IMPACT OF NON-DISPLACED PROXIMAL HUMERAL FRACTURES ON THE UPPER-EXTREMITY FUNCTION AND PATIENT’S SUBJECTIVE PERCEPTION OF HEALTH

Abstract

Background: Although most proximal humerus fractures occur in postmenopausal women and are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies due to their theoretical lower incidence. We hypothesized that proximal humeral fractures patients are among the commonest fractures associated to osteoporosis, and may represent a major cause of functional disability.

Objective: To evaluate the incidence of non-displaced proximal humeral fractures in comparison with other outpatient treated osteoporotic fractures, and to assess their functional impact and on the quality of life perceived by the patients.

Methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated non-operatively in 358 trauma centres were recorded during a three month period. The fractures were considered osteoporotic if they were caused by a low-energy trauma. Pathologic fractures were ruled out. The incidence of proximal humeral fractures in relation to other osteoporotic fractures was calculated. Patients were interviewed by telephone six months after the fracture using the Spanish versions of the DASH and EuroQoL 5D questionnaires.

Results: 5762 women (mean age: 73± 7.5 years) were studied. 912 (17.5%) had suffered proximal humeral fractures. Overall, proximal humerus fracture was the most frequent site, after distal radius and vertebral fractures, and was the most common in patients older than 75 years (393 cases, 43.1%). The mean DASH score was 26,62±17,9. The EuroQoL 5D questionnaire showed that 67,3% had pain or discomfort, and disclosed significant reductions in the functional capacity, especially concerning problems with self care (44,5%), performing usual activities (56,5%), and anxiety or depression (32,7%).

Discussion: Non-displaced proximal humeral fractures are among the most common fractures associated to osteoporosis, and constitute the most frequent non-operatively treated fracture in patients older than 75 years. Even if they are non-displaced, they can be a major cause of functional disability, and result in a reduction in the patient’s subjective perception of health.