In the present study, we evaluated the results of treatment in 8 cases in which we elected conservative treatment despite the presence of surgical indications, and we assessed the pros and cons of the indications in 18 cases that we treated surgically.
The surgically treated group (S group) consisted of 18 patients: 10 with a 2-part fracture (fracture-dislocation in 1) and 8 with a 3-part fracture (fracture-dislocation in 2). Their ages at the time of surgery ranged from 22 to 76years old (mean: 42.8 years old); and the mean postoperative follow-up period was 3 years and 2 months. There were 8 patients in the conservatively treated group (C group); 4 of them had a 2-part fracture and the other 4had a 3-part fracture. Their ages at the time of the injury ranged from 60 to 85 years old (mean: 77 years old), and the mean follow-up period was 9.5 months. The results of treatment were assessed on the basis of the JOA scores. We also calculated the humeral neck shaft angle and the distance between the tip of the head of the humerus and the plate edge or the greater tuberosity (distance A) on the radiographs, and evaluated their influence on the results. Bone union was achieved in every case. The time required for a bone union to occur in the S group ranged from 13 to 25 weeks (mean: 18 weeks), as opposed to 9 to 16 weeks (mean: 12.4 weeks) in the C group. The mean JOA score in the S group was 83.5, versus 86.7 in the C group. In the radiographic evaluation, the neck shaft angles ranged from 122° to 148° (mean: 134° ) in the S group, as opposed to 120°to 162° (mean: 140.5° ) in the C group, and the distance A ranged from 10 mm to 29 mm (mean: 21 mm) in the S group, versus -5 mm to 32 mm (mean: 6.1 mm) in the C group. No correlations were found between the radiographic evaluation data and the results of treatment in the C group, whereas in the S group a positive correlation was found between distance A and the JOA scores, and results of treatment were significantly better in those patients with a neck shaft angle of 130° or more compared to the other patients with less than 130°.
Satisfactory results were obtained by conservative treatment of fractures of the proximal humerus without dislocation in elderly patients even though a high degree of malunion persisted. Selections of surgical treatment for patients who are not very active need to be reconsidered, even in cases of severe displacement.
