Conservative treatment of displaced proximal humeral fractures

Between 11/1989 and 6/1998 52 patients (10 m,, 42 f., age median 72 years, 31-88) with proximal humeral fractures have been treated by conservative me ans (angulation of humeral head >45 degrees and/or shaft displacement > 1 c m and displacement of greater tuberosity >0,5 cm). In 37 patients (71 %, 31 f., 6 m., age median 75 years, 36-88) a clinical and radiological follow-u p could be obtained after median 20 months (3-93. According to the Neer-cla ssification, subcapital 2-part fractures were found in 19 cases and 3-part fractures in 12 cases. 4-part fractures were diagnosed in 6 cases. By using the Constant-Score, the final result was scored,,excellent" in 10 patients and,,good" in 13 patients. In 7 patients each the results achieved were,,m oderate" or,,poor''. The underlying cause for the poor results was primaril y due to persisting painful impairment in range of motion and loss of stren gth. Radiologically, persisting axial deviation was present in 23 cases, ar throsis in 14 patients and humeral head necrosis in 8 patients. Most common ly, poor functional and radiological results occurred in 4-part fractures. However, conservative therapy of displaced 2-part and 3-part fractures is a considerable therapeutical option since the final results are predominantl y good. In contrast, due to the poor results after conservative therapy 4-p art fractures should be treated surgically.