Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception

Background: Although most proximal humeral fractures are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies because of their lower incidence. The purpose of this study was to evaluate the incidence of nondisplaced proximal humeral fractures in comparison with other outpatient-treated osteoporotic fractures, as well as to assess their functional impact and effects on patient-perceived quality of life. Materials and methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated nonoperatively in 358 trauma centers were recorded during a 3-month period. Fractures were considered osteoporotic if caused by a low-energy trauma. Pathologic fractures were excluded. The incidence of proximal humeral fractures in relation to other osteoporotic fractures was calculated. Patients were interviewed by telephone 6 months after the fracture with the Disabilities of the Arm, Shoulder and Hand and EuroQoL 5D questionnaires. Results: This study comprised 5,147 women (mean age, 72.6 +/- 7.5 years) with 5,268 fractures. Of these, 912 (17.5%) had had proximal humeral fractures. The mean Disabilities of the Arm, Shoulder and Hand score was 26.6 +/- 25.7. Of the women, 67.3% had pain or discomfort and disclosed significant reductions in functional capacity, especially with regard to self-care (44.5%), daily life activities (56.5%), and anxiety or depression (32.7%). Conclusion: Nondisplaced proximal humeral fractures are among the most common fractures associated with osteoporosis, and they can be a major cause of functional disability and reduction in subjective patient-perceived health. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.