title: The impacted varus (A2.2) proximal humeral fracture in elderly patients: is minimal fixation justified? A case control study.
abstract: BACKGROUND
  The purpose of this retrospective case control study was to assess the outcome of K-wire osteosynthesis of a varus displaced proximal humeral fracture in patients over 65 years old, compared to a control group treated nonoperatively.
  
  
  METHODS
  The patient cohort was taken from our database in the period 2003-2007. After data extraction, the patients were re-examined and scored by the Constant score (CS), modified Constant score (MCS), and the QuickDASH score. The control group was carefully selected and matched to the surgical one for age, type of fracture, and degree of displacement. Minimum follow-up was 12 months, with a mean of 30 months in the surgery group, and 27 months in the nonoperative group.
  
  
  RESULTS
  K-wire osteosynthesis in our series yielded consistently good results in older patients who sustained an A2.2 proximal humeral fracture, with an average MCS of 88 points and a QuickDASH score of 15. The surgery group had a statistically significant higher CS and modified Constant score at follow-up than did the conservatively treated group (p = .03).
  
  
  CONCLUSIONS
  Operative treatment of varus displaced proximal humerus fractures treated with K-wire osteosynthesis yields good results that are superior to those treated nonoperatively.
  
  
  METHODS
  Level 3; Case control study, treatment study.
authors.affiliation: University of Turin Medical School, Mauriziano Umberto I Hospital, Turin, Italy. davide.blonna@libero.it
authors.forename: Davide
authors.initials: D
authors.lastname: Blonna
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Fantino
authors.forename: Alessio
authors.initials: A
authors.lastname: Maiello
authors.forename: Marco
authors.initials: M
authors.lastname: Assom
authors.forename: Filippo
authors.initials: F
authors.lastname: Castoldi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001864:Bone Wires; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006801:Humans; D021621:Imaging, Three-Dimensional; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome