Clinical and radiological comparison of conservative treatment options in humeral upper-end fractures. Prospective and randomized controlled trial

Objective: The role of conservative treatment in proximal humerus fracture (PHF) is increasing day by day. However, the protocol of conservative treatment is not clear in the literature. The form of immobilization, which is one of the protocols, is an important issue that has not been investigated in the literature. The aim of this study is to investigate the effect of three different types of shoulder arm slings, which provide fixation in alternating rotations of the arm. Prospective randomized trial. Patients and methods: PHF patients who applied to the Emergency Orthopedics Unit of Bezmialem Vakıf University Medical Faculty Hospital between December 2020 and March 2022 and were given a decision for conservative treatment, were followed up prospectively for one year, by giving one of the 3 types of shoulder slings according to the previous randomization. The patients were in the 1st year follow-up after the injury; Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), Disabilities of Arm, Shoulder and Hand (DASH), Constant Scores, joint range of motion and radiological results were evaluated. These results were statistically analyzed among 3 groups, each treated with a different type of sling. The study, which started with a total of 120 patients, was completed with 105 patients whose data could be collected completely. Results: The data of 34 patients in Group A (Velpau bandage), 39 patients in Group B (basic shoulder arm sling), and 32 patients in Group C (padded shoulder sling) were analyzed. The mean age for all patients was 60.6 ± 15.9 years, and 67 (63.8%) of the patients were female. In the analysis made between Groups A, B and C; it was determined that there was a homogeneous distribution between the groups according to the Neer Classification and age. Among the groups; no significant difference was found in terms of SSV, VAS, ASES, DASH Scores and joint range of motion. In the radiological evaluation, 5 (4.1%) of our 120 patients showed nonunion, and 24 (%22,9) of our 105 patients had malunion. 5 patients with nonunion were not included in the final outcome analysis. No statistically significant difference was found in the distribution of patients with malunion between groups. Conclusions: According to the results of our study; the bandage type used in conservative treatment does not affect the functional and radiological results of the patients. Decisions can be made according to patient comfort and cost while slinging in PHFs. Each parameter of conservative treatment in order to develop standard treatment protocols; should be investigated in well-planned, high-quality studies. Key words: Proximal humerus fractures, conservative treatment, shoulder arm sling