Second generation locked plating for complex proximal humerus fractures in very elderly patients |
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| Institution: | 1. Parvathy Hospital, Chennai, India;2. Sri Ramachandra Medical College, Chennai, India;3. Swaram Hospital, Chennai, India;4. Metha Hospital, Chennai, India;5. MOSC Medical College, Cochin, India;1. Conservative Surgery Orthopaedic and Innovative Techniques Unit, Department of Complex Orthopaedic-Trauma Pathology, Rizzoli Orthopaedic Institute, Bologna, Italy;2. Service of Immunohematology and Transfusional medicine, Rizzoli Orthopaedic Institute, Bologna, Italy;3. Orthopaedic Pathophysiology and Regenerative Medicine Unit, Department of Complex Orthopaedic-Trauma Pathology Rizzoli Orthopaedic Institute, Bologna, Italy;1. Department of Orthopaedic Surgery, Fatima Hospital, 99 Ayang-ro, Dong-gu, Dae-gu, Republic of Korea;2. Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, 555 Samjungja-Dong, Changwon-si, Republic of Korea;1. Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan;2. Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan;4. Department of Orthopedics, Asia University Hospital, Taichung, Taiwan;5. College of Medicine and Health Science, Department of Occupation Therapy, Asia University, Taichung, Taiwan;6. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan;7. Chaoyang University of Technology, Taichung, Taiwan;8. School of Medicine,China Medical University, Taichung, Taiwan;9. Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan;1. Microsurgery Unit, Department of Orthopedics, University of the Philippines, Philippine General Hospital, Manila, Philippines;2. ASTRO (Advanced STudy and Research in Orthopedics), Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines |
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| Abstract: | ObjectivesHumeral head sacrificing procedures are more favored in elderly patients with complex proximal humerus fractures because of high incidence of failures and complications with osteosynthesis. The purpose of this study is to assess the outcome of second generation locked plating techniques in 3 and 4 part fractures in active elderly patients >70 years with an emphasis on function and complications.Materials and methods29 patients with displaced 3 and 4 part proximal humerus fractures were treated using the principles of second-generation proximal humerus locked plating. Fixed angle locked plating (PHILOS) using the anterolateral deltoid spilt approach augmented with traction cuff sutures was performed. Minimum of 7 locking head screws including 2 calcar screws were used. In cases with a comminuted medial calcar, an endosteal fibular strut was used. Subchondral metaphyseal bone voids were filled with injectable calcium phosphate cement. Radiological outcome (union, head – shaft angle, tuberosity reduction), functional outcome assessment (Constant and ASES scores) and complications (loss of reduction, nonunion and osteonecrosis) were assessed.ResultsThe fracture united in 24 of the 26 patients available for follow up at a mean of 27 months (12–40 months). 3 patients developed complications that required arthroplasty (fixation failure in 2 patients and osteonecrosis in 1 patient). Follow up age adjusted Constant (63.1 ± 11.9) and ASES scores (62.58 ± 7.5) showed the extent of functional improvement post surgery. Patients with fractures having a non-comminuted medial calcar and valgus displacement of the humeral head had better functional scores and fewer complications.ConclusionOsteosynthesis with second generation locked plating techniques provide satisfactory outcome in very elderly patients with complex proximal humerus fractures with minimal complications. |
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| Keywords: | Proximal humerus fractures Elderly Second generation Locked plating |
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