FUNCTIONAL AND QUALITY OF LIFE OUTCOME ABOUT PROXIMAL HUMERAL FRACTURES CONSERVATIVELY TREATED

Abstract

Introduction: Optimal management of proximal humeral fractures is still to be defined. The objective of this study is to present the functional and quality of life results of proximal humeral fractures conservatively treated in elderly population

Material and Methods: Prospective study including 74 fractures in patients over 60 and less than 85 years-old. 4 patients lost at final follow-up. Fractures were assessed by X-ray and C.T. exam. There were 14 one-part fractures, 15 two-part greater tuberosity (GT), 17 two-part surgical neck, 10 three-part GT, 6 four-part, 6 two-part GT fracture dislocation, 1 four-part fracture dislocation and 1 impression fracture. Constant Score, EuroQol 5-D and X-Ray study at two-year follow-up. U Mann-Whitney for non parametric and t-student for parametric.

Results: Constant Score: non-displaced fractures mean of 73,58 while displaced fractures 59,41 (p0,003). Significant differences between them in all Constant items except for External rotation (p0,17). Total Constant Score diminished as fracture pattern increased complexity: 2-part GT 72,78, 2-part surgical neck 65,88, 2-part GT fracture dislocation 71, 3-part GT 54,64 and 4-part 33,66. Despite these differences there were no significant differences as far as pain was concerned among all displaced fractures.

Quality of life perception: no significant differences in VAS between displaced and non-displaced fractures (p 0,75). 4 avascular necrosis at final follow-up, 2 in the 4-part group, 1 in 3-part GT and 1 in 4-part fracture dislocation.

Conclusion: Conservative treatment of proximal humeral fractures give reasonable good functional results in 1-part, 2-part GT, 2-part surgical neck and 2-part GT fracture dislocation in specially selected elderly population. 3-part GT and 4-part fractures achieve a limited functional result with conservative treatment. No differences have been observed between non-displaced and displaced fractures conservatively treated as far as quality of life perception is concerned in such elderly population.