• Joshua Song, Lim Chien Joo, Low Chee Chung Jonathan, Sean Wei Loong Ho, Ivan Chua, KwekErnest Beng KeeEBKDepartment of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore., and Bryan Yijia Tan.
• Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore, 308433, Singapore. jstham@outlook.com.
• Arch Orthop Trauma Surg. 2024 Aug 1; 144 (8): 346134683461-3468.

IntroductionTreatment of proximal humerus fractures remains controversial. Understanding the factors that can affect the long-term functional outcomes can aid with management choices. This primary aim of this paper is to evaluate the association of radiographic parameters with functional outcomes.MethodsRadiographic parameters [Caput-collum-diaphyseal (CCD) angles, Y-scapular angles, and humeral head height (HHH)] were studied. The patients were split into varus and valgus groups based on the CCD angles and retroverted and anteverted groups based on Y-scapular angles. Functional outcome was measured by Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and quick Disabilities of Arm, Shoulder and Hand score at 1 year follow-up. Intra- and interrater reliability were measured with the intraclass correlation coefficients (ICCs). Receiver operator curve (ROC) analysis and logistic regression analysis defined the optimal value for abnormalities on radiographic evaluation as an outcome predictor.Results111 patients were recruited (mean age 69, 78% female). Median final radiographic assessment was at 7 months. Mean initial/final CCD was 119o /111o (varus, n = 36) and 153o/140o (valgus, n = 75). Mean initial/final Y-scapula angle was 27o/27o (retroversion, n = 101) and 70o/40o (anteversion, n = 9). There was a significant relationship between OSS and final Y-scapular angle in the retroverted group (adj coeff 0.034, p = 0.009) with optimum predictive retroversion angulation of 25o predicting poor functional outcome (OSS < 40), area under the ROC curve of 0.614. Higher initial valgus and retroversion significantly predicted more change in the final angle (adj coeff - 0.349, p = 0.002, adj coeff - 0.527, p < 0.001 respectively). Both intra-rater and inter-rater reliability for the radiographic parameters were excellent (ICC > 0.9).ConclusionRadiographic parameters whilst having excellent reliability, have a limited ability to predict short-term functional recovery. The extent of retroversion is the most important predictor for functional recovery with 25o a cut-off guide. Fractures with a higher initial valgus and retroversion tend to displace more.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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