Yaşlılarda Neer Tip 3 ve 4 Proksimal Humerus Kırıklarının Tedavisinde Kilitli Plak Osteosentezi, Hemiartroplasti ve Ters Total Omuz Artroplastisinin Karşılaştırılması: Retrospektif Bir Çalışma

Yıl 2026, Cilt: 7 Sayı: 1, 198 - 206, 31.01.2026

Niyazi İğde , Ahmet Keskin , Serhat Gürbüz , Mustafa Serpi , Ahmet Fırat Berkay , Mustafa Buğra Ayaz , Süleyman Semih Dedeoğlu

https://doi.org/10.47482/acmr.1690719

Öz

Arka Plan:
Proksimal humerus kırıkları (PHK), yaşlı bireylerde sık görülmekte olup, Neer tip 3 ve tip 4 kırıkların tedavisinde çeşitli cerrahi seçenekler bulunmaktadır. Bu çalışmanın amacı, kilitli plak osteosentezi (KPO), hemiartroplasti (HA) ve ters total omuz artroplastisinin (RTSA) klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.

Yöntemler:
Neer tip 3 veya 4 PHK tanısı almış ve KPO, HA ya da RTSA ile tedavi edilmiş 44 hasta retrospektif olarak değerlendirildi. Fonksiyonel değerlendirmede Constant-Murley Skoru (CMS), Kol, Omuz ve El Engellilik Skoru (DASH) ile Amerikan Omuz ve Dirsek Cerrahları Skoru (ASES) kullanıldı. Eklem hareket açıklığı ileri fleksiyon, ekstansiyon, abdüksiyon ve internal/eksternal rotasyon açısından ölçüldü.

Bulgular:
Ortalama yaş 76,6 ± 4,2 yıl olup, hastaların çoğunluğu kadındı (%70). HA, KPO ve RTSA’ya kıyasla anlamlı derecede daha kötü fonksiyonel sonuçlar (CMS: 50.6 ± 2.3; ASES: 60.1 ± 2.3; DASH: 37.5 ± 2.3) ve hareket açıklığı gösterdi (p<0,001). KPO ve RTSA benzer fonksiyonel skorlar sergiledi; ancak KPO, ileri fleksiyon (p<0,001) ve abdüksiyon (p<0,001) açısından üstün bulundu. Gruplar arasında ağrı görsel analog skala (VAS) skoru, yaş, cinsiyet ve kırık tarafı açısından anlamlı fark saptanmadı (p>0,05).

Sonuç:
Neer tip 3 ve tip 4 PHK’lerde HA, KPO ve RTSA’ya kıyasla daha kötü fonksiyonel sonuçlar ve hareket açıklığı sağlamaktadır. Daha az kompleks kırıklarda ve iyi kemik kalitesinde KPO tercih edilebilirken, RTSA karmaşık kırıklarda güvenilir sonuçlar sunmakta ve artan kullanımını desteklemektedir. Tedavi seçimi; kırığın karmaşıklığı ve kemik kalitesi gibi hasta özelliklerine göre belirlenmelidir.

Anahtar Kelimeler

Proksimal humerus kırıkları , Hemiartroplasti , Ters total omuz artroplastisi , Kilitli plak osteosentezi , Yaşlılar

Comparison of Locking Plate Osteosynthesis, Hemiarthroplasty, and Reverse Total Shoulder Arthroplasty in the Treatment of Neer Type 3 and 4 Proximal Humerus Fractures in the Elderly A Retrospective Study

Öz

Background: Proximal humerus fractures (PHFs) are common in elderly individuals, and various surgical options exist for the treatment of Neer type 3 and type 4 fractures. This study aimed to compare the clinical and functional outcomes of locking plate osteosynthesis (LPO), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (RTSA).
Methods: A retrospective evaluation was conducted on 44 patients with Neer type 3 or 4 PHFs who underwent LPO, HA, or RTSA. The Constant‒Murley score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score were evaluated. Range of motion was measured in terms of forward flexion, extension, abduction, and internal/external rotation.
Results: The mean age was 76.6 ± 4.2 years, and the majority of the patients were female (70%). Compared with the LPO and RTSA groups, the HA group demonstrated significantly worse functional outcomes (CMS: 50.6 ± 2.3; ASES: 60.1 ± 2.3; DASH: 37.5 ± 2.3) and range of motion (p<0.001). LPO and RTSA showed comparable functional scores; however, LPO was superior in forward flexion (p<0.001) and abduction (p<0.001). No significant differences were found between the groups regarding pain visual analog scale (VAS) scores, age, sex, or fracture side (p>0.05).
Conclusion: In Neer type 3 and type 4 PHFs, HA results in inferior functional outcomes and range of motion compared with LPO and RTSA. While LPO may be preferred for less complex fractures with good bone quality, RTSA offers reliable results in complex fractures and supports its increasing use. Treatment selection should be based on patient-specific factors, including fracture complexity and bone quality.

Anahtar Kelimeler

Proximal humerus fractures , Hemiarthroplasty , Reverse total shoulder arthroplasty , ORIF , Locking Plate Osteosynthesis , Elderly , Neer 3 and 4 part fractures.

Etik Beyan

The study was approved by the ethical committee Istanbul Okmeydanı Training and Research Hospital in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration (Date: 04.02.2020, Decision No: 49). Patient records were reviewed retrospectively and were de-identified prior to analysis. Written informed consent was handled according to the ethics committee decision and institutional policy (e.g., obtained from participants/legal guardians or waived due to the retrospective design).

Destekleyen Kurum

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Teşekkür

The authors have no acknowledgements to declare.

Kaynakça

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