Metwally Osam Mohamed, Farhan Ahmed Hatem, Mahmoud Mahmoud Abdo, Mahmoud Hossam Fathi, Fahmy Fahmy Samir
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
BMC Musculoskelet Disord. 2025 Apr 21;26(1):386. doi: 10.1186/s12891-025-08600-4.
Conservative management for elderly proximal humeral fractures is an acceptable option, but the fracture stability is dubious. The purpose of this study was to investigate fracture stability and functional outcomes after modified minimally invasive reduction osteosynthesis system (MIROS) and non-surgical treatment for Neer two and three-part proximal humeral fractures in elderly patients.
Elderly Patients with two and three-part proximal humeral fractures who underwent modified MIROS fixation and non-operative management were retrospectively included. The Constant-Murley score, and the range of shoulder forward elevation were measured for functional assessment, while the radiological humeral head height (HHH) and humeral shaft angle (HSA) were used to verify the fracture stability. The variables in both treatment groups were compared using a two-tailed t test for independent means, with a p value of less than 0.05 denoting a significant difference.
Forty-two patients were consecutively included, with a mean follow-up of 24.05 ± 3.9 months for the modified MIROS group and 24.67 ± 4.5 months for the non-operative group. The modified MIROS group had statistically significant improvements in the Constant score and shoulder forward flexion (p = 0.0001), with a lower complication rate (14.3% vs. 52.3%). Moreover, the average changes in the radiological HSA and HHH were lower in the modified MIROS group at the one-year follow-up (p = 0.00001).
Modified MIROS is recommended as an alternative to conservative treatment for Neer 2 and 3-part proximal humeral fractures in elderly, medically unfit patients. It is a minimally invasive procedure that provides adequate fracture stability and permits early shoulder motion, with satisfactory functional and radiologic outcomes and fewer complications.
Retrospective comparative cohort; level of evidence (III).
老年肱骨近端骨折的保守治疗是一种可接受的选择，但骨折稳定性存疑。本研究的目的是探讨改良微创复位内固定系统（MIROS）和非手术治疗老年患者Neer二部分和三部分肱骨近端骨折后的骨折稳定性和功能结果。
回顾性纳入接受改良MIROS固定和非手术治疗的老年二部分和三部分肱骨近端骨折患者。采用Constant-Murley评分和肩关节前屈范围进行功能评估，同时用放射学肱骨头高度（HHH）和肱骨干角（HSA）来验证骨折稳定性。两组治疗变量采用独立样本双尾t检验进行比较，p值小于0.05表示差异有统计学意义。
连续纳入42例患者，改良MIROS组平均随访24.05±3.9个月，非手术组平均随访24.67±4.5个月。改良MIROS组在Constant评分和肩关节前屈方面有统计学意义的改善（p = 0.0001），并发症发生率较低（14.3%对52.3%）。此外，改良MIROS组在1年随访时放射学HSA和HHH的平均变化较小（p = 0.00001）。
对于老年、身体状况不佳的患者，Neer 2和3部分肱骨近端骨折，推荐改良MIROS作为保守治疗的替代方法。它是一种微创手术，能提供足够的骨折稳定性并允许早期肩关节活动，功能和放射学结果满意，并发症较少。
回顾性比较队列研究；证据水平（III）。
