The Neer classification, but not the AO classification, is associated with 10-year clinical outcome in non-operatively treated proximal humeral fractures A cohort study in Malmö, Sweden.

Abstract

Proximal humeral fracture (PHF) is the fourth most common non-spinal fracture in adults. The long-term clinical outcome following non-operative treatment for different PHF types is unclear. This study aims to evaluate the long-term clinical outcome of non-operatively treated PHF across various fracture types using the Neer- and AO-classifications. This cohort study included 255 adults from Malmö, Sweden, with a PHF in 1981, treated non-operatively. Approximately ten years after the fracture event, 130 individuals (80% of those alive) participated in a follow-up. The fractures were classified by the Neer and AO classifications. Clinical outcome, including range of motion (ROM), pain, and function, were assessed through physical examinations and/or questionnaires. The mean age at fracture was 65 years, the male:female ratio was 1:3, and the mean follow-up time was 10.4 years. Individuals with Neer 1 fractures demonstrated better ROM compared to those with more complex fractures. At follow-up, 78% reported no pain and 79% reported full function. Individuals with Neer 1 fractures reported better function compared to those with more complex fractures. Fracture complexity according to the Neer classification was associated with clinical outcome 10 years after a non-operatively treated PHF, with less complex PHF showing better ROM and function compared to more complex PHF. No corresponding association was observed with the AO classification. The results of this study may provide a reference for non-operative treatment when evaluating operative methods, and as a starting point for shared decision-making in clinical practice.