Fri., 10/17/08 Geriatrics/Reconstruction, Paper #35, 4:00 pm OTA-2008
Clinical Outcomes of 3- and 4-part Proximal Humerus Fractures: Open Reduction and Internal Fixation versus Hemiarthroplasty
Brian D. Solberg, MD (e-Stryker, Zimmer); Charles N. Moon, MD (e-Stryker, Zimmer);
Dennis P. Franco, MD (n); Guy D. Paiement, MD (n);
Cedars Sinai Medical Center, Los Angeles, California, USA
Background: Optimal treatment of 3- and 4-part proximal humerus fractures remains controversial in osteoporotic patients. The purpose of this study was to clinically compare an age- and sex-matched group of patients undergoing open reduction and internal fixation or hemiarthroplasty for 3- and 4-part proximal fractures.
Study Design: This IRB-approved, retrospective, matched case control comparative study was conducted at an urban Level 1 trauma center.
Methods: 40 patients (12 men and 28 women) with 3- or 4-part proximal humerus fractures treated with a locked plate construct were compared with 40 age- and sex-matched controls treated with hemiarthroplasty during a 4-year period. Reductions were judged good, fair, or poor based on initial displacement and angulation; hemiarthroplasties were judged optimal or suboptimal based on humeral head height and medial offset. Clinical outcomes were measured using the modified Constant-Murley scoring system.
Results: Patients had average radiographic and clinical follow-up of 36 months (range, 24-58). Average age for both groups was 66 years (range, 57-88). There was no difference between groups with regard to age, sex, presence of dislocation, or fracture pattern using the Neer or OTA classification systems. The mean Constant score (CS) at final follow-up was significantly better in the locked plate group (69 ± 9.2) than for the hemiarthoplasty group (61 ± 6.2) (P <0.001). Patients with a good initial reduction had better outcome than patients with fair or poor initial reductions (CS 76 vs 61; P <0.001). All patients with initial varus malalignment had subsequent varus subsidence averaging 7° (range, 3°-12°), and a final CS of 66 (range, 55-76). The 15 patients with varus extension fracture patterns had an overall CS of 64 compared to a score of 74 for the 22 valgus impaction fractures (P <0.001). Outcomes for the locked plate group overall were still significantly better when compared to only patients with radiographically optimal hemiarthroplasty technique (CS 69 vs 64) (P <0.001).
Conclusions: In this series, open repair with locked plating gave better clinical results than even technically optimal hemiarthroplasty. Locked plating should be considered as a viable option for the treatment of these patients given its superior clinical outcomes even when compared with well-performed hemiarthroplasty.
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. Δ OTA Grant.