Surgical versus non-surgical treatment for 3- and 4-part proximal humerus fractures

Česká verzia

Authors: M. Kilian ¹; R. Zamborský ²; I. Chandoga ¹; M. Budaj ³; S. Vajczikova ¹
Authors place of work: II. Ortopedicko-traumatologická klinika, UN sv. Cyrila a Metoda a Univerzita Komenského v Bratislave prednosta: doc. MUDr. S. Vajcziková, PhD ¹; Klinika úrazovej chirurgie, UN L. Dérera a Univerzita Komenského a Slovenská Zdravotnícka Univerzita v Bratislave prednosta: prof. MUDr. P. Šimko, CSc ²; Oddelenie centrálneho príjmu, Nemocnica sv. Cyrila a Metoda a Univerzita Komenského v Bratislave primár: MUDr. D. Holas ³
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 2, s. 60-68.
Category: Původní práce

Summary

Introduction:
Proximal humerus fractures account for about 4−5% of all fractures. Treatment of 3- and 4-part fractures is difficult, and the optimal treatment option remains controversial. The aim of the study was to compare surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus in adults.

Method:
A prospective study of surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus was conducted at the 2^ndDepartment of Orthopedics and Traumatology, University Hospital Bratislava, from September 2010 until September 2013. Patients included in the study were compliant adults patients with 3- and 4-part proximal humerus fractures Neer type IV, V and VI. Twenty patients were treated surgically. The group included 13 women (65%) and 7 men (35%). Mean age was 60.9±7.67 (52–80) years. Angle-stable plates (Philos, Synthes) and intramedullary nails (Multilock, Synthes) were used.

The non-surgical group included 19 patients, consisting of 12 (63.2%) women and 7 (36.8%) men. Mean age of both sexes was 66.3±9.5 (52−88) years. Gilchrist bandage was applied for the maximum of 3 weeks. All patients were evaluated at 12 months from treatment using the Constant-Murley scoring system and the Oxford Shoulder Score. Treatment complications were evaluated as a secondary step.

Results:
The mean individual relative Constant-Murley score was 57.8±23.5% (11−88%) in the surgical group. The mean Oxford Shoulder score was 34.8±10.6 (10−46) points. Complications were recorded in 12 patients (60%). In the non-surgical group, the mean individual relative Constant-Murley score at 12 months from injury was 60.9±20.9% (16−90%). The mean Oxford Shoulder score was 36.1±8.9 (15−48) points. Complications were recorded in 4 patients (21.1%).

Conclusions:
In this study, surgical treatment patients with displaced 3- and 4-part proximal humerus fractures, mostly treated by angle-stable plates, showed a number of complications. Poor functional results of the surgical group were comparable to those of the non-surgical group. The indication for surgery, patient selection, type of surgery, surgical experience and subsequent rehabilitation should be carefully assessed for better results.

Key words:
proximal humerus fracture − surgical treatment − non-surgical treatment − 3- and 4-part fractures

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