Proximal Humeral Fracture; Predictors of Functional and Radiologic Outcome

Abstract

Background: Despite the high prevalence of proximal humeral fracture, one of the most prevalent osteoporotic fractures, its treatment has always been challenging. Here we are going to determine the factors that affect the outcomes of such fractures. Methods: The present retrograde cohort study was conducted in a tertiary trauma center during 2015-2020. The Neer classification was used to classify fracture severity. Patients’ functional status was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley Score (CMS). Patients were selected thorough purposive sampling method. Results: The study participants included 70 patients with a mean age of 50.47 ± 16.73 years. The 3 treatment options of open reduction and internal fixation (ORIF) (39 cases; 52%), hemiarthroplasty (3 cases; 4%), and conservative treatment (33 patients; 44%) were considered. Malunion was the most prevalent complication in the study population (9 cases; 12%). The mean DASH score of the participants was 29.91 ± 20.43. The mean DASH score in patients of over 65 years of age was higher than in those under 65 years (36.97 vs. 28.14; P = 0.136). The score in patients underwent surgery (ORIF and hemiarthroplasty) showed a significant difference compared to the patients who were treated non-surgically (P = 0.050). The mean CMS of participants was 64.09 ± 22.71. The mean age of patients classified as “poor” was significantly higher than the “excellent” group (P = 0.041). The mean visual analogue scale (VAS) score of the participants was 2.80 ± 2.49. The VAS score was significantly higher in patients with more severe fracture based on the Neer classification (P = 0.050).  Conclusion: The present study results showed the significant effect of age, fracture severity, and underlying disease on the proximal humeral fracture outcome. A longer follow-up period was observed in patients who had better functional outcomes. However, more studies with larger sample size are required to evaluate proximal humeral fracture outcomes in order to help us to improve outcomes and reduce complications.