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. 2024 Sep 24;16(9):e70083.
doi: 10.7759/cureus.70083. eCollection 2024 Sep.

Predictive Factors for Poor Prognosis in Non-Surgical Treatment of Proximal Humerus Fractures in Elderly Patients

Rodrigo A Beraldo  1   2 , Caroline Izidorio Bernardes Silva  1 , Ana Cecilia Benassi  1 , Alfredo Moreira De Queiroz Júnior  1 , Caio Villela Antonielli  1 , Ewerton Alexandre Galdeano  1 , Daniel Giner Roselis  1 , Renato Moraes  1
Affiliations

Predictive Factors for Poor Prognosis in Non-Surgical Treatment of Proximal Humerus Fractures in Elderly Patients

Rodrigo A Beraldo et al. Cureus. .

Abstract

Introduction: Proximal humerus fractures (PHF) are common in the elderly, accounting for significant morbidity and mortality. Non-surgical treatment is a common option for low-demand elderly patients, but it can lead to unsatisfactory functional outcomes in some cases. The identification of predictive factors for poor prognosis in non-surgical management remains unclear. This study aimed to determine the predictive factors for poor prognosis in elderly patients treated non-surgically for displaced PHF and to assess associated complications.

Methods: A retrospective cohort study was conducted involving patients aged 60 years or older with displaced PHF treated non-surgically from May 2020 to January 2023 at a reference hospital for orthopedic trauma. The primary outcome was functional assessment using the American Shoulder and Elbow Surgeons (ASES) scale at 12 months. Predictive factors such as metaphyseal fracture comminution, Pain Catastrophizing Scale (PCS) scores, and radiographic criteria were analyzed. Multivariate regression analyses were performed to identify independent predictors of poor outcomes.

Results: Out of 140 initially selected patients, 103 met the inclusion criteria and completed the follow-up. The mean ASES score was 71.3±25.4 points. Multivariate analysis identified metaphyseal comminution (p < 0.001) and PCS scores ≥ 30 (p < 0.001) as significant predictors of poorer functional outcomes. Complications were observed in 17.4% of patients, including osteonecrosis (6.7%), nonunion (4.9%), and persistent pain and stiffness (5.8%).

Conclusion: Metaphyseal comminution and high PCS scores are significant predictors of poor prognosis in elderly patients undergoing non-surgical treatment for displaced PHF. These findings highlight the importance of considering both biomechanical and psychological factors when managing proximal humerus fractures in this population. Further studies with larger sample sizes and prospective designs are needed to validate these findings and refine treatment strategies.

Keywords: elderly patients; functional outcomes; non-surgical treatment; predictive factors; proximal humerus fractures.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the Faculdade de Medicina de Jundiaí, São Paulo, Brazil issued approval 6.391.017. The study was registered in Plataforma Brasil (CAAE: 73648623.4.0000.5412). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart of participant enrollment
Figure 2
Figure 2. Outcome after one year, showing a fracture with varus displacement in the true anteroposterior view (A) and lateral view (B). Clinical outcome demonstrating active elevation (C), active lateral rotation (D), and active medial rotation (E).
Figure 3
Figure 3. Outcome after one year, showing a fracture with valgus displacement in the true anteroposterior view (A) and lateral view (B). Clinical outcome demonstrating active elevation (C), active lateral rotation (D), and active medial rotation (E).
See this image and copyright information in PMC

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