Abstract
PurposeDespite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for elderly patients. The aim of this retrospective cohort study was to evaluate health-related quality of life (HRQoL), functional outcome, pain and social participation in elderly patients, after operative and nonoperative treatment of displaced 3- and 4-part proximal humeral fractures.Methods150 patients aged ≥ 65, treated for a displaced 3- or 4-part proximal humeral fracture between 2004 and 2014, were invited to participate. Eventually 91 patients (61%) participated, of which 32 non-operatively treated patients were matched to 32 of the 59 operatively treated patients by propensity score matching. The EQ-5D, DASH, VAS for pain and WHODAS 2.0 Participation in Society domain were administered. Complications and reinterventions were registered.ResultsNo significant difference was found between the two treatment groups in HRQoL (p = 0.43), function (p = 0.78) and pain (p = 0.19). A trend toward better social participation in the operative group (p = 0.09) was found. More complications and reinterventions occurred in the operative group than the nonoperative group, with 9 versus 5 complications (p = 0.37) and 8 versus 2 reinterventions (p = 0.08).ConclusionsIn this study, we found no evidence of a difference in HRQoL, functional outcome or pain 1–10 years after operative or nonoperative treatment in patients of 65 and older with a displaced 3- or 4-part humeral fracture. Operatively treated patients showed a trend toward better social participation but also higher reintervention rates.
Highlights
Proximal humeral fractures are among the most common fractures in the elderly population [1]
Since the introduction of locking plates in the year 2000, operative treatment became a convenient option for elderly patients, as locking plates can be used in osteoporotic bone [9, 10]
This study found no significant differences in outcome between operatively and non-operatively treated patients regarding health-related quality of life (HRQoL), physical functioning or pain
Summary
Proximal humeral fractures are among the most common fractures in the elderly population [1]. Demographic research showed that proximal humeral fractures occur mostly in active persons aged 60 years and older [4]. In case of a minimally or undisplaced fracture, the treatment is mostly nonoperative. For complex 3- and 4-part fractures both operative and nonoperative treatment are implemented in clinical practice [6,7,8]. Since the introduction of locking plates in the year 2000, operative treatment became a convenient option for elderly patients, as locking plates can be used in osteoporotic bone [9, 10]. Operative treatment in elderly patients is performed more regularly than before the introduction of this technique [8]. Research has not been able to identify evident and reliable differences in outcome between
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