title: Non-operative treatment of four-part fractures of the proximal end of the humerus: results of a prospective and retrospective multicentric study.
abstract: The aim of this study was to evaluate the short- and medium-term results of non-operative treatment of four-part fractures of the proximal end of the humerus. The initial hypothesis was that non-operative treatment of fractures with little or no displacement is equivalent or superior to surgical treatment, and that non-operative treatment is probably insufficient for displaced fractures.
  
  
  
  This was a multicentric, prospective and retrospective study, based on 384 four-part proximal humerus fractures, 58 of which involved non-operative treatments - 37 in the prospective study (Pro-CT4) and 21 in the retrospective study (Retro-CT4). The average patient age was 64 +/- 14 years (39-90); 66 % were female and 34 % male. In 88 % of these cases, non-operative treatment was chosen for the fracture, as there was little or no displacement. In 10 % of cases, non-operative treatment was chosen "by default", due to the patient's medical conditions, as surgery was contraindicated, and in 2 % of cases due to the patient refusing surgery. All patients were reviewed clinically and radiologically, with SSV evaluation, absolute and weighted Constant scores and the Quick DASH score all assessed. The main evaluation criterion was the weighted Constant score which was considered a failure when below 70 %.
  
  
  
  In the Pro-CT4 study, the average follow-up period was 11 +/- four months (5-18) with functional scores as follows: average SSV: 72 +/- 26 % (8-100); average Constant score: 65 +/- 21 points (21-95); average weighted Constant score: 86 +/- 26 % (32-130); average Quick DASH: 23 +/- 21 (0-64). 27 % of patients had a weighted Constant score below 70 %. In the Retro-CT4 study, the average follow-up period was 38 +/- 13 months (18-62) with functional scores as follows: average SSV: 73 +/- 17 % (30-100); average Constant score: 68 +/- 18 points (33-95); average weighted Constant score: 88 +/- 27 % (47-133); average Quick DASH: 18 +/- 16 (0-48); 24 % of patients had a weighted Constant score below 70 %.
  
  
  
  This study confirms our initial hypothesis. When non-operative treatment of four-part proximal humerus fractures is carried out by choice, the results are excellent. However, when this treatment is carried out "by default" - especially because surgery is contraindicated - the results are disappointing.
  
  
  
  prospective and retrospective studies.
authors.affiliation: Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble Hôpital Sud, Avenue de Kimberley - BP 338, 38434, Échirolles cedex, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Bouchet
authors.affiliation: Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000, Nancy, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Block
authors.affiliation: Service de chirurgie orthopédique et traumatologie du sport, CHU Nice Pasteur 2, 30 Voie Romaine, CS 51069, 06001, Nicecedex 1, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: D'ollonne
authors.affiliation: Service d'orthopédie et Traumatologie I, CHRU Trousseau, Université François Rabelais, Avenue de la République, 37044, Tours Cedex 1, France.
authors.forename: François
authors.initials: F
authors.lastname: Gadea
authors.affiliation: Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble Hôpital Sud, Avenue de Kimberley - BP 338, 38434, Échirolles cedex, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Gaillot
authors.affiliation: Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Sirveaux
authors.affiliation: Clinique Universitaire de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble Hôpital Sud, Avenue de Kimberley - BP 338, 38434, Échirolles cedex, France. DSaragaglia@chu-grenoble.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Saragaglia
mesh_terms: D006801:Humans; D006811:Humerus / Q000293:injuries*; D011446:Prospective Studies; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000503:physiopathology*
keywords: Four-part fracture; Fracture; Humerus; Non-operative treatment; Proximal