Drawbacks of conservative treatment of proximal humerus fractures in elderly

Abstract

Background Fractures of proximal humerus are popular in older people. About ¾ of proximal humerus fractures occur in patients older than sixty. Several methods of internal fixation and arthroplasty are used. However conservative treatment continues to be used in this age group, although some complications of conservative management limit its indications. Objective To assess the outcomes of conservative treatment of proximal humerus fractures in elderlypatients. Methods It is a retrospective study of 30 elderly patients (over 50 ys) who suffered from proximal humerus fractures and received conservative treatment using broad arm sling. All patients were subjected to regular clinical and radiological examination to evaluate the time of union, range of motion, residual pain and complications. Results The average follow up time was 6 months. Nine cases(30%) showed nonunion while 11 cases(37%) showed delayed union after 3 months. The results showed8 cases (27%) with a poor range of motion and 13 cases(43%) with an acceptable range of motion while 9 cases (30%)showed a good range of motion. As regards Pain evaluation,8 cases (27%) with moderate pain while 13 cases (43%) with mild pain and 9 cases (30%) showed no pain. There were 4 cases (13%) of malunion, 3 cases (10%) of avascular necrosis of humeral head, 4 cases (13%) of inferior subluxation of the humeral head and 2 cases (7%) of posttraumatic arthritis. Conclusion Conservative treatment of proximal humerus fractures in elderly patients is associated with a significant incidence of unsatisfactory outcomes and should be limited only to patients unfit for surgery.