COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF SURGICAL AND CONSERVATIVE TREATMENT OF TWO-PART DISPLACED PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS

Purpose. To evaluate the long-term results of treatment of two-part displaced fractures of the proximal humerus in patients over 60 years of age by comparing the effectiveness of surgical treatment using fixing plates and conservative methods. Materials and methods. Between March 2022 and August 2024, a randomized controlled trial was conducted with 22 patients in the Central Hospital of the RCH. Participants were divided into two groups: surgical treatment with the use of fixing plates and non-surgical treatment. The primary outcome measure was the DASH scale, and secondary criteria were the Constant-Murley scales, the Visual Analogue Pain Scale, the 15D and EQ-5D Quality of Life questionnaires, and the Oxford Shoulder Scale. The study was semi-blind, using sealed envelopes and standardized treatments. Results. At 2 years after the start of the study, there were no statistically significant differences in the average DASH score between the groups: 29.1 in the operational group and 28.0 in the non-operational group. The difference was 1.2 points (p = 0.20). Similarly, other measures, including the Constant-Murley scale, VAS of pain, and quality of life assessments, did not demonstrate significant differences in the long term. Conclusions. The study showed that at 2 years there are no statistically significant differences in the results between the operative and conservative treatment of two-part displaced fractures in groups of patients over 60 years of age. These data confirm the lack of benefits of surgery during long-term recovery, emphasizing the importance of an individualized approach when choosing tactics for treating these fractures.