Is nonoperative treatment a valid and successful option for the management of three-part and four-part proximal humerus fractures?

Abstract

Background Proximal humerus fractures are relatively common, accounting for about 5–9% of all fractures. There is no agreement regarding the optimal interventions for these fractures. This controversy makes a dilemma for decision-makers in the clinic. This study aimed to assess the functional outcome of nonoperative management in Neer’s three, four parts proximal humerus fracture and the incidence of complications. Patients and methods This prospective case series study recruited 52 patients with three-part or four-part fractures of the proximal humerus in the Orthopedic Department. Patients were observed and followed up after conservative treatment. Patients of both sexes above 20 years, with closed Neer’s three-part and four-part fractures of proximal humerus, were included. Old (>4 weeks) and open fractures, associated neurovascular injuries, presence of infection, and mentally ill patients were excluded from the study. Ethical approval was obtained from the Institutional Review Board at Cairo University. Written informed consent was obtained from all included patients. American shoulder and elbow surgeon’s score, Constant score, and visual analog scale were assessed at 12 months. Postinjury radiographs, including true anteroposterior and lateral views, were obtained at 1, 2, 4, and 8 weeks postimmobilization, then at 3, 6, and 12 months following injury. Results This study recruited 52 patients with three-part and four-part fractures of the proximal humerus. These patients were managed conservatively, followed up, and observed for 1 year. The mean age of included patients was 64.23 years old (28–87). The majority of included patients were females, 41 (78.8%). Forty-three (82.7%) patients of included patients had three-part fractures and nine (17%) patients had four-part fractures. The age of patients with four-part fractures (75.4 ± 7.8) was higher than the age of patients with three-part fractures (61.6 ± 13.2), and this was statistically significant (P<0.05). The mean Constant score after 12 months was 79.38 ± 8.26 and the American shoulder and elbow surgeon’s was 78.9 ± 11.2. The visual analog score was 3.7 ± 1.7 after 1 year. Conclusions Nonoperative treatment of three-part and four-part proximal humeral fractures yield acceptable and satisfactory functional results. Four-part fracture has better clinical results than three-part ones.