Alexander Klug1, Jasmin Harth2, Reinhard Hoffmann2, Yves Gramlich2. 1. Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany. Electronic address: alexander.klug@bgu-frankfurt.de. 2. Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany.
Abstract
BACKGROUND: To date, there is a lack of consensus regarding the type of surgical treatment for complex proximal humeral fractures (PHFs) in elderly patients, especially between joint preservation and joint replacement techniques. MATERIALS AND METHODS: We matched 60 patients (aged 73.2 ± 6.4 years) with complex PHFs in terms of sex, age, and Charlson Comorbidity Index, who underwent locking-plate open reduction-internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) (2011-2017). Postoperative range of motion and functional outcome were assessed using the American Shoulder and Elbow Surgeons shoulder score, Oxford Shoulder Score, Constant-Murley score, and Disabilities of the Arm, Shoulder and Hand score at a mean follow-up of 49 months (ORIF group) and 38 months (RSA group). Complications and unplanned revision surgery were recorded, and all radiographs were analyzed. RESULTS: ORIF resulted in numerically, although not statistically significantly, greater mean shoulder motion vs. RSA. Significantly better outcome was reported for the Oxford Shoulder Score (P = .034) and Disabilities of the Arm, Shoulder and Hand score (P = .026) in the ORIF group, although no significant differences were observed in the American Shoulder and Elbow Surgeons shoulder score and Constant-Murley score. The complication rate (30% vs. 10%) and revision rate (20% vs. 3%) were significantly higher in the ORIF group (P = .028), with patients who had complications or required revision having worse functional results. CONCLUSION: Favorable results are achievable through both angular-stable plating and RSA. Although ORIF may be associated with a superior functional outcome, exceeding the minimal clinically important difference, RSA was linked to significantly fewer complications and revisions.
BACKGROUND: To date, there is a lack of consensus regarding the type of surgical treatment for complex proximal humeral fractures (PHFs) in elderly patients, especially between joint preservation and joint replacement techniques. MATERIALS AND METHODS: We matched 60 patients (aged 73.2 ± 6.4 years) with complex PHFs in terms of sex, age, and Charlson Comorbidity Index, who underwent locking-plate open reduction-internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) (2011-2017). Postoperative range of motion and functional outcome were assessed using the American Shoulder and Elbow Surgeons shoulder score, Oxford Shoulder Score, Constant-Murley score, and Disabilities of the Arm, Shoulder and Hand score at a mean follow-up of 49 months (ORIF group) and 38 months (RSA group). Complications and unplanned revision surgery were recorded, and all radiographs were analyzed. RESULTS: ORIF resulted in numerically, although not statistically significantly, greater mean shoulder motion vs. RSA. Significantly better outcome was reported for the Oxford Shoulder Score (P = .034) and Disabilities of the Arm, Shoulder and Hand score (P = .026) in the ORIF group, although no significant differences were observed in the American Shoulder and Elbow Surgeons shoulder score and Constant-Murley score. The complication rate (30% vs. 10%) and revision rate (20% vs. 3%) were significantly higher in the ORIF group (P = .028), with patients who had complications or required revision having worse functional results. CONCLUSION: Favorable results are achievable through both angular-stable plating and RSA. Although ORIF may be associated with a superior functional outcome, exceeding the minimal clinically important difference, RSA was linked to significantly fewer complications and revisions.
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Authors: Jeanette Köppe; Josef Stolberg-Stolberg; Robert Rischen; Andreas Faldum; Michael J Raschke; J Christoph Katthagen Journal: Clin Orthop Relat Res Date: 2021-10-01 Impact factor: 4.755
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