title: Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients.
abstract: The purpose of this single-center, randomized, controlled trial was to report on the 2-year outcomes of proximal humerus fractures in elderly patients treated with open reduction and internal fixation (ORIF) with either a locking plate or shoulder hemiarthroplasty. Thirty-two patients (87% women) with a mean age of 71.9 years (range, 67-86 years) were treated with ORIF with either a locking plate or shoulder hemiarthroplasty after shoulder injury. The main outcome measures were the Constant score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and health-related quality of life (HRQoL) according to the EQ-5D (EuroQol Group, Rotterdam, The Netherlands). At final 2-year follow-up, DASH and pain scores favored the shoulder hemiarthroplasty group. Mean flexion was 129° in the shoulder hemiarthroplasty group and 117° in the ORIF group (P=.27), and mean abduction was 123° in the shoulder hemiarthroplasty group and 111° in the ORIF group (P=.41). In the shoulder hemiarthroplasty group, the EQ-5D index score decreased from 0.85±0.21 before injury to 0.65±0.14 at 4 months postoperatively. The score was 0.79±0.24 at 12 months postoperatively and 0.81±0.17 at 24 months postoperatively. The results of this study indicate an advantage in functional outcomes and HRQoL favoring shoulder hemiarthroplasty compared with ORIF with a locking plate, although most outcomes were not significantly different.
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, People’s Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Cai
authors.forename: Kun
authors.initials: K
authors.lastname: Tao
authors.forename: Chunxi
authors.initials: C
authors.lastname: Yang
authors.forename: Shaohua
authors.initials: S
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D012784:Shoulder Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome