Locked plate fixation versus non-operative management for three and four-part proximal humeral fractures in elderly; A randomized controlled trial.

BACKGROUND: In elderly patients, the proximal humerus fracture is the third most prevalent fracture, following fractures of the hip and distal radius, and is significantly associated with osteoporosis. This research aimed to determine the functional and radiological outcomes of internal fixation of 3- and 4-part proximal humeral fractures by locked plates compared with the outcomes obtained by non-operative management in the elderly.

METHODS: In this prospective randomized trial, 52 elderly patients (≥65 years) with 3- or 4-part proximal humerus fractures were allocated to either nonoperative treatment with arm sling immobilization or operative fixation using a proximal humerus locking plate in Qena General Hospital from December 2020 to December 2023. Clinical and radiological assessments were conducted up to 12 months post-treatment, with functional outcomes measured by DASH and Constant scores.

RESULTS: Six months after surgery, the Conservative group had a significantly higher DASH score than the Operative group. At 12 months, the Conservative group had a lower DASH score and a higher total Constant score (p < 0.05). There was no significant variance in the incidence of SAI, stiffness, deformity, or AVN among the conservative and operative groups (p > 0.05). The complication rate was 13.4%, with 5.7% of cases related to conservative treatment and 7.7% to operative treatment.

CONCLUSION: Orthopaedic management of proximal humerus fractures requires proper evaluation, radiological views, patient age, and activity levels. Conservative treatment can provide good functional outcomes with a minimal complication rate, especially in elderly individuals.