Achieving satisfactory functional outcomes in conservatively treated proximal humerus fractures: relationship between shoulder range of motion and patient-reported clinical outcome scores

BackgroundProximal humerus fractures are common osteoporotic fractures. Post-injury outcome measures include objective clinician-measured range of motion (ROM), and subjective patient-reported outcome measures (PROM), but the relationship between both has not been established. This study aimed to determine the relationship between shoulder ROM and PROMs, and establish which ROMs that correlated most with PROMs.MethodsA prospective cohort study was conducted on patients with acute proximal humerus fractures. Surgical intervention, open or pathological fractures, neurovascular compromise, polytrauma or delayed presentations were excluded. Correlation and regression analyses between active ROM and PROMs (QuickDASH and Oxford Shoulder Score) at 1-year post-injury were explored. ROM cut-offs predicting satisfactory PROM scores were established.ResultsFifty-five patients were recruited. Moderate correlations were observed between PROMs and flexion, extension, and abduction, but not internal and external rotation. Multivariate analysis showed significant relationships between PROMs and flexion [QuickDASH: adjusted coefficient (AC): -0.135, p = 0.013, OSS: AC: 0.072, p = 0.002] , abduction [QuickDASH: AC: -0.115, p = 0.021, OSS: AC: 0.059, p = 0.005], , and extension [QuickDASH: AC: -0.304, p =0.020] adjusting for age, gender, Neer classification, injury on dominant side and employment. Achieving 130˚ flexion, 59˚ extension and 124˚ abduction were correlated with satisfactory OSS/QuickDASH scores respectively.ConclusionOverall, holistic assessment of outcomes with both subjective and objective outcomes are necessary, as shoulder flexion, extension and abduction are only moderately correlated with PROMs. Attaining 130˚ flexion , 59˚ extension and 124˚ abduction corresponded with satisfactory functional outcomes measured by OSS/QuickDASH and can guide rehabilitation.