Effect of tuberculum majus displacement amounts on the clinical outcomes of different treatment options in deplaced proximal humerus fractures

Title: The effect of tubercular displacement quantity in comminuted proximal humerus fractures on functional score in different treatment methods Goal: In proximal humeral fractures, another important factor other than fracture is the rotator cuff muscle group. It has been demonstrated in studies that displacement of tubercle with respect to its anatomical position has a bad effect on functional scores. Our aim in our study is to reveal that although the amount of displacement is higher in the conservative treatment method, it may have better functional scores than the group of patients treated surgically. Method: Between the years 2010-2019, 178 patients who applied to the emergency department due to proximal humerus fracture and planned to be treated were included in the study. Patients treated with or without surgery, was evaluated with true AP and transthoracic radiographs taken at the end of the first year. A total of 83 patients were included in the study. Here, vertical and horizontal displacement amounts were measured according to the anatomical position of the tuberculum majus on direct radiographs. Functional scores of these patients were evaluated according to ASES, Constant-Murley, DASH and WORC scoring systems. Results: Among 83 disease groups, 63 were women (75.9%) and 20 were men (24.1%). The average age in the groups was found to be 72.5. The mean vertical displacement of 83 patients was 7.1mm and the horizontal displacement was 4.7mm. The mean Constant score of 83 patients was 66.4, the ASES score was 75.8, the DASH score was 23.1 and the WORC score was 22.6. In conclusion, although the conservative treatment group has more displacement values in terms of vertical and horizontal displacement according to Philos group, there was no functional score difference in the comparison of the 2 groups (p <0.05). When comparing the Philos and HA groups, although the conservative treatment group has more displacement values in terms of horizontal displacement, it is observed that the conservative group ASES scores are higher and WORC scores are lower (p <0.05). When comparing the Philos and RSA groups, it is seen that the vertical displacement amount is higher in the RSA group. DASH and WORC scores appear to be higher in the RSA group (p <0.05). When the conservative treatment group is compared to the RSA group, it is observed that the CONSTANT and ASES scores of the conservative treatment method group are higher than the RSA group, and the WORC and DASH scores are statistically lower (p <0.05). In comparison of the Philos and HA groups, the DASH and WORC scores of the HA group were statistically higher than the Philos group (p <0.05). There was no significant difference between the displacement amount and functional scores of the HA and RSA groups. Conclusion: In terms of displacement, the conservative treatment group has more vertical and horizontal displacement amount compared to other groups. The functional score of the conservative treatment group has better results than the RSA and HA groups. There was no statistical difference in functional scores between the conservative treatment group and the Philos group. Keywords: Reverse Shoulder Arthroplasty, Hemiarthroplasty, Philos, Conservative, Proximal Humerus Fracture, Tuberculum Majus Displacement