# Analysis of risk factors and prevention strategies of shoulder joint stiffness after traumatic proximal humeral fracture in patients with osteoporosis

## TL;DR

This study identifies risk factors for shoulder stiffness after shoulder fractures in osteoporosis patients and suggests prevention strategies to improve clinical outcomes.

## Contribution

The study introduces a three-tiered prevention strategy for shoulder stiffness after proximal humeral fractures in osteoporosis patients.

## Key findings

- Advanced age, overweight, smoking, and prolonged disease course are independent risk factors for shoulder stiffness.
- Preoperative standardized physical therapy is a protective factor against shoulder stiffness.
- Plate and nail fixation methods do not significantly differ in shoulder stiffness incidence.

## Abstract

To explore the risk factors of shoulder stiffness after traumatic proximal humeral fracture in patients with osteoporosis, and to develop targeted prevention strategies to provide a basis for clinical optimization of perioperative management.

A retrospective analysis of 236 patients with osteoporosis and proximal humeral fractures treated from January to December 2024 was performed. According to whether shoulder stiffness occurred at 6 months after surgery, they were divided into stiffness group (119 cases) and non-stiffness group (117 cases). Clinical data such as age, body mass index (BMI), smoking history, and preoperative physical therapy were collected. Univariate and multivariate logistic regression analysis were used to analyze risk factors.

The incidence of shoulder stiffness was 50.4%. Univariate analysis showed that the stiffness group was older (52.83 ± 6.65 years vs. 43.31 ± 6.48 years), P24 kg/m2 ratio was higher (73.1% vs. 50.4%, p < 0.001), more smokers (42.9% vs. 19.7%, p < 0.001), and lower preoperative physical therapy rate (10.9% vs. 25.6%, p = 0.003). Multivariate analysis confirmed that advanced age (OR = 1.297), overweight (OR = 5.599), smoking (OR = 3.270) and prolonged course of disease (OR = 2.409) were independent risk factors, while preoperative standardized physical therapy was a protective factor (OR = 0.187). Subgroup analysis further indicated no significant difference in the incidence of shoulder stiffness between plate and nail fixation methods. ROC curve analysis demonstrated that age and course of disease possessed high predictive value (AUC = 0.857 and 0.770, respectively), whereas the predictive value of a history of standard physical therapy was relatively low (AUC = 0.570).

Patients with osteoporosis undergoing surgery for proximal humeral fractures may develop shoulder joint stiffness. To optimize perioperative management, a three-tiered prevention strategy centered on smoking cessation, weight management and early physical therapy is recommended, supplemented by personalized comprehensive preventive measures.