title: Proximal humeral fractures treated conservatively settle during fracture healing.
abstract: OBJECTIVE
  Determine the relative position of the main fractured fragments of proximal humerus fractures treated conservatively to compare displacement at 2 time points: injury (0), and 1 year later (1).
  
  
  METHODS
  Prospective, comparative cohort study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Eighty-nine prospectively enrolled adults.
  
  
  METHODS
  Six weeks of sling immobilization and a home-based program rehabilitation protocol started 2 weeks after injury.
  
  
  METHODS
  Standardized radiographs of injured shoulders were obtained in all patients at times 0 and 1. Computed tomography scans were also obtained at these times in 73 cases. Forty-two computer-assisted measurements of displacement were performed at times 0 and 1 and then compared. Factors related to progression of displacement were analyzed.
  
  
  RESULTS
  Ninety percent of fractures were classified into 1 of 4 patterns: posteromedial (varus) impaction (46), lateral (valgus) impaction (13), isolated greater tuberosity (15), and anteromedial impaction (6). Head-shaft displacement increased over time. In posteromedial impaction fractures, average fracture settling included 9 degrees in varus, 7 degrees in retroversion, and 3.2 mm in posterior shortening. In valgus-impacted fractures, a decrease in valgus tilt and a tendency toward a more anterior orientation of the articular surface was observed. Greater tuberosity displacement increased more than 5 mm in less than 20% of cases. Age and initial displacement were related to progression of displacement.
  
  
  CONCLUSIONS
  Proximal humerus fractures treated conservatively settle at the head-shaft junction during healing. Substantial additional displacement of tuberosities was seldom observed.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopedic Surgery, Fundación Jiménez Díaz, Madrid, Spain; †Department of Radiology, La Paz University Hospital, Madrid, Spain; and ‡Department of Orthopedic Surgery, The Mayo Clinic, Rochester MN.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Foruria
authors.forename: Milagros
authors.initials: M
authors.lastname: Martí
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sanchez-Sotelo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001915:Braces; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012784:Shoulder Fractures / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*