[Excellent functional outcomes after operative treatment of multifragmentary, dislocated proximal humeral fractures in patients over 65 years of age].

Introduction

Proximal humeral fractures occur frequently, and their frequency is expected to rise further. The majority of the affected patients are from the elderly population, usually with weakened bone structure. The adequate treatment of dislocated, multifragmentary fractures poses a challenge, especially when it affects an already osteoporotic humeral head. The most common technique in the operative treatment is angular stable plate fixation, however, complications may occur, and the functional outcomes are frequently poor. Nowadays, special attention is paid to reduce intra- and postoperative complications and to restore function as well as possible. Objective and methods: We perform valgising angular stable plate fixation at our institute routinely since 2019 to treat osteoporotic multifragmentary proximal humeral fractures. In our present study, we retrospectively evaluated the short-term clinical and radiological outcomes of 47 three- or four-part fractures in 46 patients aged over 65 years (76.1 ± 7.9 years).

Results

Good abduction and flexion rates (over 120°) were found in 76% of the patients. The cumulative Constant–Murley Score was 80.2 ± 12.5. Follow-up time was 17.3 ± 9.4 months and the functional outcomes were excellent in 23, good in 14, satisfactory in 7 and poor in 3 cases. Functional outcomes showed significant connection with age (p = 0.009) and primary diseases (p = 0.016), however, they were unrelated to fracture type, site of the injury or BMI. Cumulative complication rate was 6.4% and revision rate 4.3%. Neurologic deficit, pseudoarthrosis or avascular humeral head necrosis did not occur.

Conclusion

Due to the optimal head and plate position, valgising angular stable plate fixation used for proximal humeral fractures in the elderly provides excellent functional outcomes in the majority of the patients and significantly reduces post-operative complication rate. The method is especially effective for displaced, three- or four-part fractures also with weakened, osteoporotic bone structure. Orv Hetil. 2024; 165(20): 775–784.