Proximal fractures of the humerus in patients older than 75 years of age: should we consider operative treatment?

Abstract

BackgroundOver 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly.Materials and methodsIn this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations.ResultsSixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results were obtained with the modern locked plate osteosynthesis (mean DASH 34.4). Prosthetic treatment, mostly used in highly comminuted fractures, often resulted in poor function (mean DASH 72.9). Persistent pain and ADL limitations were more present in more comminuted fractures (64 and 50 % in patients with 4-part fractures vs. 14 % in 2-part fractures). There were no postoperative deaths within 3 months of surgery, and fracture-related and non-fracture-related complication rates were low (non-union 3 %; 1 myocardial infarction).ConclusionThis study shows that it is safe and justifiable to consider surgical treatment of a severely dislocated proximal humerus fracture in selected patients aged 75 and older.Level of evidenceAccording to OCEBM Working Group, Level IV.

Complications Associated with Locking Plate of Proximal Humerus Fractures

“…The results of screening and application of inclusion/exclusion criteria are outlined in Figure 1 . 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 …”

How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

“…It is still controversial which treatment might be more appropriate, however a recent systematic review showed that conservative treatment is associated to lower complications while assuring good functional outcomes compared with surgery. 7 However, the observation that most of the single center cohort studies reported good outcomes [8][9][10][11] suggested that surgeon experience act in determining the results. Moreover, Boesmueller et al observed that the results of surgically treated PHF were related not only to patient's factors (age and smoking habits) but also to the quality of reduction.…”

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

“…While many orthopaedic surgeons may prefer surgical management in younger patients with displaced fractures of greater severity, a lack of consensus exists in older patients. 7 This controversy is only heightened in the elderly, with poorer bone quality 8 and increased risk for surgical intervention 9 and complication. It has been shown that these fractures are more prevalent in fit, independent patients, who function at a moderate level despite advanced age.…”