Quality of life and functional outcome after a 2-part proximal humeral fracture: A prospective cohort study on 50 patients treated with a locking plate

• Published in: Journal of shoulder and elbow surgery Vol. 19; no. 6; pp. 814 - 822
• Main Authors: Olerud, Per, MD, Ahrengart, Leif, MD, Söderqvist, Anita, RN, Saving, Jenny, MD, Tidermark, Jan, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2010; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Bone Plates; Bone Screws; Diseases of the osteoarticular system; elderly; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; functional outcome; Humans; Injuries of the limb. Injuries of the spine; internal fixation; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Orthopedics; Prospective Studies; Prosthesis Design; Proximal humeral fractures; Quality of Life; Range of Motion, Articular - physiology; Shoulder Fractures - physiopathology; Shoulder Fractures - psychology; Shoulder Fractures - surgery; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Treatment Study; Level IV; functional outcome; Case Series; elderly; quality of life; Proximal humeral fractures; internal fixation; Human; Proximal; Prognosis; Treatment; Cohort study; Diseases of the osteoarticular system; Rheumatology; Fracture; Humerus; Trauma; Quality of life; Locking
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2009.11.046

Background The aim of the study was to report the 2-year outcome after a displaced 2-part fracture of the proximal humerus in elderly patients treated with a locking plate, including an assessment of the health-related quality of life (HRQoL). Material and methods We included 50 patients, mean age 75 (range, 55-93) years with 80% women. The fracture inclusion criteria were a displacement of the shaft of >50% of its width and/or >45° of angulation. Follow-up examinations were performed at 4, 12, and 24 months. The main outcome measures were the Constant and DASH scores and HRQoL according to the EQ-5D. Results Eight patients (16%) were re-operated upon during the study period. At the final follow-up the mean Constant score was 61 and the mean DASH score 32. The EQ-5Dindex score decreased from 0.86 before the fracture to 0.62 at 4 months. At 12 months the EQ-5Dindex score was 0.65 and at 24 months 0.68. The values at all follow-ups were significantly lower than before the fracture ( P < .001 in all 3 comparisons). Conclusion Locking plates appear to be a good treatment alternative in elderly patients with a displaced 2-part fracture of the surgical neck of the proximal humerus with an acceptable complication rate and an acceptable functional outcome; however, rigorous attention has to be paid to avoid screw penetration. Despite the overall acceptable functional outcome, the patients reported a substantial negative effect upon their HRQoL.