Comparison of Conservative and Arthroplasty Treatment for 3 or 4 Part Proximal Humerus Fractures in the Elderly
Öz
Aim: Proximal humerus fractures are common injuries in the elderly population. This study hypothesizes that arthroplasty is not superior to conservative treatment in the management of multi-part proximal humerus fractures in elderly patients.
Material and Method: Patients aged 65 and above with 3–4-part proximal humerus fractures, treated either conservatively or with arthroplasty, were included in the study. The minimum follow-up period was set at 12 months. Functional evaluations of the patients were performed using the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) scoring system. Statistical analysis comparing the two groups was conducted using the SPSS software. The mean values of numerical data were analyzed using the Mann-Whitney U test, while categorical data were compared using the Chi-square test. A significant level of 0.05 was considered.
Results: A total of 67 patients who received adequate clinical follow-up were included in the study (50 conservative 17 arthroplasty). The average age of the patients was 76.12 years, with 9 male and 58 female patients. The average follow-up period was 22.61 months (range: 12-82). There were no statistically significant differences in age, gender, side, follow-up period, and fracture type distribution between the two groups. However, a significant difference in Q-DASH scores was observed (p<0.05).
Conclusion: In the treatment of proximal humerus fractures, even when they are multi-part fractures, conservative treatment should may be the first choice. We think that the early results of conservative treatment are better than arthroplasty.
Anahtar Kelimeler
Proximal humerus fracture conservative treatment shoulder arthroplasty
Etik Beyan
Suleyman Demirel University Faculty of Medicine clinical research ethics committee approval was received. Number: 72867572.050.01.04-37133
Destekleyen Kurum
none
Teşekkür
none
Kaynakça
- Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2010;12:CD000434.
- Kancherla VK, Singh A, Anakwenze OA. Management of acute proximal humeral fractures. J Am Acad Orthop Surg. 2017;25:42-52.
- Rangan A, Handoll H, Brealey S, et al.; PROFHER trial collaborators. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313:1037-47.
- Tamimi I, Montesa G, Collado F, et al. Displaced proximal humeral fractures: when is surgery necessary?. Injury. 2015;46:1921-9.
- O'Donnell JA, Gage MJ. Proximal humerus geriatric fracture care: fix, replace, or nonoperative treatment?. J Orthop Trauma. 2021;35:S6-10.
- Gigis I, Nenopoulos A, Giannekas D, et al. Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J. 2017;11:108-18.
- Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg. 2013;22:e8-14.
- Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295-300.
- Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42:1283-8.
- Large TM, Adams MR, Loeffler BJ, Gardner MJ. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg. 2019;27:794-805.
- Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. 2016;4:e2.
- Antonios T, Bakti N, Phadkhe A, et al. Outcomes following arthroplasty for proximal humeral fractures. J Clin Orthop Trauma. 2020;11:S31-6.
- Schairer WW, Nwachukwu BU, Lyman S, et al. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2015;24:1560-6.
- Cheung E, Willis M, Walker M, et al. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439-49.
- Roberson TA, Granade CM, Hunt Q, et al. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg. 2017;26:1017-22.
- Erpala F, Tahta M, Öztürk T, Zengin Ç. Comparison of treatment options of three- and four-part humerus proximal fractures in patients over 50 years of age. Cureus. 2021;13:e17516.
- Xie L, Ding F, Zhao Z, et al. Operative versus non-operative treatment in complex proximal humeral fractures: a meta-analysis of randomized controlled trials. Springerplus. 2015;4:728.
- Song JQ, Deng XF, Wang YM, et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015;49:345-53.
- Osterhoff G, Ossendorf C, Wanner GA, et al. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;6:50.
- Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, et al. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2019;28:2259-71.
Öz
Kaynakça
- Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2010;12:CD000434.
- Kancherla VK, Singh A, Anakwenze OA. Management of acute proximal humeral fractures. J Am Acad Orthop Surg. 2017;25:42-52.
- Rangan A, Handoll H, Brealey S, et al.; PROFHER trial collaborators. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313:1037-47.
- Tamimi I, Montesa G, Collado F, et al. Displaced proximal humeral fractures: when is surgery necessary?. Injury. 2015;46:1921-9.
- O'Donnell JA, Gage MJ. Proximal humerus geriatric fracture care: fix, replace, or nonoperative treatment?. J Orthop Trauma. 2021;35:S6-10.
- Gigis I, Nenopoulos A, Giannekas D, et al. Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J. 2017;11:108-18.
- Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg. 2013;22:e8-14.
- Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295-300.
- Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42:1283-8.
- Large TM, Adams MR, Loeffler BJ, Gardner MJ. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg. 2019;27:794-805.
- Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. 2016;4:e2.
- Antonios T, Bakti N, Phadkhe A, et al. Outcomes following arthroplasty for proximal humeral fractures. J Clin Orthop Trauma. 2020;11:S31-6.
- Schairer WW, Nwachukwu BU, Lyman S, et al. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2015;24:1560-6.
- Cheung E, Willis M, Walker M, et al. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439-49.
- Roberson TA, Granade CM, Hunt Q, et al. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg. 2017;26:1017-22.
- Erpala F, Tahta M, Öztürk T, Zengin Ç. Comparison of treatment options of three- and four-part humerus proximal fractures in patients over 50 years of age. Cureus. 2021;13:e17516.
- Xie L, Ding F, Zhao Z, et al. Operative versus non-operative treatment in complex proximal humeral fractures: a meta-analysis of randomized controlled trials. Springerplus. 2015;4:728.
- Song JQ, Deng XF, Wang YM, et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015;49:345-53.
- Osterhoff G, Ossendorf C, Wanner GA, et al. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;6:50.
- Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, et al. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2019;28:2259-71.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Özgün Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Mayıs 2024 |
| Gönderilme Tarihi | 11 Ocak 2024 |
| Kabul Tarihi | 23 Nisan 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 6 Sayı: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey
Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey
E-mail: medrecsjournal@gmail.com
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