Patient-reported outcome was close to the Danish background population 6 months after non-surgical treatment of Neer 2-part surgical neck fractures: a prospective cohort study in patients aged 60 or above
DOI:
https://doi.org/10.2340/17453674.2024.42301Keywords:
Fractures, ShoulderAbstract
Background and purpose: Neer 2-part surgical neck fractures are the most common displaced proximal humerus fractures. We aimed to evaluate patient-reported outcome in a consecutive series of older people receiving nonoperative treatment.
Methods: This is a single-center prospective cohort study. We included patients aged 60 or above referred to a Danish university hospital. The preregistered protocol followed the recommendations from randomized trials. Patients were followed at the outpatient clinic at 2, 6, and 24 weeks. After 24 weeks, they were evaluated with Oxford Shoulder Score (OSS, 0–48, 48 best) and EuroQoL 5 dimensions, 3 levels (EQ-5D-3L, –0.624 to 1, 1 best). Clinical failure was defined as conversion to surgery or OSS ≤ 24. Population norms were reported to interpret the cohort data, but no formal statistical comparisons between historical cohorts were planned. We used descriptive statistics to report rates and proportions.
Results: For 36 months, 268 patients (mean age 76, 79% female) with Neer 2-part surgical neck fractures received non-surgical treatment. After excluding patients with concomitant fractures, dementia, or death, complete follow-up was available for 167 patients. 8 patients (3.0%) had surgery. The mean OSS was 37.2 (SD 8.1), which equals 78% of maximum shoulder function. The norm for the population of the same age and gender was 82%. The mean EQ-5D-3L score was 0.79 (SD 0.16), while the norm for the same-age population was 0.82. 16 (10%) had an OSS score of 24 or below.
Conclusion: Non-surgical treatment in older people with Neer 2-part surgical neck fractures resulted after 6 months in patient-reported shoulder function and quality of life close to that of the Danish background population.
Downloads
References
Brorson S. How many shoulder fractures are displaced? How a misleading statement became orthopedic knowledge. Acta Orthop 2023; 94: 328-9. doi: 10.2340/17453674.2023.13651.
Court-Brown C M, Garg A, McQueen M M. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72(4): 365-71. doi: 10.1080/000164701753542023.
Court-Brown C M, McQueen M M. Two-part fractures and fracture dislocations. Hand Clin 2007; 23(4): 397-414. doi: 10.1016/j.hcl.2007.08.003
Jaeger M L F. Proximal humerus. AO Surgical Reference; 2018. Available from: https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-humerus
Synthes D. 3.5 mm LCP® Proximal Humerus Plates: Surgical Technique; 2021; 1-60. Available from: http://synthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America/Product Support Materials/Technique Guides/DSUSTRM10161133 Rev B.pdf
DePuy Synthes. 3.5 mm LCP® Proximal Humerus Plate: Value Summary; 2019; 1-2. Available from: https://www.jnjmedtech.com/sites/default/files/user_uploaded_assets/pdf_assets/2019-03/108141-190224 DSUS_ProxHum_SS_US_150.pdf
Brorson S. Locking plate osteosynthesis in geriatric shoulder fractures: why do we continue to perform a low-value procedure? Acta Orthop 2022; 93: 355-7. doi:10.2340/17453674.2022.2208
Launonen A P, Sumrein B O, Reito A, Lepola V, Paloneva J, Jonsson K B, et al. Operative versus non-operative treatment for 2-part proximal humerus fracture: a multicenter randomized controlled trial. PLOS Med 2019; 16(7): e1002855. doi: 10.1371/journal.pmed.1002855.
Brorson S. Borg S I Z. Research Registry®: a global repository for all study types involving human participants (6502). Available from: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6013f116dd32e900213ab89c/
Neer C S. Displaced proximal humeral fractures, I: Classification and evaluation. J Bone Joint Surg Am 1970; 52(6): 1077-89. PMID: 5455339
Müller M E, Koch P, Nazarian S, Schatzker J. Principles of the classification of fractures. In: The comprehensive classification of fractures of long bones. Berlin, Heidelberg: Springer; 1990. pp: 4-7. doi: 10.1007/978-3-642-61261-9_2.
Brorson S, Eckardt H, Audigé L, Rolauffs B, Bahrs C. Translation between the Neer- and the AO/OTA-classification for proximal humeral fractures: do we need to be bilingual to interpret the scientific literature? BMC Res Notes 2013; 6(1): 69. doi: 10.1186/1756-0500-6-69.
Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 1996; 78(4): 593-600. PMID: 8682827.
Baker P, Nanda R, Goodchild L, Finn P, Rangan A. A comparison of the Constant and Oxford shoulder scores in patients with conservatively treated proximal humeral fractures. J Shoulder Elb Surg 2008; 17(1): 37-41. doi: 10.1016/j.jse.2007.04.019.
Clement N D, Court-Brown C M. Oxford shoulder score in a normal population. Int J Shoulder Surg 2014; 8(1): 10-14. doi: 10.4103/0973-6042.131849.
Euroqol. EQ-5D-3L. 2024. Available from: https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-3l/
Sørensen J, Davidsen M, Gudex C, Pedersen K M, Brønnum-Hansen H. Danish EQ-5D population norms. Scand J Public Health 2009; 37(5): 467-74. doi: 10.1177/1403494809105286.
Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 2015; 313(10): 1037-47. doi: 10.1001/jama.2015.1629.
Brorson S, Elliott J, Thillemann T, Aluko P, Handoll H. Interventions for proximal humeral fractures: key messages from a Cochrane review. Acta Orthop 2022; 93: 610-12. doi: 10.2340/17453674.2022.3495.
Martínez R, Santana F, Pardo A, Torrens C. One versus 3-week immobilization period for nonoperatively treated proximal humeral fractures: a prospective randomized trial. J Bone Joint Surg Am 2021; 103(16): 1491-8. doi: DOI: 10.2106/JBJS.20.02137.
Court-Brown C M, McQueen M M. The impacted varus (A2.2) proximal humeral fracture: prediction of outcome and results of nonoperative treatment in 99 patients. Acta Orthop Scand 2004; 75(6): 736-40. doi: 10.1080/00016470410004111.
Court-Brown C M, Garg A, McQueen M M. The translated two-part fracture of the proximal humerus: epidemiology and outcome in the older patient. J Bone Joint Surg Br 2001; 83(6): 799-804. doi: 10.1302/0301-620x.83b6.11401.
Brorson S, Hróbjartsson A. Training improves agreement among doctors using the Neer system for proximal humeral fractures in a systematic review. J Clin Epidemiol 2008; 61(1): 7-11. doi: 10.1016/j.jclinepi.2007.04.014.
Barlow J D, Logli A L, Steinmann S P, Sems S A, Cross W W, Yuan B J, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg 2020; 29(8): 1689-94. doi: 10.1016/j.jse.2019.11.026.
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Stig Brorson, Signe A Borg, Line L Houkjær, Kenneth B Holtz, Zaid Issa
This work is licensed under a Creative Commons Attribution 4.0 International License.