Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Low-energy proximal humerus fractures are common, often treated nonoperatively.
• Understanding factors predicting treatment failure is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the impact of radiographic translation on nonoperative treatment outcomes for low-energy proximal humerus fractures.
• To identify specific translation thresholds associated with treatment failure.

Main Methods:

• Retrospective multicenter analysis of 210 patients with proximal humerus fractures (OTA/AO 11-A-C).
• Radiographic translation in sagittal and coronal planes was measured.
• Comparison of outcomes based on anterior vs. posterior/no translation and >80% vs. <80% anterior translation.

Main Results:

• Nine patients (4%) required surgery, primarily for nonunion (8/9).
• All patients requiring surgery exhibited anterior translation.
• Anterior translation was significantly associated with failure of nonoperative management (P=0.012).
• ≥80% anterior translation strongly predicted the need for surgery (P=0.001).
• Symptomatic malunion occurred in 26 patients, predominantly with anterior translation (24/26, P=0.0001).

Conclusions:

• Anterior translation, particularly exceeding 80%, is a significant predictor of nonoperative treatment failure in low-energy proximal humerus fractures.
• This finding highlights the importance of assessing translation in treatment planning and prognostication.