Longterm Outcome following Proximal Humeral Fractures

Authors: Hodgson et al.

References: ICSS, Washington, 2004

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 Sheffield, UK.

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 shoulder disability.

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.

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