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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2011 February;62(1):19-27
Complex proximal humeral fractures: hemiarthroplasty versus percutaneous osteosynthesis
Bellato E. 1, Scelsi M. 1, Marini E. 1, Mortera S. 1, Marenco S. 1, Blonna D. 1, Assom M. 1, Castoldi F. 2
1 Struttura Complessa Dipartimento Universitario di Ortopedia e Traumatologia, Ospedale “Mauriziano” Umberto I
2 Struttura Complessa Dipartimento Universitario di Ortopedia e Traumatologia, Università degli Studi di Torino, Italia
Aim. The treatment of proximal humeral fractures continues to be a matter of debate among orthopaedists, especially when dealing with complex fractures in elderly people. The aim of this study was to compare percutaneous osteosynthesis with hemiarthroplasty as regards functional results and complications.
Methods. Forty patients, twenty in the osteosynthesis group and twenty in the hemiarthroplasty group, with a 3/4-fragment fracture, type B-C according to AO classification, were included in the study.
Results. The average age was 71.1+8.94 (50-84) in the hemiarthroplasty group and 55.9+13.78 (32-77) in the osteosynthesis one. After a mean follow-up of three years, the Constant Score (CS) and the Modified Constant Score (MCS) were significantly better (P=0.01) in the osteosynthesis group (hemiarthroplasty group: CS: 48.1+16.26 range 18-79; MCS: 64+22% range 28-96%; osteosynthesis group: CS: 72.35+13.26 range 49-98; MCS 83+11% range 56-100). The Oxford Score showed similar results in the osteosynthesis group (41.1+6.27 range 30-48) versus the hemiarthroplasty group (32.85+11.23 range 13-48) (P<0.01). Patients’ stratification according to age, fracture type and days elapsed between the trauma and the surgical operation confirmed the best results in the osteosynthesis group. Seven complications occurred in the hemiarthroplasty group, among which superficial infection and algodistrophy were the most frequent, while six complications occurred in the osteosynthesis group, mainly represented by necrosis (P=1).
Conclusion. Percutaneous osteosynthesis seems to be an effective alternative treatment in cases of proximal humeral fractures. Compared to hemiarthroplasty it showed better functional results and a similar incidence of complications.