[Mid-term follow-up evaluation of plate osteosynthesis and hemiarthroplasty results in multipart fractures of the proximal humerus].
BACKGROUND
The present objective was to retrospectively evaluate factors affecting functional outcome of multipart proximal humeral fracture treated with fixation or hemiarthroplasty.


METHODS
Included were 58 patients (19 women, 39 men; average age: 51.04 years; range 22-78 years) who underwent surgery for Neer type III or IV proximal humeral fractures between 2007 and 2012. All participants attended follow-up of at least 2 years. A total of 35 patients underwent open reduction and anatomical plate fixation; 23 underwent partial shoulder replacement. Patients were evaluated according to Constant-Murley shoulder scoring at final follow-up examination. Evaluated impacts on functional outcome included age, gender, American Society of Anesthesiologists (ASA) Physical Status classification, trauma energy, type of fracture, and time to surgery.


RESULTS
Mean follow-up duration was 47.25±13.29 (25-76) months. Mean Constant-Murley score was 58.65±18.62 (65.77±18.67 for the fixation group, 47.82±12.52 for the hemiarthroplasty group; p=0.001). When impact of independent variables on functional scores was assessed, ASA score and type of fracture were found to significantly affect functional outcome in the fixation group, and trauma energy was found to significantly affect functional outcome in the hemiarthroplasty group. Complications were detected in 20 patients (34.5%) upon final examination, 14 of whom (70%) had rotator cuff deficiency.


CONCLUSIONS
Though improved functional results may be obtained using plate fixation in the surgical treatment of multipart proximal humeral fractures, the high rates of rotator cuff failure associated with both surgical methods should be considered.
Department of Orthopaedic and Traumatology, Geyve State Hospital, Sakarya-Turkey.
Cem
C
Çelik
Department of Orthopaedic and Traumatology, Yavuz Selim Bone Disease and Rehabilitation Hospital, Trabzon-Turkey. seyitali_gumustas@yahoo.com.
Seyit Ali
SA
Gümüştaş
Department of Orthopaedic and Traumatology, Kartal Dr. Lütfi Kirdar Training and Research Hospital, İstanbul-Turkey.
Gültekin Sıtkı
GS
Çeçen
Department of Orthopaedic and Traumatology, Kartal Dr. Lütfi Kirdar Training and Research Hospital, İstanbul-Turkey.
Güven
G
Bulut
Department of Orthopaedic and Traumatology, Kartal Dr. Lütfi Kirdar Training and Research Hospital, İstanbul-Turkey.
Halil İbrahim
Hİ
Bekler
D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint; D016896:Treatment Outcome; D014421:Turkey