Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review
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(2020) 15:347
SYSTEMATIC REVIEW
Open Access
Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review Manuel Soler-Peiro1* , Lorena García-Martínez1, Luis Aguilella1 and Marcelino Perez-Bermejo2
Abstract Background: Although there are numerous publications about surgical treatment of proximal humeral fractures (PHFs), few assess conservative treatment, which is the most common approach. The aim of this systematic literature review was to assess criteria for indications, treatment protocols, and outcomes obtained with the conservative treatment of 3-part and 4-part PHF. Methods: We searched the PubMed and Cochrane databases for clinical studies published between 2000 and 2019 on conservative treatment for 3-part and 4-part PHF that included patients older than 18 years, a minimum followup of 1 year, fracture classification, and description of outcomes with assessment scales. Results: The search yielded 26,660 records. We reviewed 44 of them in full, and finally 6 studies were included. We obtained a population of 133 patients (79% women), with a mean age of 74.3 years (range 25 to 98) and mean follow-up of 32 months (range 12 to 68.8). According to the Neer classification system, there were 41% (55) threepart fractures and 59% (78) four-part fractures; 5.81% of the patients were lost to follow-up. The mean Constant score was 64.5 for three-part fractures and 54.9 patients with four-part fractures. Consolidation was achieved in 95% of the three-part fractures and 91% of the four-part fractures. Loss of mobility varied according to the type of fracture. Regarding complications, the most frequent was malunion (21%), followed by avascular necrosis (9%). Conclusions: Our data show that most three-part PHFs treated conservatively achieve fracture consolidation even noting a negligible rate of malunion got fair–good functional results with few complications, while the orthopedic four-part PHF treatment presents high rate of consolidation with less rate of malunion than the three-part PHF but achieve poor functional results with few complications. Level of evidence: Level IV, Systematic Review Keywords: Proximal humeral fracture, Conservative treatment, Outcomes, Constant score, Fracture consolidation, Complications, Neer classification, Review, Malunion, Nonunion, Avascular necrosis
* Correspondence: [email protected] 1 Upper Extremity Unit, Orthopaedic Surgery Service, Hospital Universitario de La Ribera, Alzira, Valencia, Spain Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commo
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