Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 10, pp 1385–1393 | Cite as

Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus

  • O. HauschildEmail author
  • G. Konrad
  • L. Audige
  • P. de Boer
  • S. M. Lambert
  • R. Hertel
  • N. P. Südkamp
Trauma Surgery



Aim of this study was to evaluate outcomes of operative as compared to conserveative treatment for two-part humerus fractures at the surgical neck.


Data from a prospective multi-centre cohort study on four treatment options (conservative treatment and three implants, i.e. LPHP, PHILOS and PHN) for proximal humerus fractures were evaluated in this post hoc analysis. All patients with two-part fractures of the surgical neck (AO types A2, n = 54 and A3, n = 110) were identified and included for the analysis. All operatively treated patients were gathered and compared to those receiving conservative treatment. Primary outcome parameters were pain, range of motion and absolute and relative Constant scores at 3, 6 and 12 months following injury and coronal plane alignment at 12 months.


Operative (n = 133) and non-operative (n = 31) groups were comparable with regard to all parameters assessed including mean age (62.9 vs. 65.6, P = 0.479), gender (27 vs. 29 % male, P = 0.826) and fracture distribution (65 vs. 77 % A3 type, P = 0.207). 26 of the 31 conservatively treated and 103 of the 133 operatively treated patients (84 and 77 %, respectively) were available for final follow-up. There was a continuous improvement for all outcome parameters in both treatment groups (P < 0.001). Operative treatment resulted in a more effective reduction of pain at 3 months (51 vs. 76 % reporting pain at fracture site, P = 0.03) and a reduction of coronal plane malalignment. Both range of motion and Constant scores were, however, comparable in both groups at all follow-up visits. Relative and absolute Constant scores were generally excellent at final follow-up (74 vs. 74, P = 0.528 and 89 vs. 91, P = 0.494, respectively).


Both non-operative treatment and operative treatment using modern implants (LPHP, PHILOS and PHN) can be considered safe and effective treatment options for two-part fractures of the proximal humerus. Operative treatment may result in better range of motion and reduced pain in the early postoperative course of treatment.


Proximal humerus fracture Two-part fracture Non-operative treatment Operative treatment 



The authors wish to thank all the following investigators and clinics for their participation in this study: Operative study arm: PHN: Centro Traumatologico Ortopedico, Firenze, Italy (R.Angeloni); UZ Gasthuisberg, Leuven, Belgium (S. Nijs); Royal Liverpool University Hospital, Liverpool, United Kingdom (C. Sinopidis); Johannes Gutenberg Universitätsklinikum, Klinik für Unfallchirurgie, Mainz, Germany (J. Blum); Università di Padova, Ortopedia e Traumatologia, Padova, Italy (A. Olmeda); Vogtlandklinikum Plauen, Plauen, Germany (W. Merbold); Kardinal Schwarzenberg’schen Krankenhaus, Abteilung für Unfallchirurgie, Schwarzach, Austria (F. Genelin); Unfallkrankenhaus Meidling, Wien, Austria (H. Matuschka); Klinikum Worms gGmbH, Worms, Germany (J. Blum) PHILOS: Rätisches Kantons- und Regionalspital, Chur, Switzerland (C. Sommer); Hôpital Cantonal de Fribourg, Fribourg, Switzerland (G. Kohut); Westpfalz-Klinikum GmbH, Unfallchirurgie Klinik, Kaiserslautern, Germany (H. Winkler); Kantonsspital Luzern, Chirurgie/Traumatologie, Luzern, Switzerland (R. Babst); Klinikum Rosenheim, Unfall- und Wiederherstellungschirurgie, Rosenheim, Germany (G. Regel); BG Unfall- und Universitätsklinik, Tübingen, Germany (D. Höntzsch) LPHP: Charité Universitätsmedizin Berlin, Zentrum für Muskuloskeletale Chirurgie, Berlin, Germany (N. Haas); Allgemeines Krankenhaus Celle, Celle, Germany (H-J. Oestern); Albert-Ludwigs-Universität, Orthopädie und Traumatologie, Freiburg, Germany (N. Südkamp); Universitätsklinik für Unfallchirurgie Graz, Graz, Austria (M. Plecko); Evangelisches Diakoniewerk Friederikenstift, Unfallklinik, Hannover, Germany (H. Lill); Universität Leipzig, Klinik für Unfall- und Wiederherstellungschirurgie, Leipzig, Germany (C. Josten). Non-operative study arm: York District Hospital, York, United Kingdom (P. De Boer)


  1. 1.
    Agudelo J et al (2007) Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 21(10):676–681PubMedCrossRefGoogle Scholar
  2. 2.
    Blum J et al (2009) Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail). Oper Orthop Traumatol 21(3):296–311PubMedCrossRefGoogle Scholar
  3. 3.
    Brunner F et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172PubMedCrossRefGoogle Scholar
  4. 4.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  5. 5.
    Court-Brown CM et al (2002) Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J B Jt Surg Br 84(4):504–508CrossRefGoogle Scholar
  6. 6.
    Court-Brown CM et al (2001) The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J B Jt Surg Br 83(6):799–804CrossRefGoogle Scholar
  7. 7.
    Handschin AE et al (2008) Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury 39(3):306–313PubMedCrossRefGoogle Scholar
  8. 8.
    Hanson B et al (2009) Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoul Elb Surg 18(4):612–621CrossRefGoogle Scholar
  9. 9.
    Helwig P et al (2009) Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop 80(1):92–96PubMedCrossRefGoogle Scholar
  10. 10.
    Kim J et al (2004) Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty. J B Jt Surg Am 1(86-A):15–21Google Scholar
  11. 11.
    Konrad G et al (2010) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J B Jt Surg Am 92(1 Pt 1):85–95Google Scholar
  12. 12.
    Kostler W et al (2003) Proximal humerus fracture in advanced age. Treatment with fixed angle plate osteosynthesis. Chirurg 74(11):985–989PubMedCrossRefGoogle Scholar
  13. 13.
    Lanting B et al (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Shoul Elb Surg 17(1):42–54CrossRefGoogle Scholar
  14. 14.
    Mueller M, Narzarian S (1990) The comprehensive classification for fractures of long bones. Heidelberg, Springer, New York, BerlinCrossRefGoogle Scholar
  15. 15.
    Neer CS 2nd (1970) Displaced proximal humeral fractures I. Classification and evaluation. J B Jt Surg Am 52(6):1077–1089Google Scholar
  16. 16.
    Olsson C et al (2005) Long-term outcome of a proximal humerus fracture predicted after 1 year: a 13-year prospective population-based follow-up study of 47 patients. Acta Orthop 76(3):397–402PubMedGoogle Scholar
  17. 17.
    Siwach R et al (2008) Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis. J Orthop Traumatol 9(3):149–153PubMedCrossRefGoogle Scholar
  18. 18.
    Sproul RC et al. (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42(4):408–413Google Scholar
  19. 19.
    Strohm PC et al (2007) Locking plates in proximal humerus fractures. Acta Chir Orthop Traumatol Cech 74(6):410–415PubMedGoogle Scholar
  20. 20.
    Strohm PC et al (2008) Proximal humerus fracture––what to do? Z Orthop Unfall 146(3):312–317PubMedCrossRefGoogle Scholar
  21. 21.
    Sudkamp N et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J B Jt Surg Am 91(6):1320–1328CrossRefGoogle Scholar
  22. 22.
    Urgelli S et al (2005) Conservative treatment versus prosthetic replacement surgery to treat 3- and 4-fragment fractures of the proximal epiphysis of humerus in the elderly patient. Chir Organi Mov 90(4):345–351PubMedGoogle Scholar
  23. 23.
    Zyto K (1998) Non-operative treatment of communited fractures of the proximal humerus in elderly patients. Injury 29(5):349–352PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • O. Hauschild
    • 1
    Email author
  • G. Konrad
    • 3
  • L. Audige
    • 2
  • P. de Boer
    • 4
  • S. M. Lambert
    • 5
  • R. Hertel
    • 6
  • N. P. Südkamp
    • 1
  1. 1.Department of Orthopaedic Surgery and TraumatologyFreiburg University Medical CentreFreiburgGermany
  2. 2.AO Clinical Investigation and DocumentationDübendorfSwitzerland
  3. 3.Kreiskrankenhaus ErdingErdingGermany
  4. 4.Honorary Consultant SurgeonYork HospitalYorkUK
  5. 5.Royal National Orthopaedic HospitalStanmoreUK
  6. 6.LindenhofspitalBernSwitzerland

Personalised recommendations