Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation.

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.

• Authors: Richard M Hinds, Matthew R Garner, Wesley H Tran, Lionel E Lazaro, Joshua S Dines, Dean G Lorich
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 24 Issue 6 Pg. 889-96 (Jun 2015) ISSN: 1532-6500 [Electronic] United States
• PMID: 25483905 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Allografts
• Bone Plates
• Bone Screws (adverse effects)
• Female
• Fibula (transplantation)
• Follow-Up Studies
• Fracture Fixation, Internal (adverse effects, methods)
• Humans
• Male
• Middle Aged
• Radiography
• Range of Motion, Articular
• Shoulder Fractures (diagnostic imaging, physiopathology, surgery)
• Shoulder Joint (diagnostic imaging, physiopathology)
• Treatment Outcome