Comparison between conservative and surgical treatment in proximal humeral fractures. A prospective randomized study with 5-years follow-up

Background. There is no consensus on the optimal treatment of displaced proximal humeral fractures. The purpose of this prospective study was to present a 5-year follow-up of conservative treatment of proximal humeral fractures as compared to surgical treatment (ORIF). Materials and methods. Fifty consecutive patients with a proximal humeral fracture (Neer types 2, 3, 4; hertel types 3 through 8) were enrolled in this study and randomized in two groups: Conservative treatment (group A) and open reduction and internal fixation (ORIF) with a plate (group B). Twenty patients of group A and 15 patients of group B were available for the final follow-up. All patients were clinically evaluated at 1, 3, and 12 months, and at final follow-up with physical and radiological examination, functional scores (Constant-Murley, quick DASH, ASES, SF-12), and overall satisfaction (from 1 to 4). Results. The groups were homogeneous with regard to demographic data and radiological classifications of fractures. At the final follow-up (5.21 ± 1.30 years), the Constant-Murley score was 82.0 ± 7.6 (group A) and 87.0 ± 5.4 (group B) (n.s.); quick- DASH was 8.7 ± 4.3 (group A) and 5.4 ± 0.37 (group B) (n.s.); ASES was 83.7 ± 7.0 (group A) and 96.1 ± 1.0 (group B) (p = 0.003); and SF-12 was 88.2 ± 5.9 (group A) and 90.1 ± 5.7 (group B) (n.s.). Eighty-five percent of patients in group A and 100% in group B were satisfied or very satisfied with their results (n.s.). One patient in group B reported wound dehiscence, which was treated with medical therapy. Conclusions. Conservative treatment in proximal humeral fractures provides similar results in functional and symptom-related scores after 5 years, compared to ORIF. Indications for ORIF should be reserved only for patients with high functional demand.