Objective: To evaluate the results of nonoperative treatment of three- and four-part fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions.
Design: Retrospective evaluation of prospective collected data.
Setting: Educational and research hospital. Level IV, therapeutic case series.
Patients: Eighteen patients (eight three- and 10 four-part fractures) were included. The mean age was 68.2 ± 13.8 years (range, 39-90 years). The mean follow-up was 39.1 ± 12.4 months (range, 24-60 months). Patients were grouped into two: Group A being younger than 65 years and Group B 65 years or older.
Intervention: Standardized nonoperative treatment and follow-up protocols were used.
Main outcome measurements: Functional and radiographic assessments were performed in posttreatment first year and at latest follow-up. Constant-Murley scores were also obtained for both shoulders.
Results: The mean Constant-Murley score was 61.3 ± 13.5 (range, 40-85) at latest follow-up. Osteonecrosis was detected in five patients. All patients had significantly lower SF-36 scores for all subscales except mental health than the normal Turkish population. There was no significant difference between three- and four-part fractures regarding age and Constant-Murley scores. The mean Constant-Murley score of the Group A patients with three-part fractures was significantly higher when compared with the Group A patients with four-part fractures. There was no significant difference between patients with and without osteonecrosis regarding fracture types or the Constant-Murley scores at the latest follow-up.
Conclusions: Although the individual fracture type does not have an influence on functional results, these results are better in patients younger than 65 years with three-part fractures. The results of the nonoperative treatment of these fractures are satisfactory even in elderly patients. The radiographic appearances did not correspond with the functional results.