Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture

Doo-Sup Kim; Dong-Kyu Lee; Chang-Ho Yi; Jang-Hee Park; Jung-Ho Rah

doi:10.12671/jkfs.2011.24.2.144

Journal List > J Korean Fract Soc > v.24(2) > 1037802

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lee, Yi, Park, and Rah: Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(2): 144-150.

Published online: 19 April 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.2.144

Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture

Doo-Sup Kim, M.D., Dong-Kyu Lee, M.D., Chang-Ho Yi, M.D., Jang-Hee Park, M.D., Jung-Ho Rah, M.D.

Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.

Address reprint requests to: Jung-Ho Rah, M.D. Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea. Tel: 82-33-741-1354, Fax: 82-33-746-7326, dskim1974@hanmail.net

Received 24 September 2010 Revised 1 January 2011 Accepted 4 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Authors compare clinical and radiological results of internal fixation group and hemiarthroplasty group for comminuted proximal humerus fracture to find out which the treatment method have to be chose for comminuted proximal humerus fractures.

Materials and Methods

Patients who were treated from March 2005 to March 2007 and available for 2 years follow-up were targets of this study. The internal fixation group had 38 cases, and hemiarthroplasty group included 26 cases. The results were analyzed both clinically and radiologically.

Results

On average, Bone union took 15.6 weeks in the internal fixation group. Constant score between the internal fixation and hemiarthroplasty groups were on average 75±6.5 points and 70±7.4 points (p=0.034). In 3-part fracture, Constant score between both groups were 78±5.4 points from the former and 71±2 points, respectively (p=0.028). In 4-part fracture group, Constant score were 72±8 points for the internal fixation group and 69±9.2 points for the hemiarthroplasty group (p=0.041).

Conclusion

Internal plate fixation can gain better outcome than hemiarthroplasty in 4-part fracture as well as 3-part fracture of proximal humerus by careful dissection for preservation of blood supply for humeral head and optimal reduction.

Keywords: Comminuted proximal humerus fracture, Internal fixation, Hemiarthroplasty

Figures and Tables

Fig. 1

(A) The initial simple radiograph taken in the emergency room of a 54-years old female show comminuted proximal humerus fracture.

(B) Internal fixation was done with a plate and screws 1 day after the injury.

(C) Follow up radiograph was taken 24 weeks after surgery, bony union was achieved.

Fig. 2

(A) The initial simple radiograph taken in the emergency room of a 68-years old male show comminuted proximal humerus fracture (4-part).

(B) Hemiarthroplasty was performed 4 days after surgery.

(C) Follow up radiograph was taken 18 weeks after surgery. The radiograph shows stable fixation of implant.

Table 1

Dermographic data on the patients

Table 2

Comparison of outcome scores for individual parameters

^*ADL: Activities of daily living, ^†ROM: Range of movements.

Table 3

Comparison of outcome scores for individual parameters for 3-part fracture

^*ADL: Activities of daily living, ^†ROM: Range of movements.

Table 4

Comparison of outcome scores for individual parameters for 4-part fracture

^*ADL: Activities of daily living, ^†ROM: Range of movements.

References

1. Bastian JD, Hertel R. Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg. 2009. 18:216–219.

2. Becker R, Pap G, Machner A, Neumann WH. Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1-6 years. Acta Orthop Scand. 2002. 73:44–49.

3. Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004. 75:741–745.

4. Bohsali KI, Wirth MA, Rockwood CA Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006. 88:2279–2292.

5. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002. 11:401–412.

6. Bosch U, Skutek M, Fremerey RW, Tscherne H. Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Shoulder Elbow Surg. 1998. 7:479–484.

7. Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elbow Surg. 2006. 15:19–22.

8. Fallatah S, Dervin GF, Brunet JA, Conway AF, Hrushowy H. Functional outcome after proximal humeral fractures treated with hemiarthroplasty. Can J Surg. 2008. 51:361–365.

9. Gaheer RS, Hawkins A. Fixation of 3- and 4-part proximal humerus fractures using the PHILOS plate: mid-term results. Orthopedics. 2010. 33:671.

10. Guy P, Slobogean GP, McCormack RG. Treatment preferences for displaced three- and four-part proximal humerus fractures. J Orthop Trauma. 2010. 24:250–254.

11. Ha SS, Kim JY, Hong KD, Sim JC, Kang JH, Park KH. Operative treatment with locking compression plate (LCP) in proximal humerus fracture. J Korean Shoulder Elbow Soc. 2008. 11:137–142.

12. Hawkins RJ, Switlyk P. Acute prosthetic replacement for severe fractures of the proximal humerus. Clin Orthop Relat Res. 1993. 289:156–160.

13. Jahoda D, Pokorný D, Nyc O, et al. Infectious complications of total shoulder arthroplasty. Acta Chir Orthop Traumatol Cech. 2008. 75:422–428.

14. Movin T, Sjödén GO, Ahrengart L. Poor function after shoulder replacement in fracture patients. A retrospective evaluation of 29 patients followed for 2-12 years. Acta Orthop Scand. 1998. 69:392–396.

15. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970. 52:1077–1089.

16. Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002. 11:389–400.

17. Oh CH, Oh JH, Kim SH, Jo KH, Bin SW, Gong HS. Hemiarthoplasty with bone block graft and low profile prosthesis for the comminuted proximal humerus fractures. J Korean Fract Soc. 2008. 21:213–219.

18. Park JY, Park HG. Operative treatment for proximal humeral fracture. J Korean Orthop Sports Med. 2003. 2:168–175.

19. Park MJ, Seong BY, Lee SK, Lee TG, Shin SY, Kim HS. The result of treatment in fracture of the proximal humerus. J Korean Soc Fract. 2002. 15:299–306.

20. Parmaksizoğlu AS, Sökücü S, Ozkaya U, Kabukçuoğlu Y, Gül M. Locking plate fixation of three- and four-part proximal humeral fractures. Acta Orthop Traumatol Turc. 2010. 44:97–104.

21. Petersen VS. Avascular necrosis of the head of the humerus. Ugeskr Laeger. 1986. 148:656–657.

22. Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2010. 19(2 Suppl):66–75.

23. Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am. 1993. 75:1751–1755.

24. Vallier HA. Treatment of proximal humerus fractures. J Orthop Trauma. 2007. 21:469–476.

25. Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002. 84:1919–1925.

26. Wirth MA, Rockwood CA Jr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996. 78:603–616.

TOOLS

Similar articles