Department of Orthopaedic Surgery, University of Modena and Reggio-Emilia, Via del Pozzo 71, 41125, Modena, Italy.
J Orthop Traumatol. 2022 Nov 5;23(1):51. doi: 10.1186/s10195-022-00668-1.
Proximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age.
This is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant-Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered.
In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery.
Anatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.
肱骨近端骨折在老年患者中较为常见。这些损伤的治疗存在争议。比较锁定钢板固定、关节置换和保守治疗的文献表明，这些治疗策略都没有明显的优势。迄今为止，还没有研究考虑过经锁定钢板治疗后获得的解剖复位骨折。为了明确中年患者的最佳手术方案，我们考虑了 50 至 75 岁 B/C 型骨折患者接受解剖复位锁定钢板固定和反肩关节置换（RSA）治疗后的结果和导致手术翻修的主要并发症。
这是一项回顾性研究，纳入了 2010 年 1 月至 2018 年 12 月期间接受 RSA 或锁定钢板固定（获得解剖复位）治疗的 50 至 75 岁 B/C 型肱骨近端骨折患者 59 例。所有患者均进行术前 X 线和 CT 评估。采用活动范围（ROM）、Constant-Murley 评分（CMS）、牛津肩肘评分（OSS）、简易肩功能测试（SST）、主观肩功能评分（SSV）和视觉模拟评分（VAS）进行临床和影像学随访。主要并发症也被考虑在内。
在钢板固定组，ROM、CMS、SST 和 VAS 均高于 RSA 组。两组的并发症发生率均低于文献报道。经钢板螺钉固定的解剖复位骨折在疗效方面优于 RSA。在二级中心，由上肢创伤经验丰富的外科医生进行创伤治疗时，应在手术中选择钢板固定或反向关节置换。
与 RSA 相比，B/C 型骨折中解剖复位骨折的疗效更好。外科医生应始终尝试复位骨折，以了解是否可行钢板固定。如果无法进行解剖复位，我们建议考虑 RSA。这是一项回顾性观察研究。
