EARLY POSTOPERATIVE IMPROVEMENT IN PATIENT-REPORTED OUTCOMES FOLLOWING OPERATIVE VERSUS NONOPERATIVE TREATMENT FOR PROXIMAL HUMERUS FRACTURES

Document Type

Conference Proceeding

Publication Date

9-1-2023

Publication Title

JSES International

Keywords

abduction, aged, complication, conference abstract, conservative treatment, controlled study, diagnosis, female, follow up, human, insulin dependent diabetes mellitus, male, medical record review, open fracture, open reduction (procedure), osteosynthesis, outcome assessment, pathologic fracture, patient-reported outcome, people by smoking status, proximal humerus fracture, range of motion, retrospective study, reverse shoulder arthroplasty, shoulder dislocation, shoulder fracture, surgery, surgical patient, therapy, upper limb

Abstract

Background: The significance of early improvements in patient-reported outcomes following treatment for proximal humerus fracture (PHF) has not been well established. This study compares early improvement in patient-reported outcomes following PHF between patients who were treated conservatively vs. surgically. The primary outcome was Patient Reported Outcome Measurement Information System (PROMIS) Upper Extremity (-UE) and Pain Interference (-PI) scores at 6-weeks, 3-months, and 6-months from date of injury or date of operation for nonsurgical and surgical patients, respectively. Methods: This single surgeon, retrospective chart review was conducted on 76 patients treated for PHF between 2/2019 and 7/2021. Exclusion criteria were presentation >4 weeks and follow up <6 weeks from the date of injury, and pathologic fractures. The final cohort included 47 patients treated nonoperatively and 8 treated operatively (3 reverse total shoulder arthroplasty, 5 open reduction and internal fixation). Data points included age, sex, race, smoking status, diagnosis of insulin-dependent diabetes mellitus, Neer classification, glenohumeral dislocation, open fracture, and PROMIS-UE and PROMIS-PI scores. Results: There was no significant differences in age, gender, race, smoking status, dominant side injury, open fractures, or insulin-dependent diabetes mellitus between the groups. Patients with 1- or 2-part fractures versus 3- or 4-part fractures was not significantly different. Those with glenohumeral dislocation were more likely to be treated operatively, (operative (n=2, 25%), nonoperative (n=2, 4.26%), p=0.037). PROMIS-UE scores were not statistically different between the groups at any time point. PROMIS-PI scores were found to be significantly lower in the operative group at both 3- and 6-months postoperatively (3-months, nonoperative 57.46 ± 7.38, operative 49.25 ± 6.85, p=0.048; 6-months, nonoperative 61.80 ± 9.31, operative 46.33 ± 6.35, p=0.046) but not at 6-weeks postoperatively. Forward flexion and abduction were not found to be significantly different between the two groups. Conclusions: Patients treated with operative intervention had significantly reduced pain as evaluated on the PROMIS-PI at both 3- and 6-month time points, but no significant differences in either function or range of motion as evaluated on PROMIS-UE. However, Early pain reduction may be a factor to consider when discussing treatment options with patients who sustain a PHF.

Volume

7

Issue

5

First Page

1799

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