Treatment of Displaced Proximal Humeral Fractures in Elderly Patients

Zyto, Karol; Ahrengart, Leif; Sperber, Anders; Törnkvist, Hans

doi:10.1302/0301-620x.79b3.0790412

Cited by 153 publications

(18 citation statements)

References 27 publications

(33 reference statements)

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“…Management of complex proximal humerus fracture is until now controversial especially in elderly [14]. However, the functional results at long-term follow-up were found to be better in reverse shoulder arthroplasty than in hemiarthroplasty group [20] Our study has several limitations.…”

Section: Discussionmentioning

confidence: 73%

Comparison of Reverse Shoulder Arthroplasty and Hemiarthroplasty for Proximal Humeral Fractures: What about Functional Outcome? Reverse versus Hemiarthroplasty in Shoulder Fractures

Kaziz¹,

Triki²,

Benzarti³

et al. 2019

OJO

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Purpose: Shoulder replacement becomes more indicated in complex fractures of the humeral head. Indications depend on some factors especially age and fracture's pattern. The aim of our study is to compare the functional results of both reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in complex proximal humerus fractures. Materials and Methods: Fifty-two shoulder arthroplasties (20 reverse shoulder arthroplasties, 38 hemiarthroplasties), were reviewed retrospectively, between January 2010, and December, 2015. Preoperative, operative, and postoperative evaluations were achieved based on medical observations. At last follow-up, functional outcomes were established according Constant-Murley Score and American Shoulder and Elbow Surgeons (ASES) score. Complications rates were well-defined and compared between the study groups. Results: The mean of follow-up was 41.5 months. Comparing the study groups, reverse shoulder arthrosplasties were significantly older (mean age: 76.3 versus 66). These fractures occur more in women (70% versus 57%). At last follow-up, functional outcomes were better in reverse shoulder arthroplasty group (Constant-Murley Score 76 versus 59; ASES score 56 versus 41). The mean anterior elevation and external rotation were better in reverse shoulder arthroplasty respectively (110˚ versus 88˚; 28˚ versus 19˚). Revision was more required in hemiarthroplasty group than reverse shoulder arthroplasty group. Conclusion: Reverse shoulder arthroplasty seems to improve functional outcome at intermediate and long-term of follow-up of proximal complex humeral fractures on comparison to hemiarthroplasty.

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Section: Discussionmentioning

confidence: 73%

Comparison of Reverse Shoulder Arthroplasty and Hemiarthroplasty for Proximal Humeral Fractures: What about Functional Outcome? Reverse versus Hemiarthroplasty in Shoulder Fractures

Kaziz¹,

Triki²,

Benzarti³

et al. 2019

OJO

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“…They concluded an absence of significant difference in patient-reported clinical outcomes between the cohorts. This finding, though similar to Zyto et al (1997), resulted in fair amounts of attention, which included a headline in the BMJ that read …"Surgery is no better than a simple sling for displaced fracture of upper arm, study finds"… (Wise 2015). A response from Hertel and Domos identified several valid points, of which a pertinent point raised was the exclusion of an uncertain number of patients from the trial for "clear indication for surgery".…”

Section: Managementmentioning

confidence: 88%

“…A surgeon commonly finds himself confronted by literature, in particular with respect to the elderly patient, when deciding upon the ideal treatment option (Zyto et al 1997;Olerud et al 2011;Olerud et al 2011b;Rangan et al 2015). In essence, one is faced with the following questions: 1.…”

Section: Managementmentioning

confidence: 99%

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Evaluation of Proximal Humerus Fractures and Its Non-Surgical Management

Emery¹,

Tan²

2016

IRONS

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Fractures of the proximal humerus are common and present a challenge to the attending surgeon. A thorough evaluation should consist of precise history, taking and physical examination, accompanied by relevant imaging studies. Confronted with literature in support of differing treatment recommendations, a surgeon must then decide upon the optimal treatment plan for each individual patient. This report presents own experiences of authors in discussion to the current literature on the topic.

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“…[1][2][3] In contradiction to the excellent outcomes reported by Neer et al [1] for both range of motion and pain relief, numerous others have reported dichotomous outcomes with very good or very poor functional outcomes. [2,4,5] Crucial for the results of HA is normal rotator cuff functioning, which depends on achieving anatomic repositioning and healing of the tuberosities. [6][7][8][9][10][11][12] Several authors showed that the application of cerclage wire is a superior way of fixating the tuberosities to the prosthetic neck.…”

Section: Introductionmentioning

confidence: 99%

Hemiarthroplasty in complex proximal humeral fractures: preserving unity of the tuberosities with the cap technique improves clinical outcome

Putzeys¹,

Uyttebroek

2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: The outcome of primary hemiarthroplasty for complex proximal humeral fractures is highly dependent on the position and survival of the tuberosities. Preserving the cuff–tuberosity complex as a unit (named cap technique) is thought to improve the reduction and stability of the tuberosities. We present the first report of the cap technique and compare it with the common intertubercular split technique. Design: Comparative retrospective study on consecutive patients Setting: Urban level 1 trauma center. Patients/Participants: Included were all patients treated between May 2010 and August 2019 with the Affinis Fracture (Mathys, Switzerland) hemiarthroplasty for complex shoulder fractures. The cap technique was used from February 2015 onward. Minimum follow-up of 11 months. Dementia was an exclusion criterium. Outcome Measure: Clinical evaluation by (normalized) Constant-Murley score, DASH score, and EQ5D-VAS score. Radiological outcomes according to the criteria of Boileau. Results: The cap-technique group consisted of 26 patients. One patient had revision surgery; 23 patients could be evaluated at a mean follow-up of 28 months. The control group consisted of 26 patients. Three patients had revision surgery. Ten patients could be scored at a mean follow-up of 101 months. A statistically significant difference in Constant-Murley score (P = .0121) could be observed between case and control group. There were no significant differences between radiological scores and between revision rates. Conclusion: The cap technique significantly improves clinical outcome in comparison with the intertubercular split technique. However, there was no significant difference in radiographic appearance of the tuberosities.

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Treatment of Displaced Proximal Humeral Fractures in Elderly Patients

Cited by 153 publications

References 27 publications

Comparison of Reverse Shoulder Arthroplasty and Hemiarthroplasty for Proximal Humeral Fractures: What about Functional Outcome? Reverse versus Hemiarthroplasty in Shoulder Fractures

Comparison of Reverse Shoulder Arthroplasty and Hemiarthroplasty for Proximal Humeral Fractures: What about Functional Outcome? Reverse versus Hemiarthroplasty in Shoulder Fractures

Evaluation of Proximal Humerus Fractures and Its Non-Surgical Management

Hemiarthroplasty in complex proximal humeral fractures: preserving unity of the tuberosities with the cap technique improves clinical outcome

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