Proximal humeral fractures in patients over 60 years old: a randomized study of nonoperative versus operative treatment with locking plate

Abstract

Background

Proximal humerus fractures (PHFs) are common in the elderly, with a rising incidence. Despite advances in surgical techniques, the optimal treatment for displaced PHFs remains controversial, as high-quality studies show no significant differences in functional outcomes between surgical and nonsurgical treatments. This study aims to compare nonoperative with surgical treatment using a locking plate (LP) for displaced PHFs in patients over 60 year old.

Methods

This prospective, randomized clinical trial compared nonoperative and operative treatments using LPs for displaced PHFs in patients over 60 year old. Patients were randomized 1:1 into 2 groups using a block randomization stratified by tuberosity involvement. The primary outcome was the Constant-Murley score at 24 months. Secondary outcomes included the Individual Relative Constant Score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) score at 3, 6, 12, and 24 months. The incidence of complications and the need for reoperations were evaluated.

Results

Eighty patients were randomized, with 71 completing 24 months of follow-up: 40 in the non-operative group and 31 in the operative group. At 24 months, the mean Constant-Murley scores were 68.7 ± 16.1 for the non-operative group and 66.5 ± 15.8 for the operative group (P = .433). The ASES score at 24 months was 77.0 ± 23.1 for the nonoperative group and 79.1 ± 20.0 for the operative group (P = .871). The SANE scores at 24 months were 83.8 ± 19.3 for the nonoperative group and 88.5 ± 17.2 for the operative group (P = .236). The Individual Relative Constant Score at 24 months was 79.5 ± 25.2% for the nonoperative group and 73.0 ± 29.2% for the operative group (P = .244). Seventeen patients experienced complications, with 6 (15.0%) in the nonoperative group and 11 (35.5%) in the operative group (P = .070). The rate of a new surgical indication was 12.5% in the nonoperative group and 22.6% in the operative group (P = .421). Rotator cuff tears were 20.0% in the nonoperative group vs. 25.8% in the operative group (P = .768).

Conclusion

The operative treatment of displaced proximal humeral fractures with LP osteosynthesis in patients over 60 year old shows no evidence of differences in clinical outcomes compared to nonoperative treatment, as measured by the Constant-Murley Score, Individual Relative Constant Score, ASES, SANE, and complication rates.