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Treatment options for proximal humeral fractures in the older adults and their implication on personal independence

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

No consensus exists on the optimal treatment of proximal humeral fractures (PHFx). Uncertainty about surgical treatment in the older adults using locking plates (e.g., PHILOS) has emerged, due to a high number of complications. This study aimed to assess the impact of non-operative versus operative treatment of a PHFx on the level of self-dependence in our older population.

Methods

We included patients aged over 65 years with some level of self-dependence, treated at our hospital between 5/2011 and 4/2013 for isolated PHFx of AO subtypes A2, A3, and B1 for which either non-operative or surgical treatment using a PHILOS plate had been applied. The patients were questioned, examined, or interviewed via phone; AO fracture patterns and treatment were documented as well as level of self-dependence, complications, constant score (CSM), subjective shoulder value (SSV), quality of life (EQ-5D), and shoulder pain and disability index (SPADI).

Results

Patients with PHFx of AO subtypes A2, A3, or B1 that were either treated non-operative (n = 50) or operative by insertion of the PHILOS plate (n = 63) were included. Operative-treated patients were 3.3 times as likely to lose some level of independence (95% CI 0.39–28, p = 0.271). Shoulder motion, strength, and functional outcomes tended to be lower in operative-treated patients, with adjusted differences of, − 11 CMS points (95% CI – 23 to 2), − 9 SPADI points (95% CI − 18 to 0), and − 6% in SSV (95% CI − 17 to 5). Quality-of-life EQ-5D utility index was similar in both groups (mean − 0.04; 95% CI − 0.18 to 0.10).

Conclusion

In our study population, non-operatively treated older adults with an AO type A2, A3, B1 fracture of the proximal humerus tended to have a high chance to return to their premorbid level of independence, compared to patients treated with a locking plate. A change in the treatment algorithm for these PHFx may be carefully considered and further investigated in clinical practice.

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Author notes

  1. Sandra Feissli and Laurent Audigé contributed equally to this manuscript and share first co-authorship.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Sandra Feissli, Laurent Audigé, Amir Steinitz, Andreas M. Müller & Daniel Rikli

  2. Research and Development Department, Schulthess Clinic, Zurich, Switzerland

    Laurent Audigé

  3. Institute of Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland

    Laurent Audigé

Authors
  1. Sandra Feissli
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  2. Laurent Audigé
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  3. Amir Steinitz
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  4. Andreas M. Müller
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  5. Daniel Rikli
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Correspondence to Daniel Rikli.

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Feissli, S., Audigé, L., Steinitz, A. et al. Treatment options for proximal humeral fractures in the older adults and their implication on personal independence. Arch Orthop Trauma Surg 140, 1971–1976 (2020). https://doi.org/10.1007/s00402-020-03452-0

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  • DOI: https://doi.org/10.1007/s00402-020-03452-0

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