Surgical versus non-surgical treatment for 3- and 4-part proximal humerus fractures

Authors: M. Kilian 1;  R. Zamborský 2;  I. Chandoga 1;  M. Budaj 3;  S. Vajczikova 1
Authors‘ workplace: II. Ortopedicko-traumatologická klinika, UN sv. Cyrila a Metoda a Univerzita Komenského v Bratislave prednosta: doc. MUDr. S. Vajcziková, PhD 1;  Klinika úrazovej chirurgie, UN L. Dérera a Univerzita Komenského a Slovenská Zdravotnícka Univerzita v Bratislave prednosta: prof. MUDr. P. Šimko, CSc 2;  Oddelenie centrálneho príjmu, Nemocnica sv. Cyrila a Metoda a Univerzita Komenského v Bratislave primár: MUDr. D. Holas 3
Published in: Rozhl. Chir., 2016, roč. 95, č. 2, s. 60-68.
Category: Original articles


Proximal humerus fractures account for about 4−5% of all fractures. Treatment of 3- and 4-part fractures is difficult, and the optimal treatment option remains controversial. The aim of the study was to compare surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus in adults.

A prospective study of surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus was conducted at the 2nd Department of Orthopedics and Traumatology, University Hospital Bratislava, from September 2010 until September 2013. Patients included in the study were compliant adults patients with 3- and 4-part proximal humerus fractures Neer type IV, V and VI. Twenty patients were treated surgically. The group included 13 women (65%) and 7 men (35%). Mean age was 60.9±7.67 (52–80) years. Angle-stable plates (Philos, Synthes) and intramedullary nails (Multilock, Synthes) were used.

The non-surgical group included 19 patients, consisting of 12 (63.2%) women and 7 (36.8%) men. Mean age of both sexes was 66.3±9.5 (52−88) years. Gilchrist bandage was applied for the maximum of 3 weeks. All patients were evaluated at 12 months from treatment using the Constant-Murley scoring system and the Oxford Shoulder Score. Treatment complications were evaluated as a secondary step.

The mean individual relative Constant-Murley score was 57.8±23.5% (11−88%) in the surgical group. The mean Oxford Shoulder score was 34.8±10.6 (10−46) points. Complications were recorded in 12 patients (60%). In the non-surgical group, the mean individual relative Constant-Murley score at 12 months from injury was 60.9±20.9% (16−90%). The mean Oxford Shoulder score was 36.1±8.9 (15−48) points. Complications were recorded in 4 patients (21.1%).

In this study, surgical treatment patients with displaced 3- and 4-part proximal humerus fractures, mostly treated by angle-stable plates, showed a number of complications. Poor functional results of the surgical group were comparable to those of the non-surgical group. The indication for surgery, patient selection, type of surgery, surgical experience and subsequent rehabilitation should be carefully assessed for better results.

Key words:
proximal humerus fracture − surgical treatment − non-surgical treatment − 3- and 4-part fractures


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