Top

Clinical Orthopaedics and Related Research®

Published in:

01-12-2011 | Symposium: Fractures of the Shoulder Girdle

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

Authors: Jonathan D. Barlow, MD, Joaquin Sanchez-Sotelo, MD, PhD, Michael Torchia, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2011

Abstract

Background

Controversy exists regarding the best treatment of proximal humerus fractures in the elderly. Recent studies of open reduction and internal fixation have demonstrated high complication rates.

Questions/purposes

We asked whether (1) open reduction and internal fixation could be performed with low rates of immediate and delayed complications, (2) reduction of these fractures could be maintained over time by evaluating long-term radiographs and visual analog pain scores, and (3) 6-week immobilization would lead to disabling stiffness by evaluating postoperative motion and functional scores.

Patients and Methods

We retrospectively reviewed all 35 patients older than 75 years with displaced proximal humerus fractures treated using a “hybrid” technique between 2002 and 2008. All patients were immobilized for 6 weeks after surgery. Thirteen of the 35 patients either died or developed severe dementia during followup. The analysis included 22 patients followed a minimum of 1 year (mean, 3 years; range, 1–6.7 years).

Results

There were no early or late reoperations in this series. An acceptable reduction was achieved in 89% of the shoulders and maintained over time. All fractures healed. Osteonecrosis was noted on radiographs in 11% of the shoulders. Six weeks of immobilization did not lead to disabling stiffness. At most recent followup, mean active elevation was 141°, mean active internal rotation L1, mean active external rotation 36°, and mean American Society of Shoulder and Elbow Surgeons score 68.

Conclusions

Utilizing this approach, open reduction and internal fixation followed by 6-week immobilization results in a low rate of reoperation and good functional outcomes for elderly patients with proximal humerus fractures.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Available only for authorised users

Antuna SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008;17:202–209.PubMedCrossRef

Banco SP, Andrisani D, Ramsey M, Frieman B, Fenlin JM Jr. The parachute technique: valgus impaction osteotomy for two-part fractures of the surgical neck of the humerus. J Bone Joint Surg Am. 2001;83(Suppl 2 Pt 1):38–42.PubMed

Bastian JD, Hertel R. Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg. 2009;18:216–219.PubMedCrossRef

Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–1046.PubMedCrossRef

Creuss RL. Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip. Clin Orthop Relat Res. 1978;130:86–93.

Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.PubMedCrossRef

Guy P, Slobogean GP, McCormack RG. Treatment preferences for displaced three- and four-part proximal humerus fractures. J Orthop Trauma. 2010;24:250–254.PubMedCrossRef

Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009;18:612–621.PubMedCrossRef

Jakob RP, Miniaci A, Anson PS, Jaberg H, Osterwalder A, Ganz R. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br. 1991;73:295–298.PubMed

10.

Konrad G, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M, Luo C, Plecko M, Wendt K, Kostler W, Sudkamp N. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate: surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):85–95.PubMedCrossRef

11.

Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90:1407–1413.PubMedCrossRef

12.

Lippit SB, Harryman DT, Matsen FA 3rd. A practical tool for evaluating function: the simple shoulder test. In: Matsen FA 3rd, Fu FH, Hawkins RJ, eds. The Shoulder: A Balance of Mobility and Stability. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1993:501–518.

13.

Neer CS 2nd. Displaced proximal humeral fractures. Part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77–82.PubMedCrossRef

14.

Orthopedic Trauma Association. Fracture and Dislocation Classification Compendium, 2007. Available at: http://www.ota.org/compendium/2007JOTFractureCompNew/97042.3Humerus%20S7-S18.pdf. Accessed October 17, 2010.

15.

Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3:347–352.CrossRef

16.

Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma. 2009;23:113–119.PubMedCrossRef

17.

Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M, Luo C, Plecko M, Wendt K, Kostler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate: results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009;91:1320–1328.PubMedCrossRef

18.

Torchia M. Technical tips for fixation of proximal humeral fractures in elderly patients. Instr Course Lect. 2010;59:553–561.PubMed

19.

Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.PubMed

20.

Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury. 1998;29:349–352.PubMedCrossRef

Title: Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique
Authors: Jonathan D. Barlow, MD
Joaquin Sanchez-Sotelo, MD, PhD
Michael Torchia, MD
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1894-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Proximal Humerus Fractures in the Elderly Can Be Reliably Fixed With a “Hybrid” Locked-plating Technique

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 12/2011

Can Computer Assistance Improve the Clinical and Functional Scores in Total Knee Arthroplasty?

Improvement in Reflux Gastroesophagitis in a Patient with Spinal Muscular Atrophy after Surgical Correction of Kyphoscoliosis: A Case Report

Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome

Polyethylene Wear is Related to Patient-specific Contact Stress in THA

Reply to Letter to the Editor: The Cam-type Deformity of the Proximal Femur Arises in Childhood in Response to Vigorous Sporting Activity