title: Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation.
abstract: BACKGROUND
  Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged ≥65 years) and non-geriatric proximal humeral fracture patients treated via locked plating with endosteal fibular strut allograft augmentation.
  
  
  METHODS
  From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes.
  
  
  RESULTS
  Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147° vs 159°, P = .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery.
  
  
  CONCLUSIONS
  Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age.
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA. Electronic address: RichardHindsResearch@gmail.com.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hinds
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garner
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Tran
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA; Orthopaedic Trauma Service, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D001860:Bone Plates; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Proximal humerus; allograft; fracture; geriatric; locking plate; outcome; prognosis