Proximal Humeral Fractures: Nonoperative Versus Operative Treatment

Background: Management of displaced proximal humeral fractures is subject of ongoing debate. Objectives: We aimed to review our results of operative treatment of proximal humeral fractures compared to age-, sex, and fracture-type controlled conservative treatment. We hypothesized that there is no significant difference in upper-extremity specific disability between patients treated with operative fixation and patients treated nonoperatively after displaced proximal humeral fracture. Our secondary null hypotheses were that there were no differences in pain intensity, satisfaction and physical function. Methods: Thirty-three patients treated with operative fixation were enrolled and randomly matched with 33 patients treated nonoperatively according to age (within 5 years), sex, ASA-score, Neer fracture type and mechanism of injury. The patients were evaluated using the disabilities of the arm, shoulder and hand (DASH) scale, the constant score, short form (SF)-36 health survey, CESD, the pain catastrophizing scale (PCS) and pain intensity and satisfaction questionnaires. Results: At follow-up, the nonoperatively treated patients had better functional outcomes than the operatively treated patients. Nonoperatively treated patients also scored better on pain intensity and satisfaction. There were no significant differences in CESD, PCS, and SF-36 physicaland mental health summary scores between cohorts. Conclusions: The results of this study suggest that operative treatment might, on average, be detrimental to patients with proximal humeral fractures compared to natural healing. It will be a key to identify patients who will benefit from surgery.