Revisiting the Outcome of Displaced Two-Part Fractures of the Humeral Neck in Elderly Patients after Conservative Treatment

Abstract

The aim of this study was to evaluate our experience with regard to the outcome of displaced two-part fractures of the humeral neck in elderly patients that were treated conservatively. Between July 2008 and June 2010, 53 consecutive patients (42 females and 11 males; mean age = 74; range = 60-92) with an acute, displaced, two-part fracture of the humeral neck were treated conservatively using a sling and swathe for two weeks, followed by a standard rehabilitation protocol. The inclusion criteria were a displacement of the shaft >50% of its width and/or angulation of the shaft >45 degrees on standard radiographs. The exclusion criteria were patients younger than 60 years of age and those with cognitive or systemic impairment that would preclude the recommended physiotherapy. Patients were followed-up for one year, and were assessed at 3, 6, and 12 months using the ConstantMurley Score (CMS) and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH). Patients were divided into two groups, those below 70 years of age and those above 70-. Two-way repeated measures analysis of variance (ANOVA) was used to determine if there were significant differences between the results at 3, 6 and 12 months for both groups, and if the results were significantly different between the two groups. Forty-eight out of 53 patients (91%) were able to complete the follow-up schedule, while five patients died. The mean CMS improved progressively at three (51.3), six (60.4), and 12 (61.3) months. The mean DASH also improved progressively at three (38.8), six (34.8), and 12 (32.6) months. For both groups, the CSS and DASH improved significantly from three to six months and from three to 12 months. However, the improvements were not significant from just six to 12 months. Between the two groups, the results at three, six, and 12 months were not significantly different from each other. On final follow-up, 42 out of 48 patients (88%) were satisfied with their outcome and reported that they would choose to undergo the same treatment if they had to do everything all over again. Conservative management of displaced two-part fractures of the humeral neck in elderly patients is a safe, efficacious, and acceptable treatment.