Richard M Hinds1, Matthew R Garner2, Wesley H Tran3, Lionel E Lazaro2, Joshua S Dines4, Dean G Lorich5. 1. Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA. Electronic address: RichardHindsResearch@gmail.com. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 3. Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA. 4. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA. 5. Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA; Orthopaedic Trauma Service, New York Presbyterian Hospital, New York, NY, USA.
Abstract
BACKGROUND: Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged ≥65 years) and non-geriatric proximal humeral fracture patients treated via locked plating with endosteal fibular strut allograft augmentation. METHODS: From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes. RESULTS: Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147° vs 159°, P = .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery. CONCLUSIONS: Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age.
BACKGROUND: Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged ≥65 years) and non-geriatric proximal humeral fracturepatients treated via locked plating with endosteal fibular strut allograft augmentation. METHODS: From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes. RESULTS: Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147° vs 159°, P = .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery. CONCLUSIONS: Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age.
Authors: Jason M Guattery; Agnes Z Dardas; Michael Kelly; Aaron Chamberlain; Christopher McAndrew; Ryan P Calfee Journal: Clin Orthop Relat Res Date: 2018-04 Impact factor: 4.176
Authors: Sjur Oppebøen; Annette K B Wikerøy; Hendrik F S Fuglesang; Filip C Dolatowski; Per-Henrik Randsborg Journal: J Orthop Surg Res Date: 2018-08-09 Impact factor: 2.359