Outcome of Surgical versus Non-Surgical Treatment for Proximal Humerus Fractures; a Cross-sectional Study
Surgical VS Non-surgical Treatment for Proximal Humerus Fracture
,
Abstract
Objectives: Proximal humerus fracture (PHF) is one of the most common upper limb fractures. PHF is more common among the elderly and usually occurrs after a fall. high-energy trauma causes this form of fracture in young persons. There are several treatment options for PFH, including surgical and non-surgical precedures. We aimed to compare the results of surgical and non-surgical treatment outcomes in Iranian patients with PHF.
Methods: This single-center cross-sectional study included 60 patients with PFHs.the patients medical records were reviewed, studied, and assesed based on demographic characteristics, underlying conditions, type of treatment, complications, and necessity for re-intervention, as well as the CONSTANT score.
Results: The mean age of the patients was 45.65 years (SD: 1.83, range:18-78 years old). Among those older than 50 years, women significantly outnumbered men by a large margin (66.7%, P =0.009), (Mean±SD age of males and females: 39.71 ± 1.52 vs 52.42 ± 1.94, respectively). Thirty-one patients received surgical treatment, while 29 patients received non-surgical care. The CONSTANT score of patients who had surgery was considerably higher than that of other patients (P =0.009, Mean±SD: 80.41 ± 1.89 against 69.82 ± 1.82); this significant relationship was only seen in the age group of 18 to 49 years.
Conclusion: PHFs were more frequent in patients over the age of 50, perticularly in women. Patients under the age of 50 and men had higher CONSTANT scores.
Keywords: Proximal humerus fracture, Treatment outcome, Cross-sectional study, trauma
Level of evidence: level 4
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Outcomes following non operative management for proximal
humerus fractures. J Clin Orthop Trauma. 2019;10(3):462-7. doi:
10.1016/j.jcot.2019.02.017. [PubMed: 31061570]. [PubMed Central:
PMC6491913].
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
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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 S,
et 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. Soleymani M, Nabian M, Mafhoumi A, Panjavi B, Oriadi Zanjani
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.
Outcomes following non operative management for proximal
humerus fractures. J Clin Orthop Trauma. 2019;10(3):462-7. doi:
10.1016/j.jcot.2019.02.017. [PubMed: 31061570]. [PubMed Central:
PMC6491913].
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 S,
et 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. Soleymani M, Nabian M, Mafhoumi A, Panjavi B, Oriadi Zanjani
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.
| Files | ||
| Issue | Vol 10 No 3 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i3.16782 | |
| Keywords | ||
| Proximal humerus fracture Treatment outcome Cross-sectional study trauma | ||
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How to Cite
1.
Kokly S, Etemadi R, Momen O, Hosseininejad S-M, Shakiba S. Outcome of Surgical versus Non-Surgical Treatment for Proximal Humerus Fractures; a Cross-sectional Study. J Orthop Spine Trauma. 2024;10(3):115-8.
