Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus
- 1.6k Downloads
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.
KeywordsProximal 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)
- 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.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
- 15.Neer CS 2nd (1970) Displaced proximal humeral fractures I. Classification and evaluation. J B Jt Surg Am 52(6):1077–1089Google Scholar
- 18.Sproul RC et al. (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42(4):408–413Google Scholar