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Assessing complications and functional outcomes in proximal humerus fracture management: a retrospective comparison between conservative and intramedullary nailing treatments

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Abstract

Introduction

Fractures of the proximal end of the humerus (FPH) are the second most common fractures in the upper limb after fractures of the distal radius and are two to three times as common in women than in men. Therefore, the main objective of the present study was to compare and analyze the complications and the functional outcomes in patients with displaced FPH receiving conservative and surgical treatments with intramedullary nailing.

Methods

A retrospective cross-sectional study was conducted to establish the differences in complications risks between surgical and non-surgical treatment of the FPH. For this purpose, the clinical and radiological results of 67 consecutive patients were analyzed.

Results

A total of 25 patients were included in the non-surgically treated group. A total of 42 patients were included in the surgically treated group. Complications occurred in a total of 4 (16.0%) patients after the non-surgical treatment. Those included frozen shoulder (n = 2), nonunion (n = 1), and avascular necrosis of the humeral head (n = 1). Complications occurred in a total of 18 (42.6%) patients after the surgical treatment. Non-surgically treated patients had statistically significantly (p < 0.05) lower scores in the Constant-Murley scale in all of the categories.

Conclusion

The present study demonstrates an overall prevalence of complications to be 16% in patients treated conservatively and 42.6% in patients treated surgically. In the non-surgical cohort, the frozen shoulder was the most frequently observed complication (8%). Interestingly, non-anatomical repositioning was the most prevalent complication in surgically treated patients. Due to the complexity of the FPH, we believe that the surgeon needs to have comprehensive knowledge regarding the characteristics of this fracture, the available treatment options, and the possible complications that may occur. This can enhance patient safety and provide satisfactory clinical outcomes.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, 61-545, Poznań, Poland

    Piotr Czarnecki, Józef Wcisłek & Leszek Romanowski

  2. Ortopaedics Unit, Hospital, Ostrow Wielkopolski, Poland

    Mirosław Falis

  3. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland

    Michał Bonczar & Patryk Ostrowski

  4. Youthoria, Youth Research Organization, Kraków, Poland

    Michał Bonczar & Patryk Ostrowski

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  1. Piotr Czarnecki
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Correspondence to Piotr Czarnecki.

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Czarnecki, P., Falis, M., Bonczar, M. et al. Assessing complications and functional outcomes in proximal humerus fracture management: a retrospective comparison between conservative and intramedullary nailing treatments. Eur J Orthop Surg Traumatol 34, 1427–1433 (2024). https://doi.org/10.1007/s00590-023-03822-5

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