Hinds Richard M, Garner Matthew R, Tran Wesley H, Lazaro Lionel E, Dines Joshua S, Lorich Dean G
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2015 Jun;24(6):889-96. doi: 10.1016/j.jse.2014.10.019. Epub 2014 Dec 4.
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.
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.
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.
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.
老年患者肱骨近端骨折的骨合成具有挑战性。本研究的目的是比较老年（年龄≥65岁）和非老年肱骨近端骨折患者采用带髓内腓骨支撑异体骨增强的锁定钢板治疗后的临床结果。
2007年3月至2013年1月，71例根据Neer分类法诊断为二部分、三部分和四部分肱骨近端骨折的成年患者接受了带腓骨异体骨增强的锁定钢板骨合成治疗，并进行了至少12个月的临床随访。所有患者均遵循相同的术后康复方案。我们比较了老年和非老年患者之间的以下指标：上肢、肩部和手部功能障碍评分；加利福尼亚大学洛杉矶分校肩关节评分；Constant-Murley评分；活动范围；以及损伤特征和影像学结果。
老年患者占研究队列的48%（71例患者中的34例）。老年和非老年队列的平均年龄分别为74岁和53岁。与非老年患者相比，老年患者的前屈明显降低（147°对159°，P = 0.04）。两组在功能评分、影像学结果或并发症发生率方面没有显著差异，尽管有1例老年患者在术后3年出现了骨坏死，且有螺钉穿透塌陷的股骨头。
采用带腓骨支撑异体骨增强的锁定钢板治疗肱骨近端骨折，老年和非老年患者的临床结果相似。我们认为，这种固定结构提供的增强稳定性允许早期强化术后治疗，尽管患者年龄不同，但仍能取得优异的结果。
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