Should valgus-impacted proximal humerus fractures necessarily be operated on? Radiological versus functional results

Abstract

Background/aim: Impacted valgus proximal humerus fracture has been known to be challenging in terms of treatment and outcomes since it was defined. Moreover, it is a type of fracture that is difficult to treat. In addition, exact limits have not yet been determined regarding which parameters affect patients' functional and reported outcomes. The purpose of this study was to compare the radiological results of patients with impacted valgus proximal humerus fractures treated conservatively and surgically and to evaluate the effect of these radiological parameters on functional outcomes.Materials and methods: A total of 79 patients who were treated between 2015 and 2021 with a diagnosis of impacted valgus fracture were evaluated retrospectively. Patients treated conservatively (Group 1) and surgically (Group 2) were evaluated in terms of radiological measurements (tubercle displacement (TD), cephalodiaphyseal angle (CDA), medial hinge (MH), cephaloglenoid angle (CGA), medial hinge impaction (MHI), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant Shoulder Score, and functional outcomes (range of motion). The effect of radiological parameters on clinical outcomes was analyzed by a correlation test. Results: In the postoperative period, the ASES and Constant scores of the patients in Group 2 were significantly higher than those of the patients in Group 1. Additionally, Group 2 had better results in terms of passive extension, active internal rotation, and active/passive external rotation. Patients in both groups exhibited improvements in radiological parameters, and the correlation test showed that MH and MHI were mostly related to ASES and Constant scores. Conclusion: The monitoring and treatment of impacted valgus proximal humerus fractures remain controversial. Although radiological parameters are a guide for orthopedic surgeons, the limits have not been clearly defined. In this study, in addition to all parameters, the effect of MH and MHI on functional results was emphasized.