Session X - Geriatrics

Sat., 10/7/06 Geriatrics & Injury Prevention, Paper #58, 10:03 am

Proximal Humeral Fractures with Angle-Stable Plate Osteosynthesis: Is Everything Better Now?

Thomas N. Frangen, MD (*); Marcel Dudda, MD (*);
Stephan Arens, MD (*); Dirk Martin, MD (*);
Gert Muhr, MD (*); Thomas Kälicke, MD (*);
BG-Kliniken Bergmannsheil, Department of General Surgery and Traumatology, University Hospital, Bochum, Germany

Purpose: Proximal humeral fractures are common in the elderly as distribution peaks in the 6th and 7th decades. Optimal operative strategy regarding complex proximal humeral fractures remains a subject of considerable controversy. The aim of the study was to evaluate implant-associated problems of angle-stable implants in comparison to other established osteosynthetic methods.

Methods: A total of 166 patients (98 females and 68 males) with proximal humeral fractures were treated operatively from 2000 to 2004 in our department with a primary angle-stable plate osteosynthesis. Retrospectively we characterized the fracture type by using the Neer classification and assessed the functional results with the Constant score (CS).

Results: Overall the average score was 73.4 ± 20 points (range, 22-94 points) compared to the nonaffected side (90.8 ±8 points (46-100 points). The relative score was 80.2% ± 20 (47.5%-98.0%). Patients with anatomic reduction of the fracture showed significantly better results in the CS. Compared with other osteosynthetic methods, the using of angle-stable plate osteosynthesis showed no better functional results in the end. In 10.8%, a humeral head necrosis occurred. 36 patients (21.6%) revealed a secondary loss of reduction with dislocation of the locking screws, regardless of the angle-stable fixation. In 14 cases operative revision was necessary.

Conclusions: Using angle-stable implants in the operative treatment of complex proximal humeral fractures, good results can be achieved in most cases. Nevertheless, in comparison to alternative operative solutions, the results do not show significantly better functional outcome. Important for good functional outcome was an exact anatomic reduction as a material independent variable rather than the decision to use more expensive angle-stable implants. Those who can fulfill such surgical demands achieve good results for the patient, even without using angle-stable implants.

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.