title: Internal fixation with locking plate of 3- and 4-part proximal humeral fractures in elderly patients: complications and functional outcome.
abstract: Despite recent advances in operative techniques, internal fixation of (3- and 4-part) displaced proximal humeral fractures in elderly patients with osteoporotic bone remains controversial, sometimes followed by poor results. The aim of the present study was to evaluate outcomes of internal fixation with locking plate of multi-fragment proximal humeral fractures in elderly patients. The study cohort comprised 59 consecutive patients (mean age 70.1) with 3- and 4-part fractures who had undergone open reduction and internal fixation with locked plate at Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients were invited for follow-up examinations and underwent standard x-ray examination preoperatively to assess fracture pattern in the operating theatre as well as at 6 weeks, 3 and 6 months, 1 year, and then annually after surgery to assess fracture healing or complications. Clinical outcomes were measured by constant score. Patients were followed-up for 14 to 36 months. The overall complication rate was 27.1%. The mean constant score at 1-year follow-up was 70.2 points for 3-part fractures vs. 64.2 for 4-part fractures (p < 0.0001). In conclusion, despite a relatively high overall complication rate, internal fixation with locking plate provided moderate to good functional results in the treatment of osteoporotic complex proximal humeral fractures.
authors.affiliation: Department of Trauma and Orthopedic Reconstructive Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
authors.forename: Aljosa
authors.initials: A
authors.lastname: Matejcić
authors.forename: Dinko
authors.initials: D
authors.lastname: Vidović
authors.forename: Mihovil
authors.initials: M
authors.lastname: Ivica
authors.forename: Dragan
authors.initials: D
authors.lastname: Durdević
authors.forename: Mladen
authors.initials: M
authors.lastname: Tomljenović
authors.forename: Miroslav
authors.initials: M
authors.lastname: Bekavac-Beslin
authors.forename: August
authors.initials: A
authors.lastname: Mijić
authors.forename: Marija
authors.initials: M
authors.lastname: Punda
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Misir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects; D017523:Croatia; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D020127:Recovery of Function; D016896:Treatment Outcome