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. 2022 Nov;142(11):3247-3254.
doi: 10.1007/s00402-021-04124-3. Epub 2021 Aug 25.

Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

M Müller  1 , F Greve  2 , M Crönlein  2 , M Zyskowski  2 , S Pesch  2 , P Biberthaler  2 , C Kirchhoff  2 , M Beirer  2
Affiliations

Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

M Müller et al. Arch Orthop Trauma Surg. 2022 Nov.

Erratum in

Abstract

Introduction: Surgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA).

Materials and methods: All patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score.

Results: A cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 63 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal.

Conclusions: Reversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.

Keywords: Complication; Locking plate fixation; Outcome; Proximal humeral fracture; Reversed total shoulder arthroplasty; Revision.

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Conflict of interest statement

CK is OR instructor for Arthrex. PB is OR instructor for DepuySynthes, Zimmer Biomet, Smith & Nephew, Arthrex, Medartis and Bonesupport. CK and PB declare that no conflicts of interest arise from these relations. All other authors declare that they have no competing interests. None of the authors have received financial payments from any commercial institution in relationship with the conduction of this study and the publication of this article.

Figures

Fig. 1
Fig. 1
Boxplot diagraphs comparing the results of the CONSTANT-Score compared between the group with plate osteosynthesis (ORIF) and reversed shoulder arthroplasty (rTSA)
Fig. 2
Fig. 2
Case presentation. A 74 year old woman presented with a four-part fracture of the right humeral head. Open reduction and internal fixation was performed 1 day after the trauma. a preoperative ap-view of the fracture; b postoperative ap-view after reconstruction using a locking plate osteosynthesis; c CT scan two months postoperative shows a collapse of the humeral head with secondary dislocation of the screws
See this image and copyright information in PMC

References

    1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365–371. doi: 10.1080/000164701753542023. - DOI - PubMed
    1. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87–92. doi: 10.1097/01.blo.0000194672.79634.78. - DOI - PubMed
    1. Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci. 2013;68(10):1236–1242. doi: 10.1093/gerona/glt092. - DOI - PubMed
    1. Neer CS., 2nd Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002;11(4):389–400. doi: 10.1067/mse.2002.124346. - DOI - PubMed
    1. Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, Tosteson AN. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am. 2011;93(2):121–131. doi: 10.2106/jbjs.i.01505. - DOI - PMC - PubMed