title: The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients.
abstract: OBJECTIVE
  To evaluate the results of nonoperative treatment of three- and four-part fractures of the proximal humerus in patients who refused surgery or could not undergo surgery because of medical conditions.
  
  
  METHODS
  Retrospective evaluation of prospective collected data.
  
  
  METHODS
  Educational and research hospital. Level IV, therapeutic case series.
  
  
  METHODS
  Eighteen patients (eight three- and 10 four-part fractures) were included. The mean age was 68.2 ± 13.8 years (range, 39-90 years). The mean follow-up was 39.1 ± 12.4 months (range, 24-60 months). Patients were grouped into two: Group A being younger than 65 years and Group B 65 years or older.
  
  
  METHODS
  Standardized nonoperative treatment and follow-up protocols were used.
  
  
  METHODS
  Functional and radiographic assessments were performed in posttreatment first year and at latest follow-up. Constant-Murley scores were also obtained for both shoulders.
  
  
  RESULTS
  The mean Constant-Murley score was 61.3 ± 13.5 (range, 40-85) at latest follow-up. Osteonecrosis was detected in five patients. All patients had significantly lower SF-36 scores for all subscales except mental health than the normal Turkish population. There was no significant difference between three- and four-part fractures regarding age and Constant-Murley scores. The mean Constant-Murley score of the Group A patients with three-part fractures was significantly higher when compared with the Group A patients with four-part fractures. There was no significant difference between patients with and without osteonecrosis regarding fracture types or the Constant-Murley scores at the latest follow-up.
  
  
  CONCLUSIONS
  Although the individual fracture type does not have an influence on functional results, these results are better in patients younger than 65 years with three-part fractures. The results of the nonoperative treatment of these fractures are satisfactory even in elderly patients. The radiographic appearances did not correspond with the functional results.
authors.affiliation: Third Orthopedics and Traumatology Clinic, Ankara Numune Educational and Research Hospital, Ankara, Turkey. hyyuksel@hotmail.com
authors.forename: Halil Yalçin
authors.initials: HY
authors.lastname: Yüksel
authors.forename: Serdar
authors.initials: S
authors.lastname: Yılmaz
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Akşahin
authors.forename: Levent
authors.initials: L
authors.lastname: Celebi
authors.forename: Hasan Hilmi
authors.initials: HH
authors.lastname: Muratli
authors.forename: Ali
authors.initials: A
authors.lastname: Biçimoğlu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult