[Effectiveness comparison of operative and non-operative treatment for complex proximal humeral fractures in elderly patients].

Objective To compare the effectiveness between operative and non-operative treatment for 3-and 4-partproximal humeral fractures in elderly patients.Methods Between January 2009 and January 2011,35 patients with 3-or4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation(n=20,operative group)and with closed reduction and splint or cast fixation(n=15,non-operative group).There was no significant diff erence in gender,age,etiology,fracture type,and disease duration between 2 groups(P 0.05).The postoperative rehabilitation protocol wasperformed in 2 groups.Results All patients of the operative group achieved healing of incision by first intention.All patientswere followed up 16 months on average(range,12-20 months).The X-ray films showed that the other fractures healed except1 case(5.0%) nonunion in operative group.Varus malunion was found in 1 case(6.7%) of non-operative group and 2 cases(10.0%) of operative group.Humeral head necrosis was found in 1 case respectively in 2 groups(5.0% and 6.7%).There wasno significant diff erence in complication incidence between 2 groups(P 0.05).The Constant-Murley scores of non-operativegroup and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively,showing no significant diff erence(t=0.59,P=0.47).Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3-and 4-part proximalhumeral fractures.In elderly patients,non-operative treatment should be chosen.