FUNCTIONAL OUTCOMES FOLLOWING SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES: A PROSPECTIVE COHORT STUDY
A. Zechariah Jebakumar
Dept. of Research and Scientific studies, Prince Sultan Military college of Health Sciences, Dhahran-31932, Kingdom of Saudi Arabia.
Hassan S. Nondo
Dept. of Research and Scientific studies, Prince Sultan Military college of Health Sciences, Dhahran-31932, Kingdom of Saudi Arabia.
Siju K. George
Dept. of Research and Scientific studies, Prince Sultan Military college of Health Sciences, Dhahran-31932, Kingdom of Saudi Arabia.
G.Manoj
Dept of Pharmacology, C.L. Baid Metha College of Pharmacy, Thoraipakkam, Chennai - 600096, India
Proximal humerus fractures represent one of the most common upper-limb fractures, particularly among older adults and individuals with osteoporosis, accounting for a substantial proportion of fragility fractures worldwide. These injuries can result in significant pain, functional impairment, reduced independence, and diminished quality of life if not managed appropriately. Although surgical fixation has become increasingly utilized for displaced and unstable proximal humerus fractures, particularly with the advent of locking plate technology and improved fixation techniques, the optimal treatment strategy remains a subject of ongoing debate. Understanding postoperative functional recovery and factors influencing outcomes is essential for patient counselling, treatment planning, and rehabilitation. Therefore, this prospective cohort study was conducted to evaluate functional outcomes following surgical management of proximal humerus fractures and to identify factors associated with poorer recovery. A total of 124 patients undergoing surgical fixation, including locking plate fixation and other accepted operative techniques, were enrolled and followed for 12 months after surgery. Functional outcomes were assessed using validated instruments, including the Constant–Murley Score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, while shoulder range of motion, radiographic healing, and postoperative complications were also documented. Functional scores were evaluated at predefined follow-up intervals and compared across patient and fracture subgroups. Regression analyses were performed to identify independent predictors of functional recovery. The results demonstrated progressive improvement in shoulder function throughout the follow-up period, with the greatest gains observed during the first six months after surgery and continued improvement up to one year. At the final assessment, patients achieved a mean Constant–Murley score of approximately 78, indicating generally good functional recovery and satisfactory restoration of shoulder function. Significant improvements were also observed in DASH scores and range-of-motion parameters, reflecting enhanced ability to perform daily activities and reduced disability. However, recovery was not uniform across all patients. Older age, increased fracture complexity, and the occurrence of postoperative complications were independently associated with poorer functional outcomes and lower final scores. Complications encountered during follow-up included varus collapse, screw cut-out, and avascular necrosis, all of which adversely affected shoulder function and delayed rehabilitation. These findings emphasize the importance of meticulous surgical technique, careful patient selection, and structured postoperative rehabilitation in optimizing outcomes. Overall, surgical management of proximal humerus fractures resulted in good functional recovery and meaningful improvements in shoulder function at one year. Nevertheless, patient age, fracture severity, and postoperative complications significantly influenced recovery, highlighting the need for individualized treatment strategies, realistic patient counselling, and targeted rehabilitation programs to maximize functional outcomes and quality of life following surgery.
6 , 2 , 2016
69 - 75