[Effectiveness comparison of operative and non-operative treatment for complex proximal humeral fractures in elderly patients].
OBJECTIVE
To compare the effectiveness between operative and non-operative treatment for 3- and 4-part proximal humeral fractures in elderly patients.


METHODS
Between January 2009 and January 2011, 35 patients with 3- or 4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation (n = 20, operative group) and with closed reduction and splint or cast fixation (n = 15, non-operative group). There was no significant difference in gender, age, etiology, fracture type, and disease duration between 2 groups (P > 0.05). The postoperative rehabilitation protocol was performed in 2 groups.


RESULTS
All patients of the operative group achieved healing of incision by first intention. All patients were followed up 16 months on average (range, 12-20 months). The X-ray films showed that the other fractures healed except 1 case (5.0%) nonunion in operative group. Varus malunion was found in 1 case (6.7%) of non-operative group and 2 cases (10.0%) of operative group. Humeral head necrosis was found in 1 case respectively in 2 groups (5.0% and 6.7%). There was no significant difference in complication incidence between 2 groups (P > 0.05). The Constant-Murley scores of non-operative group and operative group were 64.7 +/- 9.9 and 66.8 +/- 11.8 at last follow-up respectively, showing no significant difference (t = 0.59, P = 0.47).


CONCLUSIONS
Operative treatment has similar effectiveness to non-operative treatment for 3- and 4-part proximal humeral fractures. In elderly patients, non-operative treatment should be chosen.
Department of Orthopedics, 101st Hospital of Chinese PLA, Wuxi Jiangsu 214044, PR China. kingrong@sina.com
Yanhua
Y
Fan
Shibo
S
Wang
Yuchun
Y
Luo
D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000209:etiology / Q000601:surgery; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery / Q000628:therapy*; D013165:Splints; D016896:Treatment Outcome