Functional and quality-of-life results of displaced and nondisplaced proximal humeral fractures treated conservatively.

OBJECTIVES: Functional and quality-of-life outcomes of conservatively treated proximal humeral fractures. DESIGN: Prospective study. SETTING: University orthopedic department at a hospital. PATIENTS/PARTICIPANTS: Seventy consecutive patients between the ages of 60 and 85 years. INTERVENTION: Conservative treatment. MAIN OUTCOME MEASUREMENTS: Functional outcome measured according to the Constant score, quality of life assessed using EuroQol-5D, and fracture pattern analyzed with x-ray and computed tomography scan. RESULTS: : All fractures consolidated uneventfully with no loss of reduction in either group. Four-part fractures obtained the worst functional results (33.66) followed by three-part fractures (54.64) and finally two-part fractures (65.88 and 71). Mild pain was expected in three- and four-part fractures, whereas two-part fractures achieved near complete pain relief. Nondisplaced fractures obtained a final Constant score of 73.58 and displaced fractures a score of 59.41 with significant differences in all Constant score items with the exception of external rotation. Although patients older than 75 years scored lower (54.63) than those younger than 75 years (70.83), there was no difference in the quality-of-life perception. CONCLUSION: Conservative treatment of proximal humeral fractures in those patients older than age 75 years provides good pain relief with limited functional outcome. Despite limited functional outcome, this appears to have no effect on the quality-of-life perception in the population studied. Four-part fractures present the worst results and treatment options may need to be discussed with the patient to adjust treatment to patient expectations.