The Neer classification, but not the AO classification, is associated with 10-year clinical outcomes in nonoperatively treated proximal humeral fractures: a cohort study in Malmö, Sweden

Proximal humeral fracture (PHF) is the fourth most common nonspinal fracture in adults. The long-term clinical outcomes after nonoperative treatment for different PHF types are unclear. This study aims to evaluate the long-term clinical outcomes of a nonoperatively treated PHF across various fracture types using the Neer and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications. This cohort study included 255 adults from Malmö, Sweden, with a PHF in 1981, treated nonoperatively. Approximately 10 years after the fracture event, 130 individuals (80% of those alive) participated in a follow-up. The fractures were classified by the Neer and AO classifications. Clinical outcomes, including range of motion (ROM), pain, and function, were assessed through physical examinations and/or questionnaires. The mean age at fracture was 65 years, the male:female ratio was 1:3, and the mean follow-up time was 10.4 years. Individuals with Neer 1 fractures demonstrated better ROM compared with those with more complex fractures. At follow-up, 78% reported no pain and 79% reported full function. Individuals with Neer 1 fractures reported better function compared with those with more complex fractures. Fracture complexity according to the Neer classification was associated with clinical outcomes 10 years after a nonoperatively treated PHF, with a less complex PHF showing better ROM and function compared with a more complex PHF. No corresponding association was observed with the AO classification. The results of this study may provide a reference for nonoperative treatment when evaluating operative methods, and as a starting point for shared decision-making in clinical practice.