Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comparative analysis of proximal humerus fracture management in elderly patients: complications of open reduction and internal fixation by shoulder surgeons and non-shoulder surgeons-a retrospective study

  • Rui Claro (Department of Orthopaedics, Centro Hospitalar Universitario de Santo Antonio) ;
  • Bianca Barros (Department of Orthopaedics, Centro Hospitalar Universitario de Santo Antonio) ;
  • Carlos Ferreira (Department of Orthopaedics, Centro Hospitalar Universitario de Santo Antonio) ;
  • Ana Ribau (Department of Orthopaedics, Centro Hospitalar do Medio Ave) ;
  • Luis Henrique Barros (Department of Orthopaedics, Centro Hospitalar Universitario de Santo Antonio)
  • Received : 2023.07.16
  • Accepted : 2023.09.24
  • Published : 2024.03.01
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Abstract

Background: Open reduction and internal fixation (ORIF) with a locking plate is a popular surgical treatment for proximal humeral fractures (PHF). This study aimed to assess the occurrence of complications in elderly patients with PHF treated surgically using ORIF with a locking plate and to investigate the potential differences between patients treated by shoulder surgeons and non-shoulder surgeons. Methods: A retrospective study was conducted using a single-center database to identify patients aged ≥70 years who underwent ORIF for PHF between January 1, 2011, and December 31, 2021. Data on the Neer classification, follow-up, occurrence of avascular necrosis of the humeral head, implant failure, and revision surgery were also collected. Statistical analyses were performed to calculate the overall frequency of complications according to the Neer classification. Results: The rates of implant failure, avascular osteonecrosis, and revision surgery were 15.7%, 4.8%, and 15.7%, respectively. Complications were more common in patients with Neer three- and four-part fractures. Although the difference between surgeries performed by shoulder surgeons and non-shoulder surgeons did not reach statistical significance, the rate of complications and the need for revision surgery were nearly two-fold higher in the latter group. Conclusions: PHF are highly prevalent in the elderly population. However, the ORIF surgical approach, as demonstrated in this study, is associated with a considerable rate of complications. Surgeries performed by non-shoulder surgeons had a higher rate of complications and a more frequent need for revision surgery. Future studies comparing surgical treatments and their respective complication rates are crucial to determine the optimal therapeutic options. Level of evidence: III.

Keywords

Acknowledgement

The authors would like to thank the participants for their cooperation, and they also greatly appreciate the assistance of the staff members who were involved in this study.

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