title: Minimally Invasive Treatment of Displaced Proximal Humeral Fractures in Patients Older Than 70 Years Using the Humerusblock.
abstract: Background.Surgical treatment of proximal humeral fractures (PHF) in osteoporotic bone of elderly patients is challenging. The aim of this retrospective study was to evaluate the clinical and radiological outcome after percutaneous reduction and internal fixation of osteoporotic PHF in geriatric patients using the semirigid Humerusblock device.Methods.In the study period from 2005 to 2010, 129 patients older than 70 years were enrolled in the study. After a mean follow-up of 23 months, a physical examination, using the Constant-Murley score and the VAS pain scale, was performed. Furthermore radiographs were taken to detect signs of malunion, nonunion, and avascular necrosis.Results.The recorded Constant-Murley score was 67.7 points (87.7% of the noninjured arm) for two-part fractures, 67.9 points (90.8%) for three-part fractures, and 43.0 points (56.7%) for four-part fractures. In ten shoulders (7.8%) loss of reduction and in four shoulders (3.1%) nonunion were the reason for revision surgery. Avascular humeral head necrosis developed in eight patients (6.2%).Conclusions.In two- and three-part fractures postoperative results are promising. Sufficient ability for the activities of daily living was achieved. In four-part fractures the functional results were less satisfying regarding function and pain with a high postoperative complication rate. In those patients other treatment strategies should be considered.Study design.Therapeutic retrospective case series (evidence-based medicine (EBM) level IV).
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
authors.forename: Robert
authors.identifier: 0000-0002-3403-9021
authors.initials: R
authors.lastname: Bogner
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ortmaier
authors.affiliation: Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria; Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Virchow, 13353 Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Moroder
authors.affiliation: KH Oberndorf, Department of General Surgery, Paracelsusstraße 37, 5110 Oberndorf, Austria.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Karpik
authors.affiliation: Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
authors.forename: Christof
authors.initials: C
authors.lastname: Wutte
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lederer
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Auffarth
authors.affiliation: Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Resch
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D019317:Evidence-Based Medicine; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009336:Necrosis; D010024:Osteoporosis / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012782:Shoulder / Q000601:surgery; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome