Studies on patients with a proximal humerus fracture. With special reference to mortality, fragility, morbidity and outcome

Abstract: Fractures of the proximal part of the humerus occur frequently, especially in elderly women. The present thesis summarizes a series of studies analysing the impact on fracture outcome of factors related both to the fracture itself and to the patient. Fracture type based on comminution and dislocation according to the Neer classification system and epidemiological data involving trauma impact, health status, medicine consumption and fragility have been studied in 269 patients who sustained a proximal humerus fracture in Malmö in 1987 and in 100 patients who got a fracture in 1999. The patients were prospectively followed and compared with 613 controls. It was possible to demonstrate that: 1.There is an increased mortality in male patients with a proximal humerus fracture. 2.Old patients with a proximal humerus fracture have higher coincidental morbidity than their controls. 3.Proximal humerus fractures occur more frequently in patients who have sustained fractures earlier. Also, in these patients, there is an increased risk of subsequent fractures. 4.In patients with a displaced proximal humerus fracture the long-term result is worse than in patients with a minimally displaced fracture. 5.Patients with a proximal humerus fracture and coincidental morbidity have a less favourable long-term outcome. 6.It is possible to predict the long-term result of a proximal humerus fracture after one year. 7.Union with minimally displacement of a proximal humerus fracture does not preclude symptomatic fibrosis.