Comparison of Locked Plate Fixation and Nonoperative Management for Displaced Proximal Humerus Fractures in Elderly Patients
Use of locked plate fixation for proximal humerus fractures in elderly patients has increased markedly in recent years. We conducted a study to compare outcomes of operative (locked plate fixation) and nonoperative management of these fractures.
From our database, we identified 207 displaced proximal humerus fractures that met all inclusion and exclusion criteria. For patients who accepted our invitation to return for evaluation, clinical outcome was assessed using several questionnaires: Constant; DASH (Disabilities of the Arm, Shoulder, and Hand); SMFA (Short Musculoskeletal Functional Assessment); and Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test.
Of the 207 patients, 61 were managed operatively and 146 nonoperatively. Operative patients had lower rates of malunion but higher rates of complications, which included screw perforation, loss of fixation, infection, and secondary surgical procedures. Forty-seven patients (a mix of operative and nonoperative) accepted our invitation to return for clinical evaluation at a mean follow-up of 3.3 years. The 2 groups’ clinical outcomes were similar.
Conclusion
Although use of locked plate fixation in treating proximal humerus fractures in elderly patients has increased markedly over recent years, definitive evidence supporting such management is lacking. In the present study, the outcomes of locked plate fixation were similar to those of nonoperative treatment. In addition, rates of complications and secondary surgical procedures were higher for operative patients than for nonoperative patients. Research is needed to identify the circumstances under which locked plating improves treatment outcomes for displaced proximal humerus fractures in elderly patients.
