[Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty]
M Dietrich1, C Meier, T Lattmann
1Chirurgische Klinik, Stadtspital Triemli, Birmensdorferstrabe 497, 8063, Zürich, Schweiz. michael.dietrich@triemli.stzh.ch
Background:
The purpose of the present study was a direct comparison of fixed-angle plate fixation (FAPF) and shoulder hemiarthroplasty (SHA) for complex fractures of the proximal humerus in the elderly.
Patients And Methods:
A single-institution case series of 52 consecutive geriatric patients (age > or =70 years) treated with FAPF for three- and four-part fractures of the proximal humerus between 2003 and 2005 was analysed 1 year after surgery. The analysis included Constant Score (CS), Oxford Shoulder Score (OSS), and radiological evaluation. Outcome was compared with a similar historic group of patients (n=59) who received SHA in an earlier period (1995--1997).
Results:
The patient groups showed no differences in age, gender, or fracture type. Median CS was significantly better for FAPF (71 vs 41). Evaluation of pain demonstrated no differences between the two treatment modalities in the OSS. Revision surgery was performed more often in the FAPF group (25% vs 2%).
Conclusion:
Compared to SHA, functional outcome was superior with FAPF. However, this was associated with a higher rate of revision surgery. Most patients were still able to live independently in their original environment, regardless of the type of surgery.
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