Comparison of ORIF with Locked Plating System and Hemiarthroplastyfor Osteoporotic 3- and 4-Part Proximal Humerus Fractures

Session X - Geriatrics

Sat., 10/7/06 Geriatrics & Injury Prevention, Paper #57, 9:57 am

Comparison of ORIF with Locked Plating System and Hemiarthroplasty for Osteoporotic 3- and 4-Part Proximal Humerus Fractures

Brian D. Solberg, MD¹(*); Jeff Hovater, DO²(*); Charles N. Moon, MD¹(*);
¹Cedars Sinai Orthopedic Center, Los Angeles, California, USA;
²St. Vincent Mercy Medical Center, Toledo, Ohio, USA

Purpose: Our objective was to compare the functional outcomes of patients with 3- and 4-part proximal humerus fractures treated with either open reduction and internal fixation (ORIF) with a locked plating system vs. hemiarthroplasty.

Materials/Methods: This retrospective nonrandomized study was conducted at a Level 1 trauma center. 217 patients with 232 proximal humerus fractures presented to our institution between May 2002 and July 2004. Inclusion criteria included 12-month minimum clinical and radiographic follow-up. After exclusion, 27 patients with 3- or 4-part fractures were identified as having been treated with ORIF with a locked plating system. During the same period, 29 patients underwent hemiarthroplasty for proximal humerus fractures. Immediately postoperatively patients were examined and reductions were judged as anatomic, imperfect, satisfactory, or poor.

Results: 17 patients consisting of 12 women and 5 men who underwent ORIF had an overall mean Constant score of 70 (range, 43-90) with an average age of 60 (range, 25-88) at an average follow-up of 25 months (range, 16-31). Of these, 9 were 3-part fractures and 8 were 4-part fractures with Constant scores of 72 (range, 57-90) and 68 (range, 43-90) respectively. Four patients developed osteonecrosis with collapse with an average Constant score of 63 (range, 57-71); none of them elected to undergo secondary hemiarthroplasty. Two patients had plate cut-out and required revision to hemiarthroplasty with a Constant score of only 49 (range, 43-55). All patients with anatomic reductions healed without varus collapse or malunion. One patient with poor reduction went on to plate cut-out with conversion to hemiarthroplasty. Reduction was positively correlated with good outcome. Average Constant score for anatomic reduction was 79, 66 for imperfect reduction, 59 for satisfactory reduction, and 49 for poor. 15 patients who underwent hemiarthroplasty had a mean Constant score of 61 (range, 53-67) at an average follow-up of 23 months (range, 13-35). The average age was 77 with 11 women and 4 men. There was no difference between the groups with regard to comorbidities.

Conclusion: 3- and 4-part proximal humerus fractures treated with ORIF with a locked plating system have a better functional result when compared to treatment with hemiarthroplasty. The presence of osteonecrosis did not lead to poor outcomes and was led to equivocal outcomes compared to hemiarthroplasty. Quality of reduction at the time of fixation had a positive effect on overall outcome.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

· 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.