J Korean Fract Soc.  2013 Oct;26(4):292-298. 10.12671/jkfs.2013.26.4.292.

The Result of Conservative Treatment of Proximal Humerus Fracture in Elderly Patients

• Baek SG
• Oh CW
• Byun YS
• Oh JK
• Kim JW
• Yoon JP
• Lee HJ
• Kim HS

• KMID: 2183830
• DOI: http://doi.org/10.12671/jkfs.2013.26.4.292

Abstract

PURPOSE
With the increase in the old age population, proximal humerus fractures have been increasing recently. However, complications after operative treatment, such as fixation failure, are common because of osteoporosis. We treated proximal humerus fractures in patients with osteoporosis conservatively, and evaluated the radiographic and functional results by analyzing the factors affecting the results.
MATERIALS AND METHODS
Nineteen out of 30 cases for whom the clinical follow-up was over 1 year were included in this retrospective study. There were 17 females and 2 males, and the mean age was 73.2 years. The causes were slip from a short height (18 cases) and a minor car accident (1 case). We evaluated the union period, nonunion, malunion and the Constant score and analyzed several factors affecting the functional result, such as age, fracture pattern, and malunion.
RESULTS
Seventeen cases (89.5%) obtained union within 12.8 weeks on average. Neck-shaft angle was 125.3degrees on average, with seven cases of malunion. The Constant score was 84.1 on average, and there were excellent scores in 11 cases, good scores in 4 cases, and fair scores in 2 cases. Fracture pattern, neck-shaft angle, or malunion did not affect the functional outcome, and elderly patients showed poorer shoulder function.
CONCLUSION
Proximal humeral fractures with osteoporosis may achieve a high rate of bony union when treated with conservative methods. Despite the common occurrence of malunion, a satisfactory functional outcome may be expected.

Keyword

Shoulder fracutre; Proximal humeral fracture; Aged; Conservative treatment; Osteoporosis

MeSH Terms

Aged*
Female
Follow-Up Studies
Humans
Humerus*
Male
Osteoporosis
Retrospective Studies
Shoulder
Shoulder Fractures

Figure

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  Fig. 1 (A) An 80-year-old female using a shoulder immobilizer with an appropriate axillary pad. (B) An antero-posterior radiograph shows well-maintained reduction of the fracture during use of a shoulder immobilizer with axillary pad.

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  Fig. 2 (A) A 78-year-old female with a displaced proximal humerus fracture (AO/OTA 11-A2). (B) Satisfactory reduction was achieved. (C) After 16 weeks, bony union was obtained, with acceptable alignment. (D) At 1 year, the patient had almost full recovery of her shoulder movements with a Constant score of 93 points.

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  Fig. 3 (A) An 84-year-old female sustained a proximal humerus fracture (AO/OTA 11-A2). (B) Reduction was achieved. (C) At 12 weeks, bony union was obtained, with varus deformity. (D) At 4 years, the patient showed a good functional outcome with mildly limited movements of the shoulder.

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