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.
Destekleyen Kurum
This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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).
Teşekkür
The authors have no acknowledgements to declare.
Kaynakça
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