Displaced proximal humeral fractures: results of conservative treatment

Abstract

The results of 42 patients with displaced proximal humeral fractures treated by conservative means were reviewed. The system advocated by Neer was used to classify the fractures. Of the patients, 16 had two-fragment fractures, 17 three-fragment fractures and 9 four-fragment fractures. In 21 patients, fractures were treated with a sling for 1 week, and in 21 with a hanging cast for 1 week. All patients received physiotherapy after immobilization. Follow-up evaluation included clinical and radiographic examination at a median of 2 years after the trauma. The results were assessed using Neer's protocol. The patients were asked to assess the results. The patients assessed the results better than the Neer score (P less than 0.001). The patients with two-fragment fractures assessed the results as excellent or satisfactory and better than the three- and four-fragment ones (P less than 0.01). The patient response to non-operative treatment was satisfactory. It is concluded that the Neer classification of the results underestimates the degree of satisfaction achieved by the patients. It is concluded that displaced proximal humeral fractures can be treated satisfactorily by non-operative methods.