Revisiting the Outcome of Displaced Two-Part Fracturesof the Humeral Neck in Elderly Patients after Conservative Treatment

摘要

The aim of this study was to evaluate our experience with regard to the outcome of displaced two-part fractures of the humeral neck in elderly patients that were treated conservatively. Between July 2008 and June 2010, 53 consecutive patients (42 females and 11 males; mean age = 74; range = 60-92) with an acute, displaced, two-part fracture of the humeral neck were treated conservatively using a sling and swathe for two weeks, followed by a standard rehabilitation protocol. The inclusion criteria were a displacement of the shaft >50% of its width and/or angulation of the shaft >45 degrees on standard radiographs. The exclusion criteria were patients younger than 60 years of age and those with cognitive or systemic impairment that would preclude the recommended physiotherapy. Patients were followed-up for one year, and were assessed at 3, 6, and 12 months using the Constant- Murley Score (CMS) and the Disabilities of the Arm,Shoulder, and Hand Questionnaire (DASH). Patients weredivided into two groups, those below 70 years of age andthose above 70-. Two-way repeated measures analysis ofvariance (ANOVA) was used to determine if there weresignificant differences between the results at 3, 6 and 12months for both groups, and if the results were significantlydifferent between the two groups.Forty-eight out of 53 patients (91%) were able to completethe follow-up schedule, while five patients died. The meanCMS improved progressively at three (51.3), six (60.4), and12 (61.3) months. The mean DASH also improvedprogressively at three (38.8), six (34.8), and 12 (32.6)months. For both groups, the CSS and DASH improvedsignificantly from three to six months and from three to 12months. However, the improvements were not significantfrom just six to 12 months. Between the two groups, theresults at three, six, and 12 months were not significantlydifferent from each other. On final follow-up, 42 out of 48patients (88%) were satisfied with their outcome andreported that they would choose to undergo the sametreatment if they had to do everything all over again.Conservative management of displaced two-part fractures ofthe humeral neck in elderly patients is a safe, efficacious, andacceptable treatment.