Screw-Tip Augmented Locked Plating Versus Primary Reverse Total Shoulder Arthroplasty in Displaced Proximal Humeral Fractures: A Retrospective Comparative Cohort Study With a Mean Follow-Up of 39 Months

Siebenbürger, Georg; Fleischhacker, Evi; Stumpf, Ulla; Helfen, Tobias; Böcker, Wolfgang und Ockert, Ben (2021): Screw-Tip Augmented Locked Plating Versus Primary Reverse Total Shoulder Arthroplasty in Displaced Proximal Humeral Fractures: A Retrospective Comparative Cohort Study With a Mean Follow-Up of 39 Months. In: Geriatric Orthopaedic Surgery & Rehabilitation, Bd. 12, 21514593211039026

Abstract

Introduction: This study compared the clinical and radiologic outcomes of screw-tip augmented locking plate osteosynthesis (STA) vs primary reverse total shoulder arthroplasty (RSA) in elderly patients with displaced proximal humeral fractures. Methods: 60 patients (age >65 years) with a displaced proximal humeral fracture underwent open reduction and internal fixation with locking plate and fluoroscopy controlled screw-tip augmentation. Sixty matched individuals (age, gender, fracture pattern, and mean follow-up) treated by RSA for fractures were identified from the institutional database and outcomes as well as occurring complications and need for revision surgery were compared. Results: At 39 months' follow-up, 25 patients in the STA group (mean age 74.5 +/- 12 years, 76.7% woman) showed a mean Constant Score (CS) of 68 +/- 18.8 points. Mean %CS compared to the contralateral side was 81.6 +/- 19.8%. Of 60 matched individuals in the RSA group, 22 patients (mean age 78.9 +/- 8.2 years, 76.7% woman) showed a mean CS of 60.6 +/- 21.2 points (P =.33), and the mean %CS compared to the contralateral side was 81.6 (74.7 +/- 18.6)% (P =.14). The overall complication rate in STA group was 32% (secondary varus or valgus displacement >10 degrees, n = 4, avascular necrosis, n = 4). In RSA group, the overall complication rate was 4.5% (P = <.05). Weobserved one early onset infection. Revision surgery with removal of the prosthesis and PMMA spacer implantation for two-stage revision was necessary. The follow-up rate was 41.7 vs 36.7%. Conclusions: Screw-tip augmented locked plating and reverse total shoulder arthroplasty result in comparable satisfying functional outcome 3 years following a displaced proximal humeral fracture in elderly patients. However, we noted a higher complication and revision rate in the STA group. In contrast, primary reversed shoulder arthroplasty resulted in a lower rate of complications and revisions, which may be beneficial in elderly patients.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2151-4585
• Sprache: Englisch