Abstract
BackgroundProximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures.Material and methodsWe collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality.ResultsPatients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5.ConclusionsPatients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy.Level of evidenceLevel 3.
Highlights
Proximal humerus fractures (PHF), after proximal femur and distal radial fractures, represent the third most common fracture in patients over the age of 65 years [1]
Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment
Neuhaus et al [15] note that open reduction and internal fixation of these fractures is associated with a high risk of adverse events and increased mortality compared with conservative treatment, and add that surgical treatment involves significant short-term risks that must be taken into account when making decisions, especially with elderly patients
Summary
Proximal humerus fractures (PHF), after proximal femur and distal radial fractures, represent the third most common fracture in patients over the age of 65 years [1]. It has been observed that an increase in the risk of falls is accompanied by a higher rate of hip fractures and PHFs [8] and increasing numbers of surgical treatments of these fractures have been observed over recent years [9]. This explains why studies of the functional impact and results of these operations have increased. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures
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Schedule a callMore From: Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
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