Proximal humerus fracture dislocations: outcomes of management

AbstractPurposeProximal humerus fracture dislocations are amongst the most severe proximal humerus injuries, presenting a challenging management problem. The aim of this study was to report on long‐term outcomes of management of proximal humerus fracture dislocations.MethodsPatients with a proximal humerus fracture dislocation managed at a Level 1 trauma centre from January 2010 to December 2018 were included. Patients with isolated tuberosity fracture dislocations or pathological fractures were excluded. Outcome measures were the Oxford Shoulder Score (OSS), EQ‐5D‐5L, return to work and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, non‐union/malunion and avascular necrosis.ResultsSixty‐nine patients were included with a proximal humerus fracture dislocation in the study period; 48 underwent surgical management and 21 were managed successfully with closed reduction alone. The mean (SD) age of the cohort was 59.7 (±20.4), and 54% were male. Overall patients reported a mean OSS of 39.8 (±10.3), a mean EQ‐5D utility score of 0.73 (±0.20), and 78% were able to return to work at a median of 1.2 months. There was a high prevalence of complications in both patients managed operatively or with closed reduction (25% and 38% respectively). In patients undergoing surgical management, 21% required subsequent surgery.ConclusionPatient reported outcome measures post proximal humerus fracture dislocations do not return to normal population levels. Further, these injuries are associated with a high prevalence of complications. Appropriate patient counselling should be undertaken before embarking on definitive management.