Self-reducing proximal humerus fractures

Background: Proximal humeral fractures are common in the elderly and can present with multiple fracture configurations. Our case series describes a three-part valgus-impacted fracture pattern of the proximal humerus that underwent spontaneous reduction by nonsurgical management with good functional outcomes. Methods: Seven patients who sustained low-energy three-part valgus-impacted fractures of the proximal humerus were studied. We retrospectively reviewed serial anteroposterior radiographs of each patient taken as part of routine follow-up. For clinical outcomes, patients were assessed by a physical examination of both shoulders. A Disability of Arm, Shoulder, and Hand (DASH) questionnaire assessed the functional outcomes. Results: In all seven patients, fractures reduced spontaneously without any complications. Radiologically, the neck–shaft angle decreased from an average of 169° to 141°. In the six patients examined, range of motion was decreased in all planes in the affected shoulder relative to the contralateral shoulder. Two patients exhibited no loss of power in the affected arm, while the rest exhibited Medical Research Council grade 4 of 5 power in the affected arm. The mean DASH score obtained in our patients was 18.17. None of our patients reported any significant limitations in their activities of daily living and all achieved premorbid functional levels. Conclusion: Low-energy three-part valgus-impacted fracture pattern of the proximal humerus has the ability to spontaneously reduce by nonsurgical management with good functional outcomes.