Locking Plate Fixation versus Nonoperative Management in Patients Aged ≥65 Years with Proximal Humerus Fractures: Clinical and Functional Outcomes from a Retrospective Cohort Study

Objectives: This study aimed to compare the clinical and functional outcomes of geriatric patients (≥65 years) with proximal hu-merus fractures treated with locking plate fixation or nonoperative management and to identify factors associated with the development of complications. We hypothesized that fracture pattern, rather than treatment modality alone, would be more strongly associated with functional outcomes and complication risk in this population.
Methods: Patients aged 65 years and older who were treated for proximal humerus fractures were included in this retrospective cohort study. Patients were divided into two groups according to treatment modality: surgical treatment with locking plate fixation and nonoperative management. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Oxford Shoulder Score (OSS). To explore factors associated with functional outcomes and complications, multivariable linear and logistic regression models were constructed.
Results: No significant differences were observed between the groups in demographic characteristics, fracture side, or mechanism of injury (p>0.05). There were no statistically significant differences between the surgical and nonoperative treatment groups in VAS or DASH scores (p>0.05). Although unadjusted Oxford Shoulder Scores did not differ significantly between the groups (28.4±10.1 vs. 24.7±11.1; p=0.09), multivariable analysis identified nonoperative management as independently associated with lower Oxford Shoulder Scores after adjustment for confounders, with the surgical group serving as the reference category (β=−6.85; 95% CI: −11.15 to −2.55; p=0.002). In multivariable analysis, Neer fracture classification was independently associated with worse DASH scores (β=6.33; p=0.008). Additionally, Neer classification was identified as an independent risk factor for complication development, with odds ratios increasing with fracture complexity: 3-part vs. 2-part (OR 5.95; 95% CI 1.02–34.78; p=0.048), 4-part vs. 2-part (OR 12.98; 95% CI 2.19–76.86; p=0.005), and displaced 4-part vs. 2-part (OR 33.28; 95% CI 3.47–318.97; p=0.002). Treatment modality was not independently associated with complication development.
Conclusion: In patients aged 65 years and older, no significant difference in functional outcomes between surgical and nonoperative treatment of proximal humerus fractures was observed in this cohort. Fracture pattern appeared to be more strongly associated with functional outcomes and complication risk than treatment modality. Neer classification should be considered when determining the appropriate treatment strategy. Treatment decisions should primarily be based on fracture characteristics together with the patient’s overall clinical condition.

Keywords: Complications, functional outcomes, non-operative treatment, operative treatment, proximal humerus fracture