title: Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS® and hemiarthroplasty.
abstract: BACKGROUND
  Neer Group VI proximal humeral fractures often are related to persistent disability despite surgical treatment. We retrospectively compared the outcome after open reduction and internal fixation with the PHILOS(®) plate or primary hemiarthroplasty in patients with Neer Group VI fractures focusing on complications, shoulder function, health-related quality of life (SF-36), and potential risk factors for complications.
  
  
  OBJECTIVE
  The aim of this study was to compare the PHILOS(®) plate with primary hemiarthroplasty for treatment of specific Neer Group VI fractures. We asked whether (1) both procedures have comparable clinical and radiologic complication rates; (2) one procedure is superior in terms of revision rate; (3) objective and subjective shoulder function (Constant-Murley score) and health-related quality of life (SF-36) were comparable in both groups at final followup; and (4) there are clinical or radiologic predictors for complications in any group?
  
  
  METHODS
  Between 2002 and 2007, 44 consecutive patients (mean, 75.2 years) with a Neer Group VI proximal humeral fracture were included. Twenty-two patients treated with a PHILOS(®) plate were compared with 22 patients treated by primary hemiarthroplasty. Both groups were similar in all criteria. At minimum followup of 12 months (mean, 30 months; range, 12-83 months), radiographic control, Constant-Murley score, and SF-36 were performed.
  
  
  RESULTS
  Fourteen patients with complications (63.6%) were counted in the PHILOS(®) plate group, of which 10 (45.4%) needed revision surgery, mostly as a result of avascular necrosis and screw cut-outs. In the primary hemiarthroplasty group, only one patient needed revision surgery (4.5%). Smoking and steroid therapy were substantially associated with complications in the PHILOS(®) plate group. There were no differences between the two groups regarding Constant-Murley or SF-36 scores.
  
  
  CONCLUSIONS
  Angular stable open reduction and internal fixation was associated with high complication and revision rates, especially in patients who smoked and those receiving steroid therapy. Primary hemiarthroplasty provides limited function, which had little influence on the quality of life in this elderly collective. There are predictive factors for complications after the treatment of Neer Group VI proximal humeral fractures with the PHILOS(®) plate. Primary hemiarthroplasty remains a good option, especially when treating elderly patients.
authors.affiliation: Department of General Surgery, Trauma Division, Hospital Zurich-Triemli, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Spross
authors.forename: Andreas
authors.initials: A
authors.lastname: Platz
authors.forename: Matthias
authors.initials: M
authors.lastname: Erschbamer
authors.forename: Thomas
authors.initials: T
authors.lastname: Lattmann
authors.forename: Michael
authors.initials: M
authors.lastname: Dietrich
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects; D013256:Steroids / Q000009:adverse effects; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013256:Steroids