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German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

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Surgical treatment of 4-part fractures of the proximal humerus in the elderly: Plate fixation or reversed shoulder arthroplasty?

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  • presenting/speaker Chlodwig Kirchhoff - Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, München, Germany
  • Ali Deeb - Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, München, Germany
  • Salahulddin Abuljadail - Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, München, Germany
  • Peter Biberthaler - Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, München, Germany
  • Marc Beirer - Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, München, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN35-1125

doi: 10.3205/17dkou089, urn:nbn:de:0183-17dkou0891

Published: October 23, 2017

© 2017 Kirchhoff et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives: Fractures of the proximal humerus are common injuries in the elderly. Especially the treatment of 4-part fractures is discussed controversially. Favored surgical treatment options contain reconstructive locking plate fixation or reversed shoulder arthroplasty. In the current literature none of the surgical strategies is definitely superior. Therefore the aim of the presented study was to evaluate the mid-term outcome of both surgical treatment options.

Methods: In this retrospective matched pair trial, 72 patients with at least 70 years of age suffering from a 4-part fracture of the proximal humerus were enrolled. 36 patients were treated by reconstructive locking plate fixation (group 1) whereas the other 36 patients were treated by reversed shoulder arthroplasty (group 2). Functional outcome was analyzed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Constant, SPADI and Dash Scores.

Results and Conclusion: There was no significant difference regarding the follow-up (group 1: 37 ± 22 months; group 2: 34 ± 16 months; p=0.13) as well as the patient age (group 1: 77 ± 5 years; group 2: 81 ± 7 years; p=0.12) in both groups. In addition the functional outcome showed no significant difference (relative Constant Score group 1: 69 ± 24 points; relative Constant Score group 2: 66 ± 22 points; p=0.48). However the revision rate was significantly higher in plate fixation (4/36 patients; 11.1%) in contrast to reversed shoulder arthroplasty (1/36; 2.8%).

Locking plate fixation and reversed shoulder arthroplasty present equal surgical treatment options regarding the functional outcome at mid-term follow-up in the elderly suffering from 4-part fractures of the proximal humerus. However the revision rate after plate fixation was about 4 times higher than in primary reversed shoulder arthroplasty. Those facts should be considered in treatment of older patients due to an increased risk of repeated surgeries and the related danger of anesthesia.