Longterm Outcome following Proximal Humeral Fractures
Hodgson et al.
Objectives: To follow-up patients who fractured their
proximal humerus two years ago and were recruited to a
Randomised Controlled Trial (RCT) that begun in 1998 in
Methods: Each patient was sent a shoulder disability
questionnaire at 2 years following their original injury.
The Croft Shoulder Disability Questionnaire (CSDQ) asks the patient to evaluate their shoulder function in response to 22 questions. A score of zero indicates no shoulder
disability and a score of 5 and over represents significant
Design: this forms part of an RCT involving 86 patients
who fractured their proximal humerus (minimally displaced
fracture) and were randomly assigned to receive either
immediate (Group-A) physiotherapy (within 1 week of injury) or after 3 weeks immobilisation in a collar and cuff (Group-B). Both groups had the same physiotherapy programme based on maximising shoulder function with pain tolerance.
Results: At 2 years 74 patients (86%) completed and
returned the CSDQ. In Group-A, 16 (43.2%) patients reported some level of shoulder disability compared to 22 (59.5%) in Group-B. At 2 years the number of subjects scoring 5 or more (i.e. significant shoulder disability) on the
disability questionnaire was 12 (32.4%) and 13 (35.2%) in
Group A and B respectively.
Conclusions: This difference is not statistically significant, but the results suggest that patients continue to experience high levels of shoulder disability at 2 years
following their original injury. Starting physiotherapy
immediately after the fracture, does not cause fracture
complications and maximises the persons shoulder function; however a large percentage of patients in both groups continue to report some level of shoulder disability. The excellent recovery reported by previous papers within 1 year of injury is not supported by these findings.
bone of the upper arm - connecting the shoulder to the elbow
ICSS, Washington, 2004
This study shows that the results of non-operative treatment for proximal humeral fractures is not as good as previously reported and when assessing the level of shoulder disability patients continue to have disability 2 years after injury.
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