Conservative treatment of proximal humeral fractures by maintaining neutral rotation in elderly patients

• Main Authors: Mitsuko Yamada, Nobuki Terada, Shinichi Katou, Kenji Suzuki, Atsuo Furui, Osamu Niwa
• Format: Article
• Language: English
• Published: Fujita Medical Society 2018-08-01
• Series: Fujita Medical Journal
• Subjects: proximal humeral fractures; conservative treatment; arm in external rotation
• Online Access: https://www.jstage.jst.go.jp/article/fmj/4/3/4_2017023/_pdf/-char/en
• ISSN: 2189-7247; 2189-7255

Objectives: Proximal humeral fractures are common fractures in elderly patients. In some cases, operative treatment is difficult in elderly patients because of severe osteoporosis. An external rotation shoulder brace can maintain the arm in neutral rotation for conservative treatment, which has prompted its use for treatment of proximal humeral fractures in patients aged ≥65 years. We sought to confirm the efficacy of the neutral rotation position. Methods: Eleven patients with a proximal humeral fracture were clinically and radiographically reviewed. Their mean age was 75 years, and the fracture type was classified according to the Neer group classification system. The duration of brace use prior to achieving bone union and the observation period were analyzed. The shoulder range of motion (ROM) was examined during the final follow-up. Results: Displacement was not observed during the course of treatment. The patients stopped using the brace at 40 days, bone union was confirmed at 46 days, and the mean follow up period was 4 months. The mean active shoulder ROM for elevation, abduction, external rotation, and internal rotation was 148°, 146°, 50°, and L3, respectively. Conclusion: We obtained good results during treatment of proximal humeral fractures by maintaining neutral rotation of the arm in elderly patients. Neutral rotation of the arm facilitated by use of an external rotation shoulder brace is an appropriate treatment for proximal humeral fractures in the elderly.