Bezirgan Uğur, Kısmet Malik, Kıratlıoğlu Yusuf, Yalçın Mehmet, Armangil Mehmet
Ankara University, Ankara, Turkey.
Int Orthop. 2025 Mar;49(3):737-745. doi: 10.1007/s00264-025-06425-3. Epub 2025 Feb 3.
This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients.
The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded.
Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores.
In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.
本研究旨在比较老年患者移位型肱骨近端骨折的保守治疗与锁定钢板内固定的疗效。
该研究纳入了2020年至2023年间入住三级创伤中心的60岁以上患者，所有患者均被诊断为二部分、三部分或四部分肱骨近端骨折。共有45例患者接受了保守治疗或锁定钢板固定。在老年队列中，Neer 2-4型骨折患者采用Velpeau固定法进行保守治疗。移位骨折，特别是根据Neer分类的三部分和四部分骨折，采用锁定钢板固定进行手术治疗。使用Constant肩关节评分、手臂、肩部和手部功能障碍（DASH）评分以及美国肩肘外科医师（ASES）评分评估功能结局，最短随访期为一年。影像学评估重点关注内翻塌陷、内侧皮质移位、大结节移位、骨折线消失和骨痂形成。还记录了包括骨不连、畸形愈合和缺血性坏死在内的并发症。
45例患者中，22例接受了锁定钢板固定（A组），23例接受了保守治疗（B组）。在骨折类型方面，20例患者被分类为Neer 2型，23例为Neer 3型，2例为Neer 4型。患者的平均年龄为73.38岁。两组的功能评分（DASH、ASES和Constant）相似，影像学参数未观察到显著差异。然而，与保守组相比，锁定钢板组的并发症明显更频繁。两名接受手术的患者在肱骨颈处出现骨不连。此外，一名患者因术后感染需要二次手术，另一名患者因螺钉穿入关节需要二次手术。虽然未发现肱骨颈畸形愈合与功能结局之间存在相关性，但观察到大结节畸形愈合与功能评分之间存在负相关。
在老年肱骨近端骨折患者中，锁定钢板固定与保守治疗在功能结局方面未观察到显著差异。然而，锁定钢板固定与并发症和二次手术的发生率较高相关。因此，在该患者群体中，锁定钢板固定似乎并不比保守治疗具有更好的疗效。
