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

Yıl 2024, Cilt: 34 Sayı: 4, 581 - 586, 31.08.2024
https://doi.org/10.54005/geneltip.1493990

Öz

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.

Kaynakça

  • Murena L, Canton G, Ratti C et al. Indications and results of osteosynthesis for fragility fractures of the proximal humerus in elderly patients. Orthop Rev (Pavia). 2020;12(1):8559. Published on 28 April 2020. doi:10.4081/or.2020.8559
  • Lanzetti RM, Gaj E, Berlinberg EJ, Patel HH, Spoliti M. Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years. Clin Orthop Relat Res. 2023;481(4):735-747. doi:10.1097/CORR.0000000000002480
  • Gavaskar AS, Pattabiraman K, Srinivasan P, Raj RV, Jayakumar B, Rangasamy NK. What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?. Clin Orthop Relat Res. 2022;480(8):1566-1573. doi:10.1097/CORR.0000000000002190
  • Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury. 2014;45 Suppl 6:S43-S48. doi:10.1016/j.injury.2014.10.022
  • Schumaier A, Grawe B. Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient. Geriatr Orthop Surg Rehabil. 2018;9:2151458517750516. Published 2018 Jan 25. doi:10.1177/2151458517750516
  • Maier D, Jäger M, Strohm PC, Südkamp NP. Treatment of proximal humeral fractures - a review of current concepts enlightened by basic principles. Acta Chir Orthop Traumatol Cech. 2012;79(4):307-316.
  • Howard L, Berdusco R, Momoli F, et al. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord. 2018;19(1):299. Published 2018 Aug 18. doi:10.1186/s12891-018-2223-3
  • Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):RC01-RC5. doi:10.7860/JCDR/2016/18122.8281
  • Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults-A Scoping Review. J Clin Med. 2022;11(20):6140. Published 2022 Oct 18. doi:10.3390/jcm11206140
  • Patel AH, Wilder JH, Ofa SA, et al. Trending a decade of proximal humerus fracture management in older adults. JSES Int. 2021;6(1):137-143. Published 2021 Oct 13. doi:10.1016/j.jseint.2021.08.006
  • Patel AH, Wilder JH, Ofa SA, et al. How age and gender influence proximal humerus fracture management in patients older than fifty years. JSES Int. 2021;6(2):253-258. Published 2021 Dec 17. doi:10.1016/j.jseint.2021.11.007
  • Familiari F, Rojas J, Nedim Doral M, Huri G, McFarland EG. Reverse total shoulder arthroplasty. EFORT Open Rev. 2018;3(2):58-69. Published 2018 Feb 28. doi:10.1302/2058-5241.3.170044
  • Kozak T, Bauer S, Walch G, Al-Karawi S, Blakeney W. An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems. EFORT Open Rev. 2021;6(3):189-201. Published 2021 Mar 1. doi:10.1302/2058-5241.6.200085
  • Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev. 2021;6(11):1097-1108. Published 2021 Nov 19. doi:10.1302/2058-5241.6.210039
  • Luo D, Chen K, Qin P, Zhou N, Yu J, Zou J, et al. Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly. J Clin Rehabil Tissue Eng Res. 2018;22:2327-2332. doi:10.3969/j.issn.2095-4344.0187.
  • Heo S, Faulkner H, An V, Symes M, Nandapalan H, Sivakumar B. Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis. Ann R Coll Surg Engl. 2023. doi:10.1308/rcsann.2022.0120.
  • Garrigues G, Johnston P, Pepe M, Tucker BS, Ramsey M, Austin LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics. 2012;35(5):e703-8. doi:10.3928/01477447-20120426-25.
  • Grubhofer F, Wieser K, Meyer D, Catanzaro S, Beeler S, Riede U, Gerber C. Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg. 2016;25(10):1690-8. doi:10.1016/j.jse.2016.02.024.
  • Grubhofer F, Wieser K, Meyer D, Catanzaro S, Schürholz K, Gerber C. Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg. 2017;26(1):92-100. doi:10.1016/j.jse.2016.05.020.
  • Hussey M, Hussey S, Mighell M. Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications. Bone Joint J. 2015;97-B(7):967-72. doi:10.1302/0301-620X.97B7.35713.
  • Shannon SF, Wagner E, Houdek M, Cross WW, Sánchez-Sotelo J. Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis. J Shoulder Elbow Surg. 2016;25(10):1655-60. doi:10.1016/j.jse.2016.02.012.
  • Heo SM, Faulkner H, An VVG, Symes M, Nandapalan H, Sivakumar B. Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis. Ann R Coll Surg Engl. 2023. doi:10.1308/rcsann.2022.0120.
  • Chalmers PN, Slikker W, Mall NA, Gupta A, Rahman Z, Enriquez D, Nicholson GP. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg. 2014;23(2):197-204. doi:10.1016/j.jse.2013.07.044.
  • García-Fernandez C, Lopiz Y, Rizo B, Serrano-Mateo L, Alcobía-Díaz B, Rodriguez-Gonzalez A, Marco F. Reverse total shoulder arthroplasty for the treatment of failed fixation in proximal humeral fractures. Injury. 2018;49(Suppl 2):S22-S26. doi:10.1016/j.injury.2018.06.042.
  • Klug A, Wincheringer D, Harth J, Schmidt-Horlohé K, Hoffmann R, Gramlich Y. Complications after surgical treatment of proximal humerus fractures in the elderly: an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg. 2019;28(6):1022-1032. doi:10.1016/j.jse.2019.02.017.
  • Klug A, Wincheringer D, Harth J, Schmidt-Horlohé K, Hoffmann R, Gramlich Y. Complications after surgical treatment of proximal humerus fractures in the elderly: an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg. 2019;28(6):1022-1032. doi:10.1016/j.jse.2019.02.017.
  • Agarwal AR, Wang KY, Xu AL, et al. Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements. J Am Acad Orthop Surg Glob Res Rev. 2023;7(11):e23.00008. Published 2023 Nov 16. doi:10.5435/JAAOSGlobal-D-23-00008
  • Menekse S. Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair. Adv Orthop. 2024;2024:5575404. Published 2024 Jan 11. doi:10.1155/2024/5575404

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

Yıl 2024, Cilt: 34 Sayı: 4, 581 - 586, 31.08.2024
https://doi.org/10.54005/geneltip.1493990

Öz

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.

Kaynakça

  • Murena L, Canton G, Ratti C et al. Indications and results of osteosynthesis for fragility fractures of the proximal humerus in elderly patients. Orthop Rev (Pavia). 2020;12(1):8559. Published on 28 April 2020. doi:10.4081/or.2020.8559
  • Lanzetti RM, Gaj E, Berlinberg EJ, Patel HH, Spoliti M. Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years. Clin Orthop Relat Res. 2023;481(4):735-747. doi:10.1097/CORR.0000000000002480
  • Gavaskar AS, Pattabiraman K, Srinivasan P, Raj RV, Jayakumar B, Rangasamy NK. What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?. Clin Orthop Relat Res. 2022;480(8):1566-1573. doi:10.1097/CORR.0000000000002190
  • Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury. 2014;45 Suppl 6:S43-S48. doi:10.1016/j.injury.2014.10.022
  • Schumaier A, Grawe B. Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient. Geriatr Orthop Surg Rehabil. 2018;9:2151458517750516. Published 2018 Jan 25. doi:10.1177/2151458517750516
  • Maier D, Jäger M, Strohm PC, Südkamp NP. Treatment of proximal humeral fractures - a review of current concepts enlightened by basic principles. Acta Chir Orthop Traumatol Cech. 2012;79(4):307-316.
  • Howard L, Berdusco R, Momoli F, et al. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord. 2018;19(1):299. Published 2018 Aug 18. doi:10.1186/s12891-018-2223-3
  • Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):RC01-RC5. doi:10.7860/JCDR/2016/18122.8281
  • Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults-A Scoping Review. J Clin Med. 2022;11(20):6140. Published 2022 Oct 18. doi:10.3390/jcm11206140
  • Patel AH, Wilder JH, Ofa SA, et al. Trending a decade of proximal humerus fracture management in older adults. JSES Int. 2021;6(1):137-143. Published 2021 Oct 13. doi:10.1016/j.jseint.2021.08.006
  • Patel AH, Wilder JH, Ofa SA, et al. How age and gender influence proximal humerus fracture management in patients older than fifty years. JSES Int. 2021;6(2):253-258. Published 2021 Dec 17. doi:10.1016/j.jseint.2021.11.007
  • Familiari F, Rojas J, Nedim Doral M, Huri G, McFarland EG. Reverse total shoulder arthroplasty. EFORT Open Rev. 2018;3(2):58-69. Published 2018 Feb 28. doi:10.1302/2058-5241.3.170044
  • Kozak T, Bauer S, Walch G, Al-Karawi S, Blakeney W. An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems. EFORT Open Rev. 2021;6(3):189-201. Published 2021 Mar 1. doi:10.1302/2058-5241.6.200085
  • Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev. 2021;6(11):1097-1108. Published 2021 Nov 19. doi:10.1302/2058-5241.6.210039
  • Luo D, Chen K, Qin P, Zhou N, Yu J, Zou J, et al. Effects of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for the treatment of nonunions of proximal humeral fractures in the elderly. J Clin Rehabil Tissue Eng Res. 2018;22:2327-2332. doi:10.3969/j.issn.2095-4344.0187.
  • Heo S, Faulkner H, An V, Symes M, Nandapalan H, Sivakumar B. Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis. Ann R Coll Surg Engl. 2023. doi:10.1308/rcsann.2022.0120.
  • Garrigues G, Johnston P, Pepe M, Tucker BS, Ramsey M, Austin LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics. 2012;35(5):e703-8. doi:10.3928/01477447-20120426-25.
  • Grubhofer F, Wieser K, Meyer D, Catanzaro S, Beeler S, Riede U, Gerber C. Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg. 2016;25(10):1690-8. doi:10.1016/j.jse.2016.02.024.
  • Grubhofer F, Wieser K, Meyer D, Catanzaro S, Schürholz K, Gerber C. Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg. 2017;26(1):92-100. doi:10.1016/j.jse.2016.05.020.
  • Hussey M, Hussey S, Mighell M. Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications. Bone Joint J. 2015;97-B(7):967-72. doi:10.1302/0301-620X.97B7.35713.
  • Shannon SF, Wagner E, Houdek M, Cross WW, Sánchez-Sotelo J. Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis. J Shoulder Elbow Surg. 2016;25(10):1655-60. doi:10.1016/j.jse.2016.02.012.
  • Heo SM, Faulkner H, An VVG, Symes M, Nandapalan H, Sivakumar B. Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis. Ann R Coll Surg Engl. 2023. doi:10.1308/rcsann.2022.0120.
  • Chalmers PN, Slikker W, Mall NA, Gupta A, Rahman Z, Enriquez D, Nicholson GP. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg. 2014;23(2):197-204. doi:10.1016/j.jse.2013.07.044.
  • García-Fernandez C, Lopiz Y, Rizo B, Serrano-Mateo L, Alcobía-Díaz B, Rodriguez-Gonzalez A, Marco F. Reverse total shoulder arthroplasty for the treatment of failed fixation in proximal humeral fractures. Injury. 2018;49(Suppl 2):S22-S26. doi:10.1016/j.injury.2018.06.042.
  • Klug A, Wincheringer D, Harth J, Schmidt-Horlohé K, Hoffmann R, Gramlich Y. Complications after surgical treatment of proximal humerus fractures in the elderly: an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg. 2019;28(6):1022-1032. doi:10.1016/j.jse.2019.02.017.
  • Klug A, Wincheringer D, Harth J, Schmidt-Horlohé K, Hoffmann R, Gramlich Y. Complications after surgical treatment of proximal humerus fractures in the elderly: an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. J Shoulder Elbow Surg. 2019;28(6):1022-1032. doi:10.1016/j.jse.2019.02.017.
  • Agarwal AR, Wang KY, Xu AL, et al. Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements. J Am Acad Orthop Surg Glob Res Rev. 2023;7(11):e23.00008. Published 2023 Nov 16. doi:10.5435/JAAOSGlobal-D-23-00008
  • Menekse S. Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair. Adv Orthop. 2024;2024:5575404. Published 2024 Jan 11. doi:10.1155/2024/5575404
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Original Article
Yazarlar

İdris Perktaş 0009-0005-4582-1560

Erken Görünüm Tarihi 30 Ağustos 2024
Yayımlanma Tarihi 31 Ağustos 2024
Gönderilme Tarihi 1 Haziran 2024
Kabul Tarihi 5 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 34 Sayı: 4

Kaynak Göster

Vancouver Perktaş İ. Surgical Techniques for the Treatment of Proximal Humerus Fractures in Elderly Patients: A Comparative Analysis. Genel Tıp Derg. 2024;34(4):581-6.