Epidemiology of proximal humerus fractures.

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Abstract

[Indexed for MEDLINE] 18. J Orthop Trauma. 2023 Sep 1;37(9):e341-e348. doi: 10.1097/BOT.0000000000002612. The Translated Proximal Humerus Fracture: A Comparison of Operative and Nonoperative Management. Cosic F(1), Kirzner N(1), Edwards E(1)(2), Page R(3)(4), Kimmel L(2)(5), Gabbe B(2)(6). Author information: (1)Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia. (2)School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. (3)Department of Orthopaedic Surgery, University Hospital Geelong, Geelong, Australia. (4)Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Deakin University, Geelong, Australia. (5)Department of Physiotherapy, The Alfred, Melbourne, Australia; and. (6)Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, United Kingdom. OBJECTIVES: To report on the long-term outcomes of the management of translated proximal humerus fractures. DESIGN: A prospective cohort study was conducted from January 2010 to December 2018. SETTING: Academic Level 1 trauma center. PARTICIPANTS/PATIENTS: A total of 108 patients with a proximal humerus fracture with ≥100% translation, defined as no cortical bony contact between the shaft and humeral head fragments, were included. INTERVENTION: Patients were managed nonoperatively with sling immobilization or with operative management as determined by the treating surgeon. MAIN OUTCOME MEASURES: Outcome measures were the Oxford Shoulder Score, EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, nonunion/malunion, and avascular necrosis. RESULTS: Of the 108 patients, 76 underwent operative intervention and 32 were managed nonoperatively. The mean (SD) age in the operative group was 54.3 (±20.2) years and in the nonoperative group was 73.3 (±15.3) years ( P < 0.001). There was no association between Oxford Shoulder Score and management options (mean 38.5 [±9.5] operative versus mean 41.3 [±8.5] nonoperative, P = 0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference was 0.16 (95% CI, 0.04-0.27; P = 0.008); EQ-5D VAS adjusted mean difference was 19.2 (95% CI, 5.2-33.2; P = 0.008). Operative management was associated with a lower odds of nonunion (adjusted OR 0.30; 95% CI, 0.09-0.97; P = 0.04), malunion (adjusted OR 0.14; 95% CI, 0.04-0.51; P = 0.003), and complications (adjusted OR 0.07; 95% CI, 0.02-0.32; P = 0.001). CONCLUSION: Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes after surgical fixation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BOT.0000000000002612