Clinical and radiological results of locking plate surgical treatment in patients over 65 years of age with neer type 3-4 proximal humerus fractures

Kemal Kayaokay; Cemal Kazimoglu

Clinical Research

Year 2023, Volume: 16 Issue: 2, 35 - 39, 08.08.2023

Kemal Kayaokay Cemal Kazimoglu

Abstract

References

1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-371.
2. Passaretti D, Candela V, Sessa P, Gumina S. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropoli-tan area. J Shoulder Elbow Surg. 2017;26(12):2117-124.
3. Iglesias-Rodríguez S, Domínguez-Prado DM, García-Reza A, Fernández-Fernández D, Pérez-Alfonso E, García-Piñeiro J, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402.
4. Patel AH, Wilder JH, Ofa SA, Lee OC, Savoie FH, 3rd, O'Brien MJ, et al. Trending a decade of proximal humerus fracture management in ol-der adults. JSES Int. 2022;6(1):137-143.
5. McLean AS, Price N, Graves S, Hatton A, Tay-lor FJ. Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. J Shoulder El-bow Surg. 2019;28(11):2072-2078.
6. Court-Brown CM, Cattermole H, McQueen MM. Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br. 2002;84(4):504-508.
7. Thorsness R, English C, Gross J, Tyler W, Volos-hin I, Gorczyca J. Proximal humerus fractures with associated axillary artery injury. J Orthop Trauma. 2014 Nov;28(11):659-663.
8. Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79(2):203-207.
9. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Ort-hop Relat Res. 1987(214):160-164.
10. Beks RB, Ochen Y, Frima H, Smeeing DPJ, van der Meijden O, Timmers TK, et al. Operative versus nonoperative treatment of proximal hu-meral fractures: a systematic review, meta-analysis, and comparison of observational stu-dies and randomized controlled trials. J Shoul-der Elbow Surg. 2018;27(8):1526-1534.
11. Jawa A, Burnikel D. Treatment of Proximal Humeral Fractures: A Critical Analysis Review. JBJS Rev. 2016;4(1).
12. Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture tre-atment in adults. J Bone Joint Surg Am. 2014;96(3):251-261.
13. Handoll HH, Brorson S. Interventions for trea-ting proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015(11):Cd000434.
14. Boileau P, Caligaris-Cordero B, Payeur F, Tinsi L, Argenson C. [Prognostic factors during reha-bilitation after shoulder prostheses for fracture]. Rev Chir Orthop Reparatrice Appar Mot. 1999;85(2):106-116.
15. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767.
16. Mills HJ, Horne G. Fractures of the proximal humerus in adults. J Trauma. 1985;25(8):801-805.
17. Walsh S, Reindl R, Harvey E, Berry G, Beck-man L, Steffen T. Biomechanical comparison of a unique locking plate versus a standard pla-te for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristol, Avon). 2006;21(10):1027-1031.
18. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complicati-ons in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trau-ma. 2008;22(3):159-164.
19. Sun JC, Li YL, Ning GZ, Wu Q, Feng SQ. Treat-ment of three- and four-part proximal humeral fractures with locking proximal humerus plate. Eur J Orthop Surg Traumatol. 2013;23(6):699-704.
20. Yang H, Li Z, Zhou F, Wang D, Zhong B. A prospective clinical study of proximal humerus fractures treated with a locking proximal hume-rus plate. J Orthop Trauma. 2011;25(1):11-17.
21. Erpala F, Tahta M, Öztürk T, Zengin Ç. Compa-rison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age. Cureus. 2021;13(8):e17516.
22. Soler-Peiro M, García-Martínez L, Aguilella L, Perez-Bermejo M. Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review. J Orthop Surg Res. 2020;15(1):347.
23. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trau-ma. 2011;25(10):612-617.
24. Hessmann M, Baumgaertel F, Gehling H, Klin-gelhoeffer I, Gotzen L. Plate fixation of proximal humeral fractures with indirect reduc-tion: surgical technique and results utilizing three shoulder scores. Injury. 1999;30(7):453-462.
25. Neer CS, 2nd. Four-segment classification of proximal humeral fractures: purpose and reliab-le use. J Shoulder Elbow Surg. 2002;11(4):389-400.
26. Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 ye-ars and older: a randomized controlled trial. Clin Orthop Relat Res. 2012;470(12):3483-3491.
27. Olerud P, Ahrengart L, Ponzer S, Saving J, Ti-dermark J. Hemiarthroplasty versus nonopera-tive treatment of displaced 4-part proximal humeral fractures in elderly patients: a rando-mized controlled trial. J Shoulder Elbow Surg. 2011;20(7):1025-1033.
28. 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(2):113-119.

Clinical and radiological results of locking plate surgical treatment in patients over 65 years of age with neer type 3-4 proximal humerus fractures

Year 2023, Volume: 16 Issue: 2, 35 - 39, 08.08.2023

Kemal Kayaokay Cemal Kazimoglu

Abstract

Our objective was to evaluate the locking plate osteosynthesis (OS) results in treating three- and four-part humeral fractures in patients older than 65 years.
Twenty-eight patients who underwent plate osteosynthesis for proximal humerus fracture between 2017 and 2021 and had at least one year of follow-up were included in the study. The Constant-Murley shoulder score (0-55 points: poor, 56-70 points: moderate, 71-85 points: good, 86-100 points: very good), shoulder motion in all directions, pain, and performing daily activities of daily living at postoperative follow-up of the shoulder range of motion was also assessed.
The mean age of our patients was 75.14 (66-94). The mean follow-up time was 58.8 (18-73) months. One of our patients developed avascular necrosis in the humeral head, and two of our patients underwent partial shoulder arthroplasty when union could not be achieved. Graphic follow-up revealed that the plate caused subacromial compression in 5 patients, that the locking screw loosened in 3 patients, that 1 (3.22%) screw in the humeral head migrated into the joint in 3 patients in the postoperative period, and that the humeral head fused in varus position in 6 patients. In 3 of our patients, the screws that had migrated into the joint were removed. Hemiarthroplasty was performed in one patient with avascular necrosis and two patients with nonunion. The mean Constant-Murley shoulder score was calculated to be 49.74 (23-98). It was considered excellent in 2 (6.45%) patients, good in 2 patients, moderate in 6 patients, and poor in 18 (67.74%) patients. Infections, vascular and nerve damage did not occur in our patients.
Considering osteoporosis in three-part and four-part fractures of the proximal humerus of Neer, the results of plate osteosynthesis treatment are not successful in patients with advanced age, additional morbidity and high surgical risk.

Keywords

proximal humerus fractures, osteosynthesis, Neer 3 and 4 fragment fractures, upper extremity trauma, locking plate

References

1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-371.
2. Passaretti D, Candela V, Sessa P, Gumina S. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropoli-tan area. J Shoulder Elbow Surg. 2017;26(12):2117-124.
3. Iglesias-Rodríguez S, Domínguez-Prado DM, García-Reza A, Fernández-Fernández D, Pérez-Alfonso E, García-Piñeiro J, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402.
4. Patel AH, Wilder JH, Ofa SA, Lee OC, Savoie FH, 3rd, O'Brien MJ, et al. Trending a decade of proximal humerus fracture management in ol-der adults. JSES Int. 2022;6(1):137-143.
5. McLean AS, Price N, Graves S, Hatton A, Tay-lor FJ. Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. J Shoulder El-bow Surg. 2019;28(11):2072-2078.
6. Court-Brown CM, Cattermole H, McQueen MM. Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br. 2002;84(4):504-508.
7. Thorsness R, English C, Gross J, Tyler W, Volos-hin I, Gorczyca J. Proximal humerus fractures with associated axillary artery injury. J Orthop Trauma. 2014 Nov;28(11):659-663.
8. Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79(2):203-207.
9. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Ort-hop Relat Res. 1987(214):160-164.
10. Beks RB, Ochen Y, Frima H, Smeeing DPJ, van der Meijden O, Timmers TK, et al. Operative versus nonoperative treatment of proximal hu-meral fractures: a systematic review, meta-analysis, and comparison of observational stu-dies and randomized controlled trials. J Shoul-der Elbow Surg. 2018;27(8):1526-1534.
11. Jawa A, Burnikel D. Treatment of Proximal Humeral Fractures: A Critical Analysis Review. JBJS Rev. 2016;4(1).
12. Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture tre-atment in adults. J Bone Joint Surg Am. 2014;96(3):251-261.
13. Handoll HH, Brorson S. Interventions for trea-ting proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015(11):Cd000434.
14. Boileau P, Caligaris-Cordero B, Payeur F, Tinsi L, Argenson C. [Prognostic factors during reha-bilitation after shoulder prostheses for fracture]. Rev Chir Orthop Reparatrice Appar Mot. 1999;85(2):106-116.
15. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767.
16. Mills HJ, Horne G. Fractures of the proximal humerus in adults. J Trauma. 1985;25(8):801-805.
17. Walsh S, Reindl R, Harvey E, Berry G, Beck-man L, Steffen T. Biomechanical comparison of a unique locking plate versus a standard pla-te for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristol, Avon). 2006;21(10):1027-1031.
18. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complicati-ons in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trau-ma. 2008;22(3):159-164.
19. Sun JC, Li YL, Ning GZ, Wu Q, Feng SQ. Treat-ment of three- and four-part proximal humeral fractures with locking proximal humerus plate. Eur J Orthop Surg Traumatol. 2013;23(6):699-704.
20. Yang H, Li Z, Zhou F, Wang D, Zhong B. A prospective clinical study of proximal humerus fractures treated with a locking proximal hume-rus plate. J Orthop Trauma. 2011;25(1):11-17.
21. Erpala F, Tahta M, Öztürk T, Zengin Ç. Compa-rison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age. Cureus. 2021;13(8):e17516.
22. Soler-Peiro M, García-Martínez L, Aguilella L, Perez-Bermejo M. Conservative treatment of 3-part and 4-part proximal humeral fractures: a systematic review. J Orthop Surg Res. 2020;15(1):347.
23. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trau-ma. 2011;25(10):612-617.
24. Hessmann M, Baumgaertel F, Gehling H, Klin-gelhoeffer I, Gotzen L. Plate fixation of proximal humeral fractures with indirect reduc-tion: surgical technique and results utilizing three shoulder scores. Injury. 1999;30(7):453-462.
25. Neer CS, 2nd. Four-segment classification of proximal humeral fractures: purpose and reliab-le use. J Shoulder Elbow Surg. 2002;11(4):389-400.
26. Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 ye-ars and older: a randomized controlled trial. Clin Orthop Relat Res. 2012;470(12):3483-3491.
27. Olerud P, Ahrengart L, Ponzer S, Saving J, Ti-dermark J. Hemiarthroplasty versus nonopera-tive treatment of displaced 4-part proximal humeral fractures in elderly patients: a rando-mized controlled trial. J Shoulder Elbow Surg. 2011;20(7):1025-1033.
28. 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(2):113-119.

There are 28 citations in total.

Details

Primary Language	English
Subjects	Surgery (Other)
Journal Section	Research Article
Authors	Kemal Kayaokay 0000-0003-1655-0587 Cemal Kazimoglu 0000-0003-2089-5043
Publication Date	August 8, 2023
Submission Date	June 22, 2023
Published in Issue	Year 2023 Volume: 16 Issue: 2

Cite

Vancouver	Kayaokay K, Kazimoglu C. Clinical and radiological results of locking plate surgical treatment in patients over 65 years of age with neer type 3-4 proximal humerus fractures. JSurgArts. 2023;16(2):35-9.

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