Comparison of locking plate and conservative treatment in elderly patients with displaced proximal humerus fractures

This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients.

The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded.

Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores.

In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.