EFFECTIVENESS COMPARISON OF OPERATIVE AND NON-OPERATIVE TREATMENT FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Rong , FENG Yanhua , WANG Shibo , LUO Yuchun.

Department of Orthopedics, 101st Hospital of Chinese PLA, Wuxi Jiangsu, 214044, P.R.China.;

Corresponding author：

Keywords：

Proximal humeral fracture; Operative treatment; Non-operative treatment; Elderly patient

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Objective To compare the effectiveness between operative and non-operative treatment for 3- and 4-part proximal humeral fractures in elderly patients. Methods Between January 2009 and January 2011, 35 patients with 3- or 4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation (n=20, operative group) and with closed reduction and splint or cast fixation (n=15, non-operative group). There was no significant difference in gender, age, etiology, fracture type, and disease duration between 2 groups (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. Results All patients of the operative group achieved healing of incision by first intention. All patients were followed up 16 months on average (range, 12-20 months). The X-ray films showed that the other fractures healed except 1 case (5.0%) nonunion in operative group. Varus malunion was found in 1 case (6.7%) of non-operative group and 2 cases (10.0%) of operative group. Humeral head necrosis was found in 1 case respectively in 2 groups (5.0% and 6.7%). There was no significant difference in complication incidence between 2 groups (P gt; 0.05). The Constant-Murley scores of non-operative group and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively, showing no significant difference (t=0.59, P=0.47). Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3- and 4-part proximal humeral fractures. In elderly patients, non-operative treatment should be chosen.

Citation： FAN Rong,FENG Yanhua,WANG Shibo,LUO Yuchun.. EFFECTIVENESS COMPARISON OF OPERATIVE AND NON-OPERATIVE TREATMENT FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(9): 1029-1032. doi: Copy

1.	廖春来, 王培信, 谢逸波, 等. 老年骨质疏松性肱骨近端粉碎性骨折手术方式的选择. 中国修复重建外科杂志, 2009, 23(12): 1443-1446.
2.	Barrett JA, Baron JA, Karagas MR, et al. Fracture risk in the U. S. Medicare population. J Clin Epidemiol, 1999, 52(3): 243-249.
3.	Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg (Br), 2007, 89(9): 1206-1209.
4.	van den Broek CM, van den Besselaar M, Coenen JM, et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg, 2007, 127(6): 459-463.
5.	Kollig E, Kutscha-Lissberg F, Roetman B, et al. Complex fractures of the humeral head: which long-term results can be expected? Zentralbl Chir, 2003, 128(2): 111-118.
6.	Neer CS 2nd. Displaced proximal humeral fractures. Ⅱ. Treatment of three-part and four-part displacement. J Bone Joint Surg (Am), 1970, 52(6): 1090-1103.
7.	Rees J, Hicks J, Ribbans W. Assessment and management of three- and four-part proximal humeral fractures. Clin Orthop Relat Res, 1998, (353): 18-29.
8.	Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury, 1998, 29(5): 349-352.
9.	Hanson B, Neidenbach P, de Boer P, et al. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg, 2009, 18(4): 612-621.
10.	Yüksel HY, Yimaz S, Akşahin E, et al. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma, 2011, 25(10): 588-595.
11.	Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observationalstudy. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
12.	Hirschmann MT, Quarz V, Audigé L, et al. Internal fixation of unstable proximal humerus fractures with an anatomically preshaped interlocking plate: a clinical and radiologic evaluation. J Trauma, 2007, 63(6): 1314-1323.
13.	Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
14.	Iyengar JJ, Devcic Z, Sproul RC, et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma, 2011, 25(10): 612-617.
15.	Kontakis G, Koutras C, Tosounidis T, et al. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg (Br), 2008, 90(11): 1407-1413.
16.	Kralinger F, Unger S, Wambacher M, et al. The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties. J Bone Joint Surg (Br), 2008, 91(7): 973-976.

1. 廖春来, 王培信, 谢逸波, 等. 老年骨质疏松性肱骨近端粉碎性骨折手术方式的选择. 中国修复重建外科杂志, 2009, 23(12): 1443-1446.
2. Barrett JA, Baron JA, Karagas MR, et al. Fracture risk in the U. S. Medicare population. J Clin Epidemiol, 1999, 52(3): 243-249.
3. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg (Br), 2007, 89(9): 1206-1209.
4. van den Broek CM, van den Besselaar M, Coenen JM, et al. Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg, 2007, 127(6): 459-463.
5. Kollig E, Kutscha-Lissberg F, Roetman B, et al. Complex fractures of the humeral head: which long-term results can be expected? Zentralbl Chir, 2003, 128(2): 111-118.
6. Neer CS 2nd. Displaced proximal humeral fractures. Ⅱ. Treatment of three-part and four-part displacement. J Bone Joint Surg (Am), 1970, 52(6): 1090-1103.
7. Rees J, Hicks J, Ribbans W. Assessment and management of three- and four-part proximal humeral fractures. Clin Orthop Relat Res, 1998, (353): 18-29.
8. Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury, 1998, 29(5): 349-352.
9. Hanson B, Neidenbach P, de Boer P, et al. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg, 2009, 18(4): 612-621.
10. Yüksel HY, Yimaz S, Akşahin E, et al. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma, 2011, 25(10): 588-595.
11. Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observationalstudy. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
12. Hirschmann MT, Quarz V, Audigé L, et al. Internal fixation of unstable proximal humerus fractures with an anatomically preshaped interlocking plate: a clinical and radiologic evaluation. J Trauma, 2007, 63(6): 1314-1323.
13. Olerud P, Ahrengart L, Ponzer S, et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg, 2011, 20(5): 747-755.
14. Iyengar JJ, Devcic Z, Sproul RC, et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma, 2011, 25(10): 612-617.
15. Kontakis G, Koutras C, Tosounidis T, et al. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg (Br), 2008, 90(11): 1407-1413.
16. Kralinger F, Unger S, Wambacher M, et al. The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties. J Bone Joint Surg (Br), 2008, 91(7): 973-976.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON OF OPERATIVE AND NON-OPERATIVE TREATMENT FOR COMPLEX PROXIMAL HUMERAL FRACTURES IN ELDERLY PATIENTS

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