Comparison between Results of Open Reduction Internal Fixation and Conservative Treatment in Comminuted Proximal Humerus Fractures in Elderly

Abstract Introduction: Proximal humerus fractures (PHFs) are common injuries in the elderly population. The literature on the management of PHFs is vast and controversy remains regarding the optimal care of displaced fractures with potential treatment options of nonoperative management, open reduction internal fixation (ORIF), and arthroplasty. Aim of the Work: The study aims to compare the radiological and functional outcome between ORIF and nonoperative treatment of displaced three/four-part PHFs in the elderly. Methods: This study included 40 patients with PHFs admitted between February 2020 and March 2023. The study included two groups. Group I ( n = 20) underwent ORIF, while group II ( n = 20) was treated conservatively. The mean age was 66.50 ± 4.95. All cases were assessed retrospectively after at least 12 months as regards the radiological outcome using plain X-ray, the functional outcome using the Constant-Murley score, the quality of life using the disabilities of arm, shoulder, and hand score, and the extent of pain using the Visual Analog Scale. Results: There was no statistically significant difference between the two groups as regards the functional outcome ( P = 0.820), the satisfaction rates ( P = 0.678), and extent of pain ( P = 0.678). Radiological assessment showed no statistically significant difference as regards the union rates or avascular necrosis. Valgus malunion was significantly higher in the conservative group compared to the fixation group ( P = 0.02). Conclusion: Fixation of comminuted proximal humerus fractures in the elderly does not provide a better functional outcome when compared to the conservative treatment.However, malunion rates are higher in the conservative treatment.