et al. Management options for proximal humerus fractures - A systematic review & network meta-analysis of randomized control trials. Injury. 2022;53(2):244-9. doi: 10.1016/j.injury.2021.12.022. [PubMed: 34974908].
25. SoleymaniM,NabianM,MafhoumiA,PanjaviB,OriadiZanjani L, Mehrpour SR. Proximal humeral fracture; predictors of functional and radiologic outcome. J Orthop Spine Trauma. 2023;9(2):82-7. doi: 10.18502/jost.v9i2.12826.
2. Ahmad T, Muhammad ZA, Haroon A. Functional outcomes in proximal humerus fractures: A prospective registry-based analysis. J Pak Med Assoc. 2021;71(7):1870-4. doi: 10.47391/JPMA.04-600. [PubMed: 34410263].
3. Patel AH, Wilder JH, Ofa SA, Lee OC, Iloanya MC, Savoie FH3rd, et al. How age and gender influence proximal humerus fracture management in patients older than fifty years. JSES Int. 2022;6(2):253-8. doi: 10.1016/j.jseint.2021.11.007. [PubMed: 35252922]. [PubMed Central: PMC8888168].
4. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71. doi: 10.1080/000164701753542023. [PubMed: 11580125].
5. Greiwe M. Shoulder and elbow trauma and its complications: Volume 1: The shoulder. Cambridge, UK: Woodhead Publishing; 2015.
6. Launonen AP, Lepola V, Saranko A, Flinkkila T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Arch Osteoporos. 2015;10:209. doi: 10.1007/s11657-015-0209-4. [PubMed: 25675881].
7. Newcomb PA, Adams SV, Mayer S, Passarelli MN, Tinker L, Lane D, et al. Postmenopausal fracture history and survival after reproductive cancer diagnosis. JNCI Cancer Spectr. 2018;2(1):ky001. doi: 10.1093/jncics/pky001. [PubMed: 31355356]. [PubMed Central: PMC6643753].
8. Sharifi MD, Mohebbi M, Farrokhfar M, Farzaneh R, Disfani HF, Hashemian AM. Analysis of correlation between estradiol and fracture of femur neck. Eur J Transl Myol. 2018;28(2):7379. doi: 10.4081/ejtm.2018.7379. [PubMed: 29991984]. [PubMed Central: PMC6036315].
9. Neer CS. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. doi: 10.1097/01.blo.0000198718.91223.ca. [PubMed: 16394743].
10. Chivot M, Lami D, Bizzozero P, Galland A, Argenson JN. Three- and four-part displaced proximal humeral fractures in patients older than 70 years: Reverse shoulder arthroplasty or nonsurgical treatment? J Shoulder Elbow Surg. 2019;28(2):252- 9. doi: 10.1016/j.jse.2018.07.019. [PubMed: 30348542].
11. Marongiu G, Leinardi L, Congia S, Frigau L, Mola F, Capone A. Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: A comparison of three different classification systems. J Orthop Traumatol. 2020;21(1):4. doi: 10.1186/s10195-020-0543-1. [PubMed: 32166457]. [PubMed Central: PMC7067934].
12. Matsumura N, Furuhata R, Seto T, Takada Y, Shirasawa H, Oki Set al. Reproducibility of the modified Neer classification defining displacement with respect to the humeral head fragment for proximal humeral fractures. J Orthop Surg Res. 2020;15(1):438. doi: 10.1186/s13018-020-01966-2. [PubMed: 32967709]. [PubMed Central: PMC7509915].
13.Iglesias-Rodriguez S, Dominguez-Prado DM, Garcia-Reza A, Fernandez-Fernandez D, Perez-Alfonso E, Garcia-Pineiro J, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402. doi: 10.1186/s13018-021-02551-x. [PubMed: 34158100]. [PubMed Central: PMC8220679].
14. Cheung EV, Sperling JW. Management of proximal humeral nonunions and malunions. Orthop Clin North Am. 2008;39(4): 475-82, vii. doi: 10.1016/j.ocl.2008.06.002. [PubMed: 18803977].
15. Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg. 2016;25(2):330-40. doi: 10.1016/j.jse.2015.08.030. [PubMed: 26644230].
16. Handoll H, Brealey S, Rangan A, Keding A, Corbacho B, Jefferson L, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial - a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015;19(24):1- 280. doi: 10.3310/hta19240. [PubMed: 25822598]. [PubMed Central: PMC4781052].
17. Mao Z, Zhang L, Zhang L, Zeng X, Chen S, Liu D, et al. Operative versus nonoperative treatment in complex proximal humeral fractures. Orthopedics. 2014;37(5):e410-e419. doi: 10.3928/01477447-20140430-50. [PubMed: 24810816].
18. Richard GJ, Denard PJ, Kaar SG, Bohsali KI, Horneff JG, Carpenter S, et al. Outcome measures reported for the management of proximal humeral fractures: a systematic review. J Shoulder Elbow Surg. 2020;29(10):2175-84. doi: 10.1016/j.jse.2020.04.006. [PubMed: 32951643].
19. Soler-Peiro M, Garcia-Martinez L, Aguilella L, Perez-Bermejo M. Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review. J Orthop Surg Res. 2020;15(1):347. doi: 10.1186/s13018-020-01880-7. [PubMed: 32831119]. [PubMed Central: PMC7444241].
20. Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res. 2016;5(10):470-80. doi: 10.1302/2046-3758.510.2000638. [PubMed: 27756738]. [PubMed Central: PMC5086838].
21. Mao F, Zhang DH, Peng XC, Liao Y. Comparison of surgical versus non-surgical treatment of displaced 3- and 4-part fractures of the proximal humerus: A meta-analysis. J Invest Surg. 2015;28(4):215-24. doi: 10.3109/08941939.2015.1005781. [PubMed: 26268421].
22. Boileau P, Pennington SD, Alami G. Proximal humeral fractures in younger patients: Fixation techniques and arthroplasty. J Shoulder Elbow Surg. 2011;20(2 Suppl):S47-S60. doi: 10.1016/j.jse.2010.12.006. [PubMed: 21281922].
23. Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohe K, Hoffmann R. Trends in surgical management of proximal humeral fractures in adults: A nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019;139(12):1713-21. doi: 10.1007/s00402-019-03252-1. [PubMed: 31375915].
24. Davey MS, Hurley ET, Anil U, Condren S, Kearney J, O'Tuile C, et al. Management options for proximal humerus fractures - A systematic review & network meta-analysis of randomized control trials. Injury. 2022;53(2):244-9. doi: 10.1016/j.injury.2021.12.022. [PubMed: 34974908].
25. SoleymaniM,NabianM,MafhoumiA,PanjaviB,OriadiZanjani L, Mehrpour SR. Proximal humeral fracture; predictors of functional and radiologic outcome. J Orthop Spine Trauma. 2023;9(2):82-7. doi: 10.18502/jost.v9i2.12826.
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| Issue | Vol 10 No 3 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i3.16782 | |
| Keywords | ||
| Shoulder Fractures Humeral Fracture Treatment Outcome Cross-Sectional Studies | ||
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How to Cite
1.
Kokly S, Etemadi R, Momen O, Hosseininejad S-M, Shakiba S. Comparison of Surgical and Non-Surgical Treatments for Proximal Humerus Fractures: A Cross-Sectional Study. J Orthop Spine Trauma. 2024;10(3):115-8.
