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

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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