Influence of patient-related factors and surgeon experience on functional outcomes in conservatively treated proximal humerus fractures: a retrospective cohort study

Purpose Proximal humerus fractures (PHFs) are common in the elderly population, but the optimal treatment strategy remains controversial. This study evaluated long-term functional outcomes of conservatively treated PHFs and assessed whether shoulder surgeon experience influences treatment indication and prognosis. Material and Methods A retrospective cohort study included 150 PHFs in 149 patients treated nonoperatively between 2020 and 2021. Two-, three-, and four-part fractures with a minimum 12-month follow-up were analyzed. Outcomes included QuickDASH, Oxford Shoulder Score (OSS), Subjective Shoulder Value (SSV), and SF-12. Radiographic features and demographic variables were analyzed. In a second phase, five shoulder surgeons independently reviewed anonymized cases and retrospectively indicated surgical or conservative treatment, blinded to outcomes. Results: At a mean follow-up of 32.1 months, younger age, absence of comorbidities, better pre-injury physical status, and dominant limb involvement were significantly associated with superior outcomes, whereas fracture fragment number had no significant impact. Displaced fractures showed worse outcomes than non-displaced fractures. However, among displaced fractures, no significant differences in SSV, OSS, QuickDASH, or SF-12 scores were found between fractures retrospectively considered surgical candidates and those considered suitable for conservative treatment. Conclusions: Functional recovery after conservatively treated PHFs appears to depend more on patient-related factors than fracture morphology or surgeon experience. Even displaced fractures can achieve satisfactory long-term outcomes with nonoperative treatment.