Return-to-Work Following Open Reduction and Internal Fixation of Proximal Humerus Fractures

Michael Dietrich*, 1, Mathias Wasmer 2, Andreas Platz 2, Christian Spross 3
1 Department of Orthopaedics, University Hospital Balgrist, Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
2 Department of Traumatology, City Hospital Triemli Zurich, Zurich, Birmensdorferstrasse 497, CH-8063 Zurich, Switzerland
3 Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstr. 95, CH-9007 St. Gallen, Switzerland

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© Dietrich et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics, University Hospital Balgrist, Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland; Tel: +41 44 386 57 66; Fax: +41 44 386 12 90; E-mail:


Objectives :

Shoulder disorders have an important impact on a patient’s capacity to work. We investigated whether there is a relationship between subjective or objective outcome measures and the ability and time for returning to work (RTW) after a proximal humerus fracture (PHF).

Design :

Retrospective single-centre study from March 2003 to June 2008.

Setting :

City hospital, trauma level one centre.

Intervention :

All PHF stabilized with a PHILOS®.

Main Outcome Measurements :

Routine follow-up examinations (X-ray, Constant-Murley Score (CMS), Short-Form 36 (SF-36)) were performed prospectively after 1.5, 3, 6 and 12 months or until RTW. Primary interest was the comparison of the outcome scores with the time needed for RTW.

Results :

72 patients (52 years (22-64), 37 (51%) women) fulfilled the inclusion criteria. We distinguished “office-workers” (OW) (n = 49, 68%) from patients who worked at a physically demanding job (PW) (n = 23, 32%). Although time for RTW was fundamentally different (42 (OW) vs 118 days (PW), p<0.001), CMS (64.7 vs 64.1) and SF-36 (66.8 vs 69.9) at time of RTW were almost identical. At follow-up, CMS and SF-36 were always lower in the PW group.

Conclusion :

Jobs which require higher physical demands were likely to influence and to delay RTW. This study identifies cut off values for CMS and SF-36 at which a patient feels capable or willing to RTW after PHF. These values show the importance and impact of a patient’s occupation or demands on RTW. We were able to show, that besides age, sex and fracture, the type of occupation might alter the scores in postoperative outcomes.

Keywords: CMS, fracture, proximal humerus, return to work, SF-36, workers compensation..