Revisiting the Outcome of Displaced Two-Part Fractures of the Humeral Neck in Elderly Patients after Conservative Treatment
- Author:
Peter Syson
- Publication Type:Journal Article
- MeSH:
Humeral Fractures
- From:Malaysian Orthopaedic Journal
2014;8(1):57-60
- CountryMalaysia
- Language:English
-
Abstract:
The aim of this study was to evaluate our experience with
regard to the outcome of displaced two-part fractures of the
humeral neck in elderly patients that were treated
conservatively.
Between July 2008 and June 2010, 53 consecutive patients
(42 females and 11 males; mean age = 74; range = 60-92)
with an acute, displaced, two-part fracture of the humeral
neck were treated conservatively using a sling and swathe for
two weeks, followed by a standard rehabilitation protocol.
The inclusion criteria were a displacement of the shaft >50%
of its width and/or angulation of the shaft >45 degrees on
standard radiographs. The exclusion criteria were patients
younger than 60 years of age and those with cognitive or
systemic impairment that would preclude the recommended
physiotherapy. Patients were followed-up for one year, and
were assessed at 3, 6, and 12 months using the ConstantMurley
Score (CMS) and the Disabilities of the Arm,
Shoulder, and Hand Questionnaire (DASH). Patients were
divided into two groups, those below 70 years of age and
those above 70-. Two-way repeated measures analysis of
variance (ANOVA) was used to determine if there were
significant differences between the results at 3, 6 and 12
months for both groups, and if the results were significantly
different between the two groups.
Forty-eight out of 53 patients (91%) were able to complete
the follow-up schedule, while five patients died. The mean
CMS improved progressively at three (51.3), six (60.4), and
12 (61.3) months. The mean DASH also improved
progressively at three (38.8), six (34.8), and 12 (32.6)
months. For both groups, the CSS and DASH improved
significantly from three to six months and from three to 12
months. However, the improvements were not significant
from just six to 12 months. Between the two groups, the
results at three, six, and 12 months were not significantly
different from each other. On final follow-up, 42 out of 48
patients (88%) were satisfied with their outcome and
reported that they would choose to undergo the same
treatment if they had to do everything all over again. Conservative management of displaced two-part fractures of
the humeral neck in elderly patients is a safe, efficacious, and
acceptable treatment.
- Full text:P020150525344635298334.pdf
