From the Guidelines
Conservative management is an acceptable option for a 70-year-old man with a displaced humeral surgical neck fracture, as it can provide good functional outcomes with minimal complications, as suggested by the EULAR/EORT recommendations 1. When considering conservative management for this patient, several factors come into play, including the degree of displacement, the patient's overall health status, and their functional demands.
- The initial approach to conservative management would involve immobilization with a sling for 2-3 weeks to allow for initial healing and pain reduction.
- Following immobilization, pendulum exercises can be initiated around week 3 to maintain range of motion and prevent stiffness.
- Progressive range of motion exercises can then begin at 4-6 weeks, as pain allows, to improve shoulder function and strength.
- Pain management is crucial and can typically be managed with acetaminophen 650-1000mg every 6 hours as needed, possibly supplemented with NSAIDs like ibuprofen 400-600mg three times daily if not contraindicated by renal function, cardiac issues, or bleeding risk.
- Close follow-up with radiographs at 1,3, and 6 weeks is essential to monitor fracture alignment and healing, allowing for early detection of any complications that may require surgical intervention. The decision to proceed with conservative management should be made on a case-by-case basis, considering the patient's specific circumstances and the potential risks and benefits of surgery, as outlined in the EULAR/EORT recommendations for the management of patients older than 50 years with a fragility fracture 1.
From the Research
Conservative Management for a 70-year-old Man
- Conservative management can be an acceptable treatment option for a 70-year-old man with a displaced humeral surgical neck fracture, as studies have shown that it can result in comparable functional outcomes to surgical treatment 2, 3.
- A study published in 1997 found that there were no functional differences between conservative treatment and tension-band osteosynthesis in elderly patients with displaced proximal humeral fractures at one year and after three to five years of follow-up 3.
- Another study published in 2007 found that the results of intramedullary nailing were not very satisfactory compared to the conservative-treated group, although the functional results of the operative group were comparable to those from other studies in literature 2.
- However, the decision to use conservative management should be based on individual patient factors, such as the type and severity of the fracture, as well as the patient's overall health and activity level.
- Other studies have also compared the outcomes of different treatment options for proximal humeral fractures, including conservative treatment, proximal humeral nails, percutaneous K-wiring, and locking-plates 4.
- A review of management options for proximal humeral fractures published in 2014 noted that non-operative treatment is typically selected for minimally displaced fractures, while surgical fixation is considered for displaced or complex fractures 5.
Factors Influencing Treatment Outcome
- The type and severity of the fracture can influence the treatment outcome, with some studies suggesting that conservative treatment may be more suitable for certain types of fractures 4.
- The patient's age and overall health can also impact the treatment outcome, with older patients potentially being more suitable for conservative management due to the risks associated with surgery 3, 4.
- The experience and skill of the healthcare provider can also play a critical role in determining the success of conservative management or surgical treatment 2, 6.