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. 2021 Aug 28;13(8):e17516.
doi: 10.7759/cureus.17516. eCollection 2021 Aug.

Comparison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age

Firat Erpala  1 , Mesut Tahta  2 , Tahir Öztürk  3 , Çağatay Zengin  4
Affiliations

Comparison of Treatment Options of Three- and Four-Part Humerus Proximal Fractures in Patients Over 50 Years of Age

Firat Erpala et al. Cureus. .

Abstract

Introduction Our aim was to evaluate different treatment methods including conservative treatment (CT), locking-plate osteosynthesis (OS) and hemiarthroplasty (HA) in three- and four-part humeral fractures in patients older than 50 years. Methods Forty-seven patients that have at least one year of follow-up were divided into three groups: 18 patients treated with OS, 14 patients treated conservatively and 15 patients treated with HA. For further evaluation, constant shoulder score, disabilities of the arm, shoulder and hand score (DASH), American Shoulder and Elbow Society (ASES) score had been used. Shoulder range of motion was also assessed. Results OS and CT groups had better scores than HA group. In OS group, average Constant score was 71.6 ± 16.2, DASH score was 12.1 (5.2-24.2) and ASES score was 77.5 (50.8-96.6). In CT group, average Constant score was 69.6 ± 19.2, DASH score was 16.4 (12.5-36.7) and ASES score was 76.6 (45.4-87.9). DASH scores (p = 0.032), Constant scores (p = 0.001), forward elevation (p < 0.001), abduction (p < 0.001), internal (p = 0.022) and external rotation (p = 0.048) were significantly improved in OS and CT groups than HA group. Conclusions HA should not be considered a priority in surgical planning in Neer three-part and four-part proximal humerus fractures. CT is superior for patients with additional morbidity and advanced age. But in patients who are younger and can tolerate the surgical procedure, the priority should be OS.

Keywords: neer 3- and 4-part fractures; osteosynthesis; proximal humerus fractures; shoulder hemiarthroplasty; upper extremity trauma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A 61-year-old female’s preoperative X-ray.
Figure 2
Figure 2. Locking plate osteosynthesis postoperative X-ray.
Figure 3
Figure 3. A 75-year-old female’s preoperative X-ray.
Figure 4
Figure 4. Postoperative X-ray after hemiarthroplasty (HA).
Figure 5
Figure 5. A 70-year-old female’s first X-ray.
Figure 6
Figure 6. X-ray after conservative follow-up, full union achieved.
See this image and copyright information in PMC

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References

    1. Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. Wang J, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y. Int Orthop. 2016;40:531–539. - PubMed
    1. Epidemiology of proximal humerus fractures. Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM. Arch Osteoporos. 2015;10:2. - PubMed
    1. Evaluation of vitamin D and biochemical parameters in patients operated for hip fracture. Mert M, Ermutlu C. Dicle Med J. 2020;47:446–454.
    1. Mortality rates of humerus fractures in the elderly: does surgical treatment matter? Lander ST, Mahmood B, Maceroli MA, Byrd J, Elfar JC, Ketz JP, Nikkel LE. J Orthop Trauma. 2019;33:361–365. - PMC - PubMed
    1. Osteoporosis risk factors in the women over 45-years old. Pınar G, Pınar T, Doğan N, Karahan A, Algıer L, Abbasoğlu A, Kuşçu E. https://dergipark.org.tr/tr/download/article-file/53986 Dicle Med J. 2009;36:258–266.

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