RESULTS OF CONSERVATIVE TREATMENT IN PATIENTS WITH NEER TYPE III AND IV PROXIMAL HUMERUS FRACTURES

Abstract

Aim: The aim of this study is to evaluate the results of conservative treatment of Neer type III and IV fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions.

Methods: Eighteen patients were included in the study. There were 8 Neer type III and 10 Neer type IV fractures. None of the patients had head-splitting fractures. Treatment and follow-up protocols were standardized for all cases. All patients were assessed for Constant scores in postoperative first year and at latest follow-up. Patients were divided into two groups regarding their age. Patients of 65 years or under that were named as group A (7 patients), while patients over 65 years old were named as group B (11 patients). Patients were further divided into two groups regarding their Constant scores. Patients with less than 70 points were named as group I (12 patients), while patients with 70 points or higher were named as group II (6 patients). Statistical analysis was performed using student’s t test, chi-square test and Fischer exact test.

Results: Mean age was 68.2± 13.8(39–90) years. Mean follow-up was 34.5±12.4 (18–56) months. Mean Constant score was 56.1±14.7 (26–76) points in postoperative first year follow-up. Mean Constant score was 59.7±13.9 (36–84) points at latest follow-up. Osteonecrosis of the humeral head was dedected in 5 patients. There was no significant difference between group A and group B regarding Constant scores (p=0.233). There was no significant difference between group I and group II regarding age (p=0.178). There was no significant difference between Neer type III and Neer type IV fractures regarding age (p=0.176) and Constant scores (p=0.075). Mean postoperative first year Constant score of Group A patients with type III fractures was significantly higher when compared to group B patients with type IV fractures (p=0.046). Constant scores at latest follow-up (p=0.261) and fracture types (p=0.618) were similar between patients with osteonecrosis and without osteonecrosis.

Conclusions: Results of conservative treatment of these fractures are satisfactory even in elderly patients. Similar functional results as in younger patients can be achieved with proper and accurate treatment. While fracture type individually does not have an influence on functional results, functional results are better in young patients with type III fractures then in old patients with type IV fractures.