OTA 2013 Posters

Scientific Poster #22 Geriatric OTA 2013

Locked Plating Versus Nonoperative Management of Displaced Proximal Humerus Fractures in the Elderly

Kanu Okike, MD, MPH1; Olivia C. Lee, MD2; Heeren Makanji, BA3; Jordan H. Morgan, BS4, Mitchel B. Harris MD5, Mark S. Vrahas MD4;
1Division of Orthopaedic Traumatology, Shock Trauma Center, Baltimore, Maryland, USA;
2Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana, USA;
3Harvard Medical School, Boston, Massachusetts, USA;
4Department of Orthopaedic Surgery, Massachusetts General Hospital,
Boston, Massachusetts, USA;
5Department of Orthopaedic Surgery, Brigham and Women’s Hospital,
Boston, Massachusetts, USA

Purpose: The purpose of this study was to compare the outcomes of locked plate fixation and nonoperative care in the treatment of displaced proximal humerus fractures in individuals aged 60 years or older. Our hypothesis was that patients treated nonoperatively would have outcomes that were similar to those treated operatively.

Methods: From our prospectively collected trauma database, we identified 207 displaced proximal humerus fractures that met all inclusion and exclusion criteria. For each patient, the medical record and available radiographs were retrospectively reviewed to obtain data on baseline characteristics, method of treatment, radiographic outcome, and complications sustained. For patients who accepted our invitation to return for evaluation, clinical outcome was assessed using the Constant questionnaire, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Short Musculoskeletal Functional Assessment (SMFA) questionnaire, and the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test.

Results: 207 patients met inclusion and exclusion criteria, including 146 patients managed nonoperatively and 61 patients treated operatively with locked plate internal fixation. Patients treated operatively had lower rates of malunion (40.0% vs 86.9%) but higher rates of complications including screw perforation (35.6% vs 0.0%), loss of fixation (17.5% vs 0.0%), infection (6.6% vs 0.0%), and secondary surgical procedures (13.1% vs 1.4%). 47 patients accepted our invitation to return for clinical evaluation at a mean follow-up of 3.3 years, including 22 patients treated nonoperatively and 25 patients treated with locked plate fixation. While patients in the nonoperative group tended to be older and have a greater number of comorbidities, clinical outcomes were similar in the two groups for all outcome measures including SMFA, DASH, Constant, and PROMIS.

Conclusion: In this study of displaced proximal humerus fractures in the elderly, those patients treated operatively demonstrated a lower rate of malunion but a higher rate of complications and secondary surgical procedures as compared to the nonoperative group. While patients in the nonoperative group tended to be older and have a greater number of comorbidities, clinical outcomes were similar in the two groups. Further research is required to determine the circumstances under which locked plating improves outcomes in the treatment of displaced proximal humerus fractures in the elderly.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.