The Translated Proximal Humerus Fracture: A Comparison of Operative and Nonoperative Management

Objectives: To report on the long-term outcomes of the management of translated proximal humerus fractures. Design: A prospective cohort study was conducted from January 2010 to December 2018. Setting: Academic Level 1 trauma center. Participants/Patients: A total of 108 patients with a proximal humerus fracture with ≥100% translation, defined as no cortical bony contact between the shaft and humeral head fragments, were included. Intervention: Patients were managed nonoperatively with sling immobilization or with operative management as determined by the treating surgeon. Main Outcome Measures: Outcome measures were the Oxford Shoulder Score, EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, nonunion/malunion, and avascular necrosis. Results: Of the 108 patients, 76 underwent operative intervention and 32 were managed nonoperatively. The mean (SD) age in the operative group was 54.3 (±20.2) years and in the nonoperative group was 73.3 (±15.3) years ( P < 0.001). There was no association between Oxford Shoulder Score and management options (mean 38.5 [±9.5] operative versus mean 41.3 [±8.5] nonoperative, P = 0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference was 0.16 (95% CI, 0.04–0.27; P = 0.008); EQ-5D VAS adjusted mean difference was 19.2 (95% CI, 5.2–33.2; P = 0.008). Operative management was associated with a lower odds of nonunion (adjusted OR 0.30; 95% CI, 0.09–0.97; P = 0.04), malunion (adjusted OR 0.14; 95% CI, 0.04–0.51; P = 0.003), and complications (adjusted OR 0.07; 95% CI, 0.02–0.32; P = 0.001). Conclusion: Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes after surgical fixation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.