Background: Proximal humerus fractures are the third most common fractures after distal radius and hip fractures. Non-union rate of fractures in the proximal third of humerus and head of the femur is relatively very higher as compare to other regions with conservative treatment cases. The optimum treatment becomes more important for patient good life unlikely most of the cases they treated non operatively. Non operatively lead lots of problem and make patient’s life uncomfortable.

Objective: To compare outcomes of operative and non- operative treatment of proximal humerus fracture in tertiary care hospital.

Material and Methods: There were 100 patient who had fracture among that 50 patients are treated with non -operatively and 50 are treated with operatively.

Non-operative Treatment: Upper extremity shoulder was immobilized in a sling for 2-3 weeks with passive range of motion exercises starting after ending of 2 weeks including pendulum exercises.

Surgical Treatment: All surgeries were performed in the beach chair position and most of the case lateral deltoid split approach are using with AO reduction techniques by surgeons in upper extremity trauma. In all operations, PHILOS plates were used and after surgery, immobilization was done with a sling.

Results: In 2-Part, 3 part and 4 part fractures the ASES scores was high in operative patient than non operative patient. Similarly the VAS score was high in operative patient than non operative patient. Displacement rates were 50% of non-operative treatment where as only 10% patients X ray show displacement in operative group. The healing rate was much higher in operative group as compare to non operative group.

Conclusion: In case of the comminuted fracture in humerus the best treatment is implanting PHILOS plates which provided best ROM muscle strength and wrist grip as compare to non- operative. Non- operative comminuted fracture may lead to not proper union and lead to a prolong problem. 

Keywords: ASES, Non operative, Operative, Proximal humerus fracture, PHILOS plates, VAS.

1. Court-Brown CM and Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37(8):691–7
2. Dheenadhayalan J, Prasad VD, Devendra A Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: a study of 127 cases. J OrthopSurg (Hong Kong) 2019;27(2):1–8.
3. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop. 2006;(442): 87-92.
4. Baron JA, Karagas M, Barrett J. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology.1996;7(6):612-8
5. Court-Brown CM, Garg A, and McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001;72(4):365–71.
6. Lind T, Krøner K, and Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 1989; 108(5):285-7.
7. Roux A, Decroocq L, Batti EI S. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 2012;98 (6):715-9.
8. Alie, Griffiths D, Obi N, Tytherleigh-Strong G, VanRensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elb Surg. 2015;24:210–4.
9. Palvanen M, Kannus P, Niemi S Update in the epide- miology of proximal humeral fractures. Clin Ortho Relat Res 2006; 442:87-92
10. Okike K, Lee OC, Makanji H, Harris MB, Vrahas MS. Factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly. Injury. 2013;44(4): 448-455. doi:10.1016/j.injury.2012.09.002.
11. Sumrein BO, Huttunen TT, Launonen AP, Berg HE, Fellander-Tsai L, Mattila VM. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int. 2017; 28(3):901–7.
12. Huttunen TT, Launonen AP, Pihlajamaki H, Kannus P, Mattila VM. Trends in the surgical treatment of proximal humeral fractures—a nationwide 23-year study in Finland. BMC Musculoskelet Disord. 2012;13:261
13. Rabi S, Evaniew N, Sprague SA, Bhandari M, Slobogean G. Operation vs non-operative management of displaced proximal humeral fractures in the elderly: a systematic review and meta-analysis of randomized controlled trials. World J Orthop 2015;6:838–46
14. Jia Z, Li W, Qin Y, Li H, Wang D, Zhang C, He C, Ruan D (2014) Operative versus nonoperative treatment for complex proximal humeral fractures: a meta-analysis of randomized con- trolled trials. Ortho pedics 37:e543–e551.
15. Lange M, Brandt D, Mittlmeier T. Proximal humeral fractures: non-operative treatment versus intramedullary nailing in 2-, 3- and 4-part fractures. Injury 2016;47(7):14-9.
16. Fjalestad T and Hole MO. Displaced proximal humeral frac- tures: operative versus non-operative treatment – a 2-year extension of a randomized controlled trial. Eur J Otrhop Surg Traumatol 2014;24 (7):1067-73.
17. Tamimi I, Montesa G, Collado F Displaced proximal humeral fractures: when is surgery necessary? Injury 2015;46(10):1921-9.
18. Olerud P, Ahrengart L, Ponzer S. Internal fixation versus non-operative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 2011;20(5):747-55.

Sanjay Yadav

Department of Orthopaedics, Dr. S. N Medical College, Jodhpur, Rajasthan, India