CLINICAL RESEARCH
Hemiarthroplasty vs. locking plate osteosynthesis – what is the better solution for displaced proximal humerus fractures?
 
More details
Hide details
 
Submission date: 2016-08-16
 
 
Final revision date: 2017-01-23
 
 
Acceptance date: 2017-02-04
 
 
Publication date: 2017-03-06
 
 
Arch Med Sci Civil Dis 2017;2(1):13-20
 
KEYWORDS
TOPICS
ABSTRACT
Introduction: Displaced proximal humerus fractures pose significant clinical problems. The aim of this study was to compare treatment results between open reduction and internal fixation (ORIF) and hemiarthroplasty (HA).
Material and methods: The study was a retrospective assessment. Sixty-three patients (30 HA, 33 ORIF) met the inclusion criteria; mean age: 64.5 years. The Constant-Murley scale, DASH score and VAS surveys for pain and satisfaction were used to evaluate the results.
Results: The HA group: the constant score was 44 points, and the DASH score was 57 points; 53% of patients had osteolysis of the greater tubercle; none of the patients had revision surgery. ORIF group: the constant score was59 points, and the DASH score was 38 points; 21% of patients had a vascular necrosis; revision surgery was performed in 18% of cases. A significant correlation between good functional outcomes and young age of patients was found in the ORIF group (p-value < 0.048). Patients who started physical therapy earlier achieved better results. DASH scores were better compared to ones from the objective Constant-Murley score. There was no difference in satisfaction between HA and ORIF groups (p-value < 0.1).
Conclusions: The ORIF should be considered for patients < 60 years old, but gives increased risk of urgent revision, due to screw protrusion. The HA provides fewer complications, lower risk of revision and can be better for patients between 60 and 70 years old. When choosing the treatment method, we should avoid focusing only on fracture configuration, but should also consider patient-related factors, such as age and lifestyle.
 
REFERENCES (27)
1.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006; 37: 691-7.
 
2.
AO/OTA Fracture Classification AO surgery. https://www2.aofoundation.org/.... Accessed 17 Apr 2015.
 
3.
Slobogean GP, Johal H, Lefaivre KA, et al. A scoping review of the proximal humerus fracture literature. BMC Musculoskelet Disord 2015; 16: 112.
 
4.
Handford C, Nathoo S, Porter K, Kalogrianitis S. A review of current concepts in the management of proximal humerus fractures. Trauma 2014; 17: 181-90.
 
5.
Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults: a systematic review of management. Injury 2001; 32: 363-72.
 
6.
Zyto K, Kronberg M, Broström LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg 1995; 4: 331-6.
 
7.
Baudi P, Campochiaro G, Serafini F, et al. Hemiarthroplasty versus reverse shoulder arthroplasty: comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture. Musculoskelet Surg 2014; 98: S19-25.
 
8.
Chalmers PN, Slikker W, Mall NA, et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elb Surg 2014; 23: 197-204.
 
9.
Cai M, Tao K, Yang C, Li S. Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients. Orthopedics 2012; 35: e1340–6.
 
10.
Bahrs C, Oehm J, Rolauffs B, et al. T-plate osteosynthesis – an obsolete osteosynthesis procedure for proximal humeral fractures? Middle term clinical and radiological results. Z Orthop Ihre Grenzgeb 2007; 145: 186-94.
 
11.
Boileau P, Krishnan SG, Tinsi L, et al. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elb Surg 2002; 11: 401-12.
 
12.
Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br 2008; 90: 1407-13.
 
13.
Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970; 52: 1090-103.
 
14.
Boileau P, Trojani C, Walch G, et al. Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elb Surg 2001; 10: 299-308.
 
15.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987; 214: 160-4.
 
16.
DASH (Disabilities of the Arm, Shoulder and Hand). http://www.dash.iwh.on.ca/. Accessed 23 Apr 2015.
 
17.
Robinson CM, Page RS, Hill RMF, et al. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 2003; 85: 1215-23.
 
18.
Pinkas D, Wanich TS, DePalma AA, Gruson KI. Management of malunion of the proximal humerus: current concepts. J Am Acad Orthop Surg 2014; 22: 491-502.
 
19.
Fjalestad T, Strømsøe K, Hole MØ, et al. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma 2012; 26: 98-106.
 
20.
Olerud P, Ahrengart L, Ponzer S, et al. Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg 2011; 20: 1025-33.
 
21.
Spross C, Platz A, Erschbamer M, et al. Surgical treatment of neer group vi proximal humeral fractures: retrospective comparison of PHILOS® and hemiarthroplasty. Clin Orthop Relat Res 2012; 470: 2035-42.
 
22.
Kralinger F, Schwaiger R, Wambacher M, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 2004; 86: 217-9.
 
23.
Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93: 1-11.
 
24.
Reuther F, Wahl D, Mühlhäusler B, Nijs S. Functional outcome of shoulder hemiarthroplasty for fractures: a multicentre analysis. Injury 2010; 41: 606-12.
 
25.
Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 2008; 22: 195-200.
 
26.
Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 2009; 23: 163-72.
 
27.
Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 2009; 91: 1689-97.
 
ISSN:2451-0637
Journals System - logo
Scroll to top