Reverse shoulder prosthesis to treat complex proximal humeral fractures in the elderly patients: results after 10-year experience

Background: Treatment of proximal humeral fractures is challenging. Despite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for the elderly patients. The aim of this prospective study was to evaluate the radiological in terms of union and functional outcome in terms of pain, range of motion of conservatively managed proximal humeral fractures in elderly patients.Methods: This was an observational prospective study of 35 patients aged above 65 years with proximal humeral fractures including 2 part, 3 part and 4 part based on Neer’s classification, treated by conservative method. Functional outcome was assessed by using Constant score at follow up of 1 year.Results: Out of 35 patients, 21(60%) were female and 14 (40%) were male with mean age of 76.8 (range 65 to 91years). On the basis of Neer’s classification, majority of patients (15, 42.8%) had 3 part fracture. Radiological union was achieved within 13 to 24 weeks, with an average of 18.4 weeks. Out of 35, 5 (14.3%) had excellent outcome, 8 (22.8%) had good functional outcome, 16 (45.7%) had moderate outcome, 6 (17.14%) had poor outcome. The results were comparable with the existing literature.Conclusion: In the present study, our data shows that the proximal humeral fractures can be effectively managed conservatively in the elderly patients. Two part fractures have best functional outcome and four part fractures have highest rate of complications.

Download Full-text

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211043961 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110439

Author(s):

Guoyun Bu ◽

Weitang Sun ◽

Jian’an Li ◽

Tao Yang ◽

Mingxin Li ◽

...

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Operation Time ◽

The Elderly ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Plate Group ◽

Philos Plate ◽

Fracture Types

Background Proximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. Methods A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. Results No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). Conclusions Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

Download Full-text

The reverse shoulder prosthesis for primary and secondary treatment of proximal humeral fractures: a case report

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-007-0519-0 ◽

2007 ◽

Vol 128 (9) ◽

pp. 973-978 ◽

Cited By ~ 16

Author(s):

Thomas Tischer ◽

Tim Rose ◽

Andreas B. Imhoff

Keyword(s):

Case Report ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Shoulder Prosthesis ◽

Secondary Treatment ◽

Reverse Shoulder Prosthesis

Download Full-text

Reverse Total Shoulder Arthroplasty for Treatment of 3- and 4-Part Proximal Humeral Fractures: Clinical and Radiological Analysis With Minimum Follow-Up of 2 Years

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320915321 ◽

2020 ◽

Vol 11 ◽

pp. 215145932091532

Author(s):

Luis Barbosa ◽

Luis Pires ◽

Paulo Rego ◽

Raul Alonso

Keyword(s):

Elderly Patients ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Complication Rates ◽

The Mean ◽

Complex Proximal Humeral Fractures

Background: Hemiarthroplasty has been associated with inferior and unpredictable outcomes when used in the treatment of complex proximal humeral fractures in elderly patients. In this age-group, reverse shoulder arthroplasty is gaining popularity due to the promising results presented in recent evidence. Our aim is to analyze the cases of complex proximal humeral fractures treated by reverse shoulder arthroplasty, regarding functional results and complications. Materials and Methods: Thirty-five fractures from 33 patients with the mean age of 73.5 (65-81) years were treated with reverse shoulder arthroplasty for complex fractures of the proximal humerus. These patients were followed for a mean of 38.3 months (24-68) and analyzed regarding clinical outcomes and complications. Results: The average Quick-Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 6.8 points and 78.3%, respectively. The mean Constant score on the affected side was 64.4 points, 19.5% less than the nonoperated side. The mean active elevation was 123°, abduction 109°, external rotation 38°, and internal rotation 41°. The radiographic tuberosity healing rate was 85.7%. There were no significant differences in outcomes, between patient with healed and reabsorbed tuberosities. Inferior scapular notching was seen in 8 patients. The global complication rate was 12.8%. Conclusion: Reverse shoulder arthroplasty yields good and reproductive results with acceptable complication rates in selected elderly patients with complex proximal humeral fractures.

Download Full-text