Clinical and radiological results of locking plate surgical treatment in patients over 65 years of age with neer type 3-4 proximal humerus fractures

Year 2023, Volume: 16 Issue: 2, 35 - 39, 08.08.2023

Kemal Kayaokay , Cemal Kazimoglu

Abstract

Our objective was to evaluate the locking plate osteosynthesis (OS) results in treating three- and four-part humeral fractures in patients older than 65 years.
Twenty-eight patients who underwent plate osteosynthesis for proximal humerus fracture between 2017 and 2021 and had at least one year of follow-up were included in the study. The Constant-Murley shoulder score (0-55 points: poor, 56-70 points: moderate, 71-85 points: good, 86-100 points: very good), shoulder motion in all directions, pain, and performing daily activities of daily living at postoperative follow-up of the shoulder range of motion was also assessed.
The mean age of our patients was 75.14 (66-94). The mean follow-up time was 58.8 (18-73) months. One of our patients developed avascular necrosis in the humeral head, and two of our patients underwent partial shoulder arthroplasty when union could not be achieved. Graphic follow-up revealed that the plate caused subacromial compression in 5 patients, that the locking screw loosened in 3 patients, that 1 (3.22%) screw in the humeral head migrated into the joint in 3 patients in the postoperative period, and that the humeral head fused in varus position in 6 patients. In 3 of our patients, the screws that had migrated into the joint were removed. Hemiarthroplasty was performed in one patient with avascular necrosis and two patients with nonunion. The mean Constant-Murley shoulder score was calculated to be 49.74 (23-98). It was considered excellent in 2 (6.45%) patients, good in 2 patients, moderate in 6 patients, and poor in 18 (67.74%) patients. Infections, vascular and nerve damage did not occur in our patients.
Considering osteoporosis in three-part and four-part fractures of the proximal humerus of Neer, the results of plate osteosynthesis treatment are not successful in patients with advanced age, additional morbidity and high surgical risk.

Keywords

proximal humerus fractures, osteosynthesis, Neer 3 and 4 fragment fractures, upper extremity trauma, locking plate

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