Surgical Techniques for the Treatment of Proximal Humerus Fractures in Elderly Patients: A Comparative Analysis

Year 2024, Volume: 34 Issue: 4, 581 - 586, 31.08.2024

İdris Perktaş

https://doi.org/10.54005/geneltip.1493990

Abstract

Aims: It is common for the elderly, mostly due to osteoporosis and falls, to suffer proximal humerus fractures. This study aims to compare the efficacy of reverse total shoulder arthroplasty (rTSA) and open reduction with internal fixation (ORIF) in the treatment of these fractures with a focus on functional outcomes and patient satisfaction.
Methods: In this retrospective study, 65-85-year-old patients who underwent rTSA or ORIF for displaced proximal humerus fractures between January 1, 2021 and January 1, 2022 were analysed. Sixty patients participated in this study; they were divided into two groups as follows: Group 1 (rTSA, n=30) and Group 2 (ORIF, n=30). Constant and Oxford shoulder scores were used to evaluate outcomes while complications and patient satisfaction were also recorded. Statistical analysis involved t-tests and Chi-square tests whereby the p-value <0.05 indicated significance.
Results: There was considerable improvement in various categories: Group 1 (rTSA), the constant score improved from preoperative stage of 35 ±8 to postoperatively of 75±10; oxford score ranged from preoperative level of 25±6 to postoperative level of 80±9 respectively p<0.05 for both cases Group II (ORIF), the constant score improved from preoperative stage of33±7to postoperatively of65±12; oxford score ranged from preoperative level24±5to postoperative level70±11respectively(p<0.05 for both). Patients undergoing rTSA than those on ORIF, with corresponding rates being very satisfied at66.7% versus54.5%. Several complications occurred more frequently in the ORIF group including delayed union (18.2% vs3.3%) and infection (22.7 vs6.7%).
Conclusions: rTSA is associated with better functional outcomes, higher patient satisfaction, and fewer complications compared to ORIF for proximal humerus fractures in the elderly. These findings suggest that rTSA may be a more favourable surgical option for this population of patients. Moreover, future studies should involve larger samples and look at longer follow-up periods to ascertain these results.

Keywords

Proximal humerus fractures, reverse total shoulder arthroplasty, open reduction internal fixation

Yaşlı Hastalarda Proksimal Humerus Kırıklarının Tedavisinde Cerrahi Teknikler: Karşılaştırmalı Bir Analiz

Abstract

Amaçlar: Yaşlılarda proksimal humerus kırıkları, düşmeler ve osteoporoz nedeniyle yaygındır. Bu çalışmanın amacı, bu kırıkların tedavisinde ters total omuz artroplastisi (rTSA) ve açık redüksiyon ve internal tespiti (ORIF) etkinliğini karşılaştırmak, fonksiyonel sonuçlar ve hasta memnuniyetine odaklanmaktır.
Yöntemler: Bu retrospektif çalışma, 1 Ocak 2021 ile 1 Ocak 2022 tarihleri arasında yer değiştirmiş proksimal humerus kırıkları nedeniyle rTSA veya ORIF uygulanan 65-85 yaş arası hastaları analiz etti. Çalışmaya toplam 60 hasta dahil edildi, iki gruba ayrıldı: Grup 1 (rTSA, n=30) ve Grup 2 (ORIF, n=30). Sonuçlar Constant ve Oxford Omuz Skorları kullanılarak değerlendirildi ve komplikasyonlar ile hasta memnuniyeti de kaydedildi. İstatistiksel analizlerde t-testleri ve Ki-kare testleri kullanıldı, p-değerleri <0.05 anlamlı kabul edildi.
Bulgular: Grup 1'de (rTSA) Constant Skorları preoperatif olarak 35 ± 8'den postoperatif olarak 75 ± 10'a, Oxford Skorları ise 25 ± 6'dan 80 ± 9'a anlamlı şekilde iyileşme gösterdi (her ikisi de p < 0.05). Grup 2'de (ORIF) Constant Skorları 33 ± 7'den 65 ± 12'ye, Oxford Skorları ise 24 ± 5'ten 70 ± 11'e iyileşti (her ikisi de p < 0.05). rTSA hastaları, %66.7 çok memnuniyet oranı ile ORIF grubundaki %54.5'ten daha yüksek memnuniyet bildirdi. ORIF grubunda gecikmiş kaynama (%18.2'ye karşı %3.3) ve enfeksiyon (%22.7'ye karşı %6.7) gibi komplikasyonlar daha yaygındı.
Sonuçlar: rTSA, yaşlılarda proksimal humerus kırıkları için ORIF'e kıyasla daha iyi fonksiyonel sonuçlar, daha yüksek hasta memnuniyeti ve daha az komplikasyon ile ilişkilidir. Bu bulgular, rTSA'nın bu hasta popülasyonunda tercih edilebilir bir cerrahi seçenek olabileceğini göstermektedir. Bu sonuçları doğrulamak için daha büyük örneklemli ve uzun takip süreli gelecekteki çalışmalara ihtiyaç vardır.

Keywords

Proksimal humerus kırıkları, Ters total omuz artroplastisi, Açık redüksiyon internal tespit

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