Surgical treatment outcomes of proximal humerus fractures including shoulder hemiarthroplasty in patients of the Orthopedics and Trauma Department in Siedlce

Abstract

Proximal humerus fractures constitute 4-5% of all fractures occurring in adults. The aim of the study was to evaluate treatment outcomes for displaced proximal humerus fractures in patients eligible for surgical treatment who were hospitalized in the Orthopedics and Trauma Department of the Ministry of the Interior Hospital in Siedlce between 2016 and 2018. During this period, 153 patients with proximal humerus fractures were treated: 54 men (average age was 54 years) and 99 women (average age was 72 years). Surgical treatment was used in 112 patients. Follow-ups were carried out for 105 operated shoulders: 81 patients treated with intramedullary nailing -group IIa, 13 patients treated with fixed-angle plate fixation -group IIb, 10 patients treated with hemiarthroplasty -group III and 14 patients treated conservatively -group I. The authors evaluated the results based on the functional assessment of the shoulder according to the modified Constant-Murley Score and the occurrence of complications in individual groups. The best outcomes were in the group of patients treated with intramedullary nailing (group IIa) -49.4% good and very good outcomes, mean CM score of 67 was achieved. In group IIb, the average functional score was 56 points, in group III -49 points. The worst functional outcomes were recorded in the non-surgical patients (group I), mean CM score of 39 points. As a result of complications, reoperation was necessary in 7 patients treated with internal fixation. Patients treated with hemiarthroplasty did not require revision surgery. The authors state that surgical treatment of displaced proximal humerus fractures gives better outcomes in the early followup period than the conservative treatment; in elderly patients who sustained comminuted fractures of the proximal humerus for which stable internal fixation cannot be performed, shoulder arthroplasty is recommended. According to the authors, none of the surgical methods of treating displaced proximal humerus fractures guarantees regaining full shoulder function.