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Conservative treatment of 3- and 4-part proximal humeral fractures: Can poor outcomes be predicted?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.

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Authors and Affiliations

  1. Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, Wellhouse Lane Barnet, London, Hertfordshire, EN5 3DJ, UK

    George Matheron, Melissa Mahoney & Peter Domos

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  1. George Matheron
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  2. Melissa Mahoney
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Contributions

GM and PD and researched literature and conceived the study. GM, MM and PD were involved in protocol development, patient recruitment and data analysis. GM wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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Correspondence to George Matheron.

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Matheron, G., Mahoney, M. & Domos, P. Conservative treatment of 3- and 4-part proximal humeral fractures: Can poor outcomes be predicted?. Eur J Orthop Surg Traumatol 34, 2031–2040 (2024). https://doi.org/10.1007/s00590-024-03890-1

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  • DOI: https://doi.org/10.1007/s00590-024-03890-1

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