Operative repair of proximal humerus fractures in septuagenarians and octogenarians: Does chronologic age matter?

Goch, Abraham; Christiano, Anthony; Konda, Sanjit R.; Leucht, Philipp; Egol, Kenneth A.

doi:10.1016/j.jcot.2017.01.006

Cited by 17 publications

(10 citation statements)

References 29 publications

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“…Several studies have shown no difference in outcomes between elderly patients and younger patients following surgical fixation of proximal humerus fractures. 25 - 27 Further, a 1-year outcome study of 637 proximal humerus fractures showed that social independence, not age, was a predictor of outcome. 19 …”

Section: Evaluation and General Considerationsmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

140

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Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

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Section: Evaluation and General Considerationsmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

140

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“…Anatomic reduction and firm fixation of the humerus is the basic guarantee of proximal stability [15]. However, while there are many clinical studies that show follow-up data [16–18], with useful recommendations for the management of complex proximal humeral fractures [13], few studies have been undertaken on the dynamic and static stability of different methods of fixing PHILP [19, 20]. In the present study, we aimed to investigate the effects of contact reduction of inferomedial cortical bone at proximal humerus and placement of calcar screw on the stability of proximal humerus fractures, as well as to address the dynamic and static biomechanics, to provide a theoretical reference for clinical treatment.…”

Section: Introductionmentioning

confidence: 99%

Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures

et al. 2019

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BackgroundThis study aimed to explore the effect of retaining inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures treated with a locking plate.MethodsTwelve Synbone prosthetic humeri (SYNBONE-AG, Switzerland) were used for a wedge osteotomy model at the proximal humerus, in four groups. In the cortex contact + screw fixation group and cortex contact group, the inferomedial cortical bone contact was retained. In the screw fixation group and control group, the inferomedial cortical bone contact was not retained. Calcar screw fixation was implemented only in the screw fixation groups. The dynamic and static mechanical stability of the models were tested with dynamic fatigue mechanics testing, quasi-static axial compression, three-point bending, and torsion testing.ResultsThe cortex contact + screw fixation group showed the longest fatigue life and the best stability. There was 35% difference in fatigue life between the cortex contact + screw fixation group and the cortex contact group, 43%between the cortex contact + screw fixation group and screw fixation group, and 63% between the cortex contact + screw fixation group and screw fixation group (P < 0.01). The cortex contact + screw fixation group showed the best axial compressive stiffness, bending stiffness, and torsion stiffness; these were successively decreased in the other three groups (P < 0.01).ConclusionRetaining inferomedial cortical bone contact and fixation with two calcar screws maintained fracture stability with the highest strength and minimum deformation. Of the two methods, restoration of the inferomedial cortical bone support showed better dynamic and static biomechanical properties than placement of calcar screws alone.

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“…Furthermore, information about the surgeons' experience and operative techniques, stability of fixation, and radiographic outcomes are lacking 36,37 . Thus, careful preoperative planning and surgeon's evaluation can give good clinical outcomes and minimize the risk of perioperative and postoperative complications, even in elderly patients 38,39 . On the other hand, surgeons need to be aware that surgical treatment after failed conservative treatment and revision surgery provide worse clinical results than primary surgery 29,40 .…”

Section: Treatmentmentioning

confidence: 99%