Klinik Araştırma
BibTex RIS Kaynak Göster

Comparison of Conservative and Arthroplasty Treatment for 3 or 4 Part Proximal Humerus Fractures in the Elderly

Yıl 2024, Cilt: 6 Sayı: 2, 219 - 223, 16.05.2024
https://doi.org/10.37990/medr.1418007

Öz

Aim: Proximal humerus fractures are common injuries in the elderly population. This study hypothesizes that arthroplasty is not superior to conservative treatment in the management of multi-part proximal humerus fractures in elderly patients.
Material and Method: Patients aged 65 and above with 3–4-part proximal humerus fractures, treated either conservatively or with arthroplasty, were included in the study. The minimum follow-up period was set at 12 months. Functional evaluations of the patients were performed using the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) scoring system. Statistical analysis comparing the two groups was conducted using the SPSS software. The mean values of numerical data were analyzed using the Mann-Whitney U test, while categorical data were compared using the Chi-square test. A significant level of 0.05 was considered.
Results: A total of 67 patients who received adequate clinical follow-up were included in the study (50 conservative 17 arthroplasty). The average age of the patients was 76.12 years, with 9 male and 58 female patients. The average follow-up period was 22.61 months (range: 12-82). There were no statistically significant differences in age, gender, side, follow-up period, and fracture type distribution between the two groups. However, a significant difference in Q-DASH scores was observed (p<0.05).
Conclusion: In the treatment of proximal humerus fractures, even when they are multi-part fractures, conservative treatment should may be the first choice. We think that the early results of conservative treatment are better than arthroplasty.

Etik Beyan

Suleyman Demirel University Faculty of Medicine clinical research ethics committee approval was received. Number: 72867572.050.01.04-37133

Destekleyen Kurum

none

Teşekkür

none

Kaynakça

  • Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2010;12:CD000434.
  • Kancherla VK, Singh A, Anakwenze OA. Management of acute proximal humeral fractures. J Am Acad Orthop Surg. 2017;25:42-52.
  • Rangan A, Handoll H, Brealey S, et al.; PROFHER trial collaborators. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313:1037-47.
  • Tamimi I, Montesa G, Collado F, et al. Displaced proximal humeral fractures: when is surgery necessary?. Injury. 2015;46:1921-9.
  • O'Donnell JA, Gage MJ. Proximal humerus geriatric fracture care: fix, replace, or nonoperative treatment?. J Orthop Trauma. 2021;35:S6-10.
  • Gigis I, Nenopoulos A, Giannekas D, et al. Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J. 2017;11:108-18.
  • Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg. 2013;22:e8-14.
  • Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295-300.
  • Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42:1283-8.
  • Large TM, Adams MR, Loeffler BJ, Gardner MJ. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg. 2019;27:794-805.
  • Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. 2016;4:e2.
  • Antonios T, Bakti N, Phadkhe A, et al. Outcomes following arthroplasty for proximal humeral fractures. J Clin Orthop Trauma. 2020;11:S31-6.
  • Schairer WW, Nwachukwu BU, Lyman S, et al. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2015;24:1560-6.
  • Cheung E, Willis M, Walker M, et al. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439-49.
  • Roberson TA, Granade CM, Hunt Q, et al. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg. 2017;26:1017-22.
  • Erpala F, Tahta M, Öztürk T, Zengin Ç. Comparison of treatment options of three- and four-part humerus proximal fractures in patients over 50 years of age. Cureus. 2021;13:e17516.
  • Xie L, Ding F, Zhao Z, et al. Operative versus non-operative treatment in complex proximal humeral fractures: a meta-analysis of randomized controlled trials. Springerplus. 2015;4:728.
  • Song JQ, Deng XF, Wang YM, et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015;49:345-53.
  • Osterhoff G, Ossendorf C, Wanner GA, et al. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;6:50.
  • Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, et al. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2019;28:2259-71.
Yıl 2024, Cilt: 6 Sayı: 2, 219 - 223, 16.05.2024
https://doi.org/10.37990/medr.1418007

Öz

Kaynakça

  • Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2010;12:CD000434.
  • Kancherla VK, Singh A, Anakwenze OA. Management of acute proximal humeral fractures. J Am Acad Orthop Surg. 2017;25:42-52.
  • Rangan A, Handoll H, Brealey S, et al.; PROFHER trial collaborators. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313:1037-47.
  • Tamimi I, Montesa G, Collado F, et al. Displaced proximal humeral fractures: when is surgery necessary?. Injury. 2015;46:1921-9.
  • O'Donnell JA, Gage MJ. Proximal humerus geriatric fracture care: fix, replace, or nonoperative treatment?. J Orthop Trauma. 2021;35:S6-10.
  • Gigis I, Nenopoulos A, Giannekas D, et al. Reverse shoulder arthroplasty for the treatment of 3 and 4- part fractures of the humeral head in the elderly. Open Orthop J. 2017;11:108-18.
  • Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg. 2013;22:e8-14.
  • Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295-300.
  • Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42:1283-8.
  • Large TM, Adams MR, Loeffler BJ, Gardner MJ. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg. 2019;27:794-805.
  • Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. 2016;4:e2.
  • Antonios T, Bakti N, Phadkhe A, et al. Outcomes following arthroplasty for proximal humeral fractures. J Clin Orthop Trauma. 2020;11:S31-6.
  • Schairer WW, Nwachukwu BU, Lyman S, et al. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2015;24:1560-6.
  • Cheung E, Willis M, Walker M, et al. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439-49.
  • Roberson TA, Granade CM, Hunt Q, et al. Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg. 2017;26:1017-22.
  • Erpala F, Tahta M, Öztürk T, Zengin Ç. Comparison of treatment options of three- and four-part humerus proximal fractures in patients over 50 years of age. Cureus. 2021;13:e17516.
  • Xie L, Ding F, Zhao Z, et al. Operative versus non-operative treatment in complex proximal humeral fractures: a meta-analysis of randomized controlled trials. Springerplus. 2015;4:728.
  • Song JQ, Deng XF, Wang YM, et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015;49:345-53.
  • Osterhoff G, Ossendorf C, Wanner GA, et al. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;6:50.
  • Lopiz Y, Alcobía-Díaz B, Galán-Olleros M, et al. Reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humeral fractures in elderly patients: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2019;28:2259-71.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Özgün Makaleler
Yazarlar

Mehmet Akdemir 0000-0001-9638-4907

Ahmet Çağdaş Biçen 0000-0002-0711-9376

Ahmet Cemil Turan 0000-0002-7149-3055

Ahmet Ekin 0000-0001-9302-9475

Ali İhsan Kılıç 0000-0001-7491-6044

Meric Unal 0000-0001-9576-5994

Yayımlanma Tarihi 16 Mayıs 2024
Gönderilme Tarihi 11 Ocak 2024
Kabul Tarihi 23 Nisan 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 6 Sayı: 2

Kaynak Göster

AMA Akdemir M, Biçen AÇ, Turan AC, Ekin A, Kılıç Aİ, Unal M. Comparison of Conservative and Arthroplasty Treatment for 3 or 4 Part Proximal Humerus Fractures in the Elderly. Med Records. Mayıs 2024;6(2):219-223. doi:10.37990/medr.1418007

 Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey

E-mail: medrecsjournal@gmail.com

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