Underlying Mental Illness and Psychosocial Factors Are Predictors of Poor Outcomes After Proximal Humerus Repair

J Orthop Trauma. 2019 Sep;33(9):e339-e344. doi: 10.1097/BOT.0000000000001494.


Objectives: (1) To assess the correlation of psychosocial factors and long-term outcomes of proximal humerus fractures all in surgical repair; (2) to identify specific psychosocial factors with favorable and unfavorable outcomes; and (3) to assess the correlation between DSM-V mental health diagnoses and long-term Disabilities of Arm, Shoulder, and Hand (DASH) scores.

Design: Prospective cohort study.

Setting: Academic medical center.

Patients: Patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board-approved registry. One hundred eighty-five proximal humerus fractures of 247 met inclusion criteria.

Intervention: Surgical repair of proximal humerus fractures.

Main outcome measure: All patients were prospectively followed up and assessed for clinical and functional outcomes at latest follow-up visit (mean = 24.8 months) using the DASH questionnaires along with ranges of motion and pain level. Psychosocial factors at 3 months were obtained from the DASH survey.

Results: Concomitant diagnosis of depressed mood (P = 0.001), anxiety (P < 0.0005), low energy level (P = 0.003), and fatigue (P = 0.001) correlated significantly with poorer outcome. All 6 psychosocial factors correlated directly and significantly with pain at latest follow-up (P < 0.0005). Multiple regression analysis revealed that the strongest predictor of the overall DASH score was the extent of interference with social life (P = 0.001).

Conclusion: Analysis demonstrated that psychological and social factors at 3 months postoperatively have a strong correlation with negative long-term (>1 year) outcomes after proximal humerus fixation. Clinicians may offer psychological support and encourage social support to these patients postoperatively to improve pain and treatment outcomes.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Aged
  • Correlation of Data
  • Female
  • Humans
  • Male
  • Mental Disorders / complications*
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Shoulder Fractures / complications*
  • Shoulder Fractures / psychology
  • Shoulder Fractures / surgery*
  • Time Factors
  • Treatment Outcome