Displaced XXXX : When is surgery necessary?

@entity6342 @entity1 @entity14423 @entity174
BACKGROUND: Several therapeutic methods have been traditionally used in the treatment of displaced @entity6342 ; however, the indication of these treatments is still controversial. The purpose of this study was to compare the medium-term functional results of four methods commonly used in the treatment of @entity6342 [conservative treatment, proximal humeral nails (PHN), @entity14423 ( @entity14423 ), and locking-plates (LP)] taking into consideration the type of @entity174 and the age of the @entity1 . METHODS: We conducted a retrospective cohort study on @entity1 with @entity6342 treated with one of the following methods: conservative treatment, PHN, @entity14423 , or LP. Functional results were assessed using the absolute Constant score and the disabilities of the arm shoulder and hand score (DASH). The functional outcome was analysed according to age (>= 65 years and <65 years) and @entity174 type (displaced 2-fragment and 3-4-fragment @entity174 ). RESULTS: A total of 113 @entity1 were included in the study, with a mean age of 65.3 SD 15.2 years and average follow-up time of 26.2 SD 12.6 months. @entity1 under 65 years had higher Constant scores when treated with PHN and @entity14423 than those treated conservatively (77.2 vs. 54.7, p=0.01 and 74.0 vs. 54.7, p=0.03, respectively). @entity1 above 65 years had higher Constant scores when treated with @entity14423 compared to PHN and conservative treatment (68.7 vs. 51.9, p=0.02 and 68.7 vs. 55.9, p=0.029, respectively). In 2-fragment @entity174 , @entity14423 resulted in higher Constant scores than conservative treatment (70.4 vs. 53.9, p=0.048). No differences were found in the final outcome between @entity1 treated with LP and those treated conservatively regardless of age, and @entity174 type. There were also no differences between any of the evaluated methods in the treatment of 3-4-fragment @entity174 . CONCLUSION: The use of @entity14423 was associated with better functional results than conservative treatment in individuals of all ages, especially in @entity1 with 2-fragment @entity174 ; @entity14423 also achieved better functional results than PHN in elderly @entity1 . PHN was superior to conservative treatment in young individuals. No significant differences were found between LP and conservative treatment in any of the analysed categories.
