Proximal humeral fractures treated conservatively settle during fracture healing

• Published in: Journal of orthopaedic trauma Vol. 29; no. 2; p. e24
• Main Authors: Foruria, Antonio M, Martí, Milagros, Sanchez-Sotelo, Joaquin
• Format: Journal Article
• Language: English
• Published: United States 01.02.2015
• Subjects: Adult; Aged; Aged, 80 and over; Braces; Female; Fracture Healing - physiology; Humans; Immobilization; Male; Middle Aged; Prognosis; Prospective Studies; Risk Factors; Shoulder Fractures - physiopathology; Shoulder Fractures - rehabilitation; Shoulder Fractures - therapy
• ISSN: 1531-2291
• DOI: 10.1097/BOT.0000000000000244

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). Prospective, comparative cohort study. Level I trauma center. Eighty-nine prospectively enrolled adults. Six weeks of sling immobilization and a home-based program rehabilitation protocol started 2 weeks after injury. 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. 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. Proximal humerus fractures treated conservatively settle at the head-shaft junction during healing. Substantial additional displacement of tuberosities was seldom observed. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.