title: Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures.
abstract: Surgical treatment of 3- and 4-part proximal humeral fractures remains challenging. This study retrospectively evaluated functional outcomes of locked plate fixation vs hemi-arthroplasty in 57 patients with 3- and 4-part proximal humerus fractures from 2003 to 2005 with a mean follow-up time of 35 months (range, 15.7-52.7 months). Mean patient age was 56.9 years (range, 29-81.7 years) for the open reduction and internal fixation group (n=42) and 66.4 years (range, 38.1-90 years) for hemiarthroplasty group (n=15). All 57 patients completed the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test, the Euroqol EQ-5D, [corrected] and the visual analog pain scale. Range of motion, the Constant Score, and the UCLA Shoulder score were used to evaluate a subset of 33 patients. Forty-one patients in the open reduction and internal fixation group achieved union, and 1 had symptomatic avascular necrosis requiring subsequent hemiarthroplasty. Two patients had implant removal for impingement symptoms. In the hemiarthroplasty group, there was 1 revision for a loose prosthesis. The American Shoulder and Elbow Surgeons score (P=.023), Simple Shoulder Test (P=.012), patient satisfaction (P=.034), Constant Score (P=.008), Kelsh Adjusted Constant Score (P=.015), UCLA Shoulder score (P=.01), and range of motion (forward flexion, P=.002; abduction, P=.001) were significantly better in the open reduction and internal fixation group than the hemiarthroplasty group. No significant differences between the groups existed in terms of SF-12 (physical, P=.118; mental, P=.134), Euroqol EQ-5D [corrected] (P=.169), or visual analog pain scale scores (P=.135), but all trended toward better with open reduction and internal fixation.
authors.affiliation: Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona, USA. jwildmd@yahoo.com
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wild
authors.forename: Ariana
authors.initials: A
authors.lastname: DeMers
authors.forename: Robert
authors.initials: R
authors.lastname: French
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Shipps
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Bergin
authors.forename: Dana
authors.initials: D
authors.lastname: Musapatika
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Jelen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome