The outcome of proximal humeral fractures in the elderly

Abstract

This study describes the epidemiology and outcome of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients. Most were either minimally displaced (n = 278, 44%) or two-part fractures (n = 250, 39%) that predominantly occurred in women (n = 525, 82%) after a simple fall (n = 604, 95%), who lived independently in their own home (n = 560, 88%), and one in ten sustained a concomitant fracture (n = 76, 11.9%). The rate of mortality at one year was 10%, with the only independent predictor of survival being whether the patient lived in their own home (p = 0.025). Many factors associated with the patient's social independence significantly influenced the age and gender adjusted Constant score one year after the fracture. More than a quarter of the patients had a poor functional outcome, with those patients not living in their own home (p = 0.04), participating in recreational activities (p = 0.01), able to perform their own shopping (p < 0.001), or able to dress themselves (p = 0.02) being at a significantly increased risk of a poor outcome, which was independent of the severity of the fracture (p = 0.001). A poor functional outcome after a proximal humeral fracture is not independently influenced by age in the elderly, and factors associated with social independence are more predictive of outcome.

Epidemiology of proximal humerus fractures

“…Previously, it has been reported that elderly women who sustain proximal humerus fractures tend to live independently in their own houses. Together with the seasonal variation that is observed, this may suggest that proximal humerus fracture patients tend to be more active and ambulatory than hip fracture patients [17].…”

Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)

“…showering and dressing), or a focus on concomitant mobility problems, may be overlooked in the busy ED environment. Consideration should also be given to the impact that immobilising proximal humeral fractures will have on the patient's functional outcomes in the context of social independence, returning to their own home, participation in recreational activities, doing the shopping or dressing themselves . These social aspects are often more predictive of outcome than the severity of fracture, and as such, referrals to the multi‐disciplinary team within the ED should be considered to promote a safe discharge home and improved patient outcomes for more vulnerable adults.…”

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

“…Proximal humeral fractures in the elderly have a poor outcome, and open reduction with locking plate osteosynthesis accounts for substantial complication rates that range from 49% [12]up to 76% [28-32], with secondary dislocation/cutting out as one major problem [33]. Although intraoperative failures are frequently preventable [34], postoperative X-rays are often difficult to evaluate, and comparison remains challenging [13, 35, 36], especially because missing cortical support causes a poor outcome [37].…”