Skip to main content
Top
Published in: European Journal of Orthopaedic Surgery & Traumatology 7/2014

01-10-2014 | Original Article

Displaced proximal humeral fractures: operative versus non-operative treatment—a 2-year extension of a randomized controlled trial

Authors: Tore Fjalestad, Margrethe Øye Hole

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 7/2014

Login to get access

Abstract

Background

Surgical treatment for displaced proximal humeral fractures is widely used. However, there are very few randomized controlled studies comparing surgical treatment to conservative treatment, and the evidence is debated. The aim of this study was to describe patients with displaced proximal humeral fractures in a 2-years extension of a randomized controlled trial, their functional outcome and quality of life.

Materials and methods

Patients from a single-center randomized controlled study of fifty patients aged 60 or above with displaced proximal humeral fracture (AO/OTA group B2 or C2) were randomized to surgical or conservative treatment. Surgery was performed with an angular stable implant. The main outcome was Constant score at 2-year follow-up. Secondary outcomes were an ASES self-assessment form, the 15D quality of life assessment and radiographs at 2 years.

Results

A marked improvement of shoulder function and health-related quality of life for both surgically and conservatively treated patients occurs between 6 and 12 months. Almost no change was observed between 1 and 2 year. There were no significant differences between the two treatments at 2-year follow-up.

Conclusions

In this randomized controlled trial, surgical treatment proved no better results than conservative treatment for patients with displaced proximal humeral fracture at 2-year follow-up.
Appendix
Available only for authorised users
Literature
1.
go back to reference Court Brown CM, McQueen MM (2002) The relationship between fractures and increasing age with reference to the proximal humerus. Curr Orthop 16:213–222CrossRef Court Brown CM, McQueen MM (2002) The relationship between fractures and increasing age with reference to the proximal humerus. Curr Orthop 16:213–222CrossRef
2.
go back to reference Hallberg I, Rosenqvist AM, Kartous L, Löfman O, Wahlström O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841PubMedCrossRef Hallberg I, Rosenqvist AM, Kartous L, Löfman O, Wahlström O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841PubMedCrossRef
3.
go back to reference Iyengar JJ, Devcic Z, Sproul RC, Feeley BT (2011) Nonoperative treatment of proximal humeral fractures. A systematic Review. J Orthop Trauma 25:612–617PubMedCrossRef Iyengar JJ, Devcic Z, Sproul RC, Feeley BT (2011) Nonoperative treatment of proximal humeral fractures. A systematic Review. J Orthop Trauma 25:612–617PubMedCrossRef
4.
go back to reference Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91(7):1689–1697PubMedCrossRef Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91(7):1689–1697PubMedCrossRef
5.
go back to reference Hodgson S (2006) Proximal humerus fracture rehabilitation. Clin Orthop Relat Res 442:131–138PubMed Hodgson S (2006) Proximal humerus fracture rehabilitation. Clin Orthop Relat Res 442:131–138PubMed
6.
go back to reference Robinson CM, Amin AK, Godley KC, Murray IR, White TO (2011) Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma 25(10):618–629PubMedCrossRef Robinson CM, Amin AK, Godley KC, Murray IR, White TO (2011) Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma 25(10):618–629PubMedCrossRef
7.
go back to reference Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD (2007) Management of Proximal Humeral Fractures Based on Current Litterature. J Bone Joint Surg (Am) 89:44–58CrossRef Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD (2007) Management of Proximal Humeral Fractures Based on Current Litterature. J Bone Joint Surg (Am) 89:44–58CrossRef
8.
go back to reference Reitman RD, Kerzhner E (2011) Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop 40(9):458–461PubMed Reitman RD, Kerzhner E (2011) Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop 40(9):458–461PubMed
9.
go back to reference Cazeneuve JF, Cristofari DJ (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95(5):325–329PubMedCrossRef Cazeneuve JF, Cristofari DJ (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95(5):325–329PubMedCrossRef
10.
go back to reference Handoll HHG, Ollivere BJ, Rollins KE (2012) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 12:CD000434PubMed Handoll HHG, Ollivere BJ, Rollins KE (2012) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 12:CD000434PubMed
11.
go back to reference Fjalestad T, Hole MØ, Hovden IAH, Blücher J, Strømsøe K (2012) Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Ortop Traum 26(2):98–106CrossRef Fjalestad T, Hole MØ, Hovden IAH, Blücher J, Strømsøe K (2012) Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Ortop Traum 26(2):98–106CrossRef
12.
go back to reference Fjalestad T, Hole MØ, Jørgensen JJ, Strømsøe K, Kristiansen IS (2010) Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients. Injury 41(6):599–605PubMedCrossRef Fjalestad T, Hole MØ, Jørgensen JJ, Strømsøe K, Kristiansen IS (2010) Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients. Injury 41(6):599–605PubMedCrossRef
13.
go back to reference Marsh JL, Slongo TF, Angel J et al (2007) Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(Suppl.10):1–163CrossRef Marsh JL, Slongo TF, Angel J et al (2007) Fracture and dislocation classification compendium—2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(Suppl.10):1–163CrossRef
14.
go back to reference Hertel R, Hemfing A, Stiehler M et al (2004) Predictors of humeraL head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433PubMedCrossRef Hertel R, Hemfing A, Stiehler M et al (2004) Predictors of humeraL head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433PubMedCrossRef
15.
go back to reference Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed
16.
go back to reference Constant CR, Gerber C, Emery RJ et al (2008) A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361PubMedCrossRef Constant CR, Gerber C, Emery RJ et al (2008) A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361PubMedCrossRef
17.
go back to reference Sintonen H (2001) The 15D instrument of health-related quality of life: properties and applications. The Finnish Medical Society Duodecim. Ann Med 33:328–336PubMedCrossRef Sintonen H (2001) The 15D instrument of health-related quality of life: properties and applications. The Finnish Medical Society Duodecim. Ann Med 33:328–336PubMedCrossRef
18.
go back to reference Richards RR et al (1994) A standardized method for the assessment of shoulder function. ASES Research Commitee, American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg 3:347–352PubMedCrossRef Richards RR et al (1994) A standardized method for the assessment of shoulder function. ASES Research Commitee, American Shoulder and Elbow Surgeons. J Shoulder Elbow Surg 3:347–352PubMedCrossRef
19.
go back to reference Zyto K, Ahrengart L, Sperber A, Törnkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg 79-B:412–417CrossRef Zyto K, Ahrengart L, Sperber A, Törnkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg 79-B:412–417CrossRef
20.
go back to reference Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20(5):747–755PubMedCrossRef Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20(5):747–755PubMedCrossRef
21.
go back to reference Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371PubMedCrossRef Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371PubMedCrossRef
22.
go back to reference Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluations. J Bone Joint Surg Am 52(6):1077–1089PubMed Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluations. J Bone Joint Surg Am 52(6):1077–1089PubMed
23.
24.
go back to reference Owsley KC, Gorczyca JT (2008) Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am 90:233–240PubMedCrossRef Owsley KC, Gorczyca JT (2008) Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am 90:233–240PubMedCrossRef
25.
go back to reference Bell JE, Leung BC, Spratt KF et al (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J.Bone Joint Surg Am 93(2):121–131PubMedCentralPubMedCrossRef Bell JE, Leung BC, Spratt KF et al (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J.Bone Joint Surg Am 93(2):121–131PubMedCentralPubMedCrossRef
26.
go back to reference Huttunen TT, Launonen AP, Philajamäki H, Kannus P, Mattila VM (2012) Trends in the surgical treatment of proximal humeral fractures—a nationwide 23-year study in Finland. BMC Musculoskelet Disord 13:261PubMedCentralPubMedCrossRef Huttunen TT, Launonen AP, Philajamäki H, Kannus P, Mattila VM (2012) Trends in the surgical treatment of proximal humeral fractures—a nationwide 23-year study in Finland. BMC Musculoskelet Disord 13:261PubMedCentralPubMedCrossRef
27.
go back to reference Hodgson SA, Mawson SJ, Saxton JM et al (2007) Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elbow Surg 16:143–145PubMedCrossRef Hodgson SA, Mawson SJ, Saxton JM et al (2007) Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elbow Surg 16:143–145PubMedCrossRef
28.
go back to reference Wildner M, Sangha O, Clark DE, Döring A, Manstetten A (2002) Independent living after fractures in the elderly. Osteoporos Int 13:579–585PubMedCrossRef Wildner M, Sangha O, Clark DE, Döring A, Manstetten A (2002) Independent living after fractures in the elderly. Osteoporos Int 13:579–585PubMedCrossRef
29.
go back to reference Conboy VB, Morris RW, Kiss J, Carr AJ (1996) An evaluation of the constant—murley shoulder assessment. J Bone Joint Surg 78-B(2):229–232 Conboy VB, Morris RW, Kiss J, Carr AJ (1996) An evaluation of the constant—murley shoulder assessment. J Bone Joint Surg 78-B(2):229–232
30.
go back to reference Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V.(2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Jul 12. doi: 10.1016/j.jse.2013.05.002. [Epub ahead of print] Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V.(2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Jul 12. doi: 10.​1016/​j.​jse.​2013.​05.​002. [Epub ahead of print]
Metadata
Title
Displaced proximal humeral fractures: operative versus non-operative treatment—a 2-year extension of a randomized controlled trial
Authors
Tore Fjalestad
Margrethe Øye Hole
Publication date
01-10-2014
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 7/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-013-1403-y

Other articles of this Issue 7/2014

European Journal of Orthopaedic Surgery & Traumatology 7/2014 Go to the issue