Treatment Preferences for Displaced Three- and Four-Part Proximal Humerus Fractures

Objectives: To assess the treatment preferences of orthopaedic surgeons for displaced three-and four-part proximal humerus fractures. Design: Cross-sectional survey. Setting: Academic and nonacademic institutions across Canada, Patients/Participants: Members of the Canadian Orthopedic Trauma Society and the Joint Orthopedic Initiative for National Trials of the Shoulder. Intervention: Mailed questionnaire requesting treatment preferences for eight clinical scenarios with differing patient age (45 or 68 years), patient activity level (active/healthy or frail/low demand), and fracture type (Neer III or IV). Main Outcome Measurements: Treatment preference for each clinical scenario using a five-level ordinal scale. Results: Thirty-six completed questionnaires were included in the analysis. Internal fixation, particularly with locking plates, was the preferred treatment for young patients regardless of fracture type or activity level. Treatment preferences for elderly patients demonstrated the least consensus. Hemiarthroplasty, locked plating, and non-operative management all received high treatment preferences depending on the fracture type and activity level of the patient. Conclusions: This survey quantifies treatment preferences for a wide range of strategies used to manage displaced proximal humerus fractures. The results of this survey suggest that, despite consulting orthopaedic trauma and shoulder experts, a wide range of treatments appear acceptable for displaced fractures in the elderly. Prospective clinical trials are needed to guide effective treatment decisions for these patients.