Second generation locked plating for complex proximal humerus fractures in very elderly patients

Area of Science:

• Orthopedic Surgery
• Traumatology
• Geriatric Medicine

Background:

• Humeral head sacrificing procedures are often preferred for elderly patients with complex proximal humerus fractures due to high failure rates with osteosynthesis.
• Evaluating advanced fixation methods is crucial for improving outcomes in this vulnerable patient population.

Purpose of the Study:

• To assess the functional outcomes and complication rates of second-generation locked plating for 3 and 4-part proximal humerus fractures in active elderly patients (>70 years).
• To emphasize the functional recovery and identify potential complications associated with this technique.

Main Methods:

• Twenty-nine elderly patients with displaced 3 and 4-part proximal humerus fractures underwent fixation using second-generation locked plating (PHILOS plate).
• The anterolateral deltoid split approach was employed, augmented with traction cuff sutures, and a minimum of seven locking head screws, including two calcar screws.
• Comminuted medial calcar fractures were addressed with endosteal fibular struts, and bone voids were filled with calcium phosphate cement. Radiological and functional outcomes (Constant and ASES scores) were evaluated.

Main Results:

• Fracture union was achieved in 24 of 26 patients followed for a mean of 27 months.
• Three patients experienced complications requiring arthroplasty (two fixation failures, one osteonecrosis).
• Postoperative functional scores showed significant improvement, with age-adjusted Constant scores averaging 63.1 and ASES scores 62.58. Fractures with non-comminuted medial calcars and valgus head displacement correlated with better outcomes.

Conclusions:

• Osteosynthesis using second-generation locked plating techniques yields satisfactory functional outcomes in very elderly patients with complex proximal humerus fractures.
• The technique demonstrates a low rate of significant complications, making it a valuable option for this patient demographic.