Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients
Background: Multiple studies have reported an unacceptable implant-related complication rate in proximal humeral fractures treated with locking plates, particularly in older patients. Our objective was to compare the fracture fixation failure rates in elderly patients, after a dedicated technique fo...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-11-01
|
| Series: | JSES International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638321001663 |
| _version_ | 1818725318820626432 |
|---|---|
| author | Antonio M. Foruria, MD, PhD Natalia Martinez-Catalan, MD María Valencia, MD, PhD Diana Morcillo, MD Emilio Calvo, MD, PhD, MBA |
| author_facet | Antonio M. Foruria, MD, PhD Natalia Martinez-Catalan, MD María Valencia, MD, PhD Diana Morcillo, MD Emilio Calvo, MD, PhD, MBA |
| author_sort | Antonio M. Foruria, MD, PhD |
| collection | DOAJ |
| description | Background: Multiple studies have reported an unacceptable implant-related complication rate in proximal humeral fractures treated with locking plates, particularly in older patients. Our objective was to compare the fracture fixation failure rates in elderly patients, after a dedicated technique for locking plate fixation with cement augmentation or without it. Methods: A total of 168 open reduction and internal fixation with locking plates were performed for complex proximal humerus fractures by a single surgeon in 136 women and 32 men older than 65 years of age (average 76 years). Treatment groups included group 1 with noncemented screws (n = 90) and group 2 with cemented screws (n = 78). As per Mayo-FJD Classification, there were 74 (44%) varus posteromedial impaction, 41 (24%) algus impaction, 46 (28%) surgical neck, and 7 (4%) head dislocation injuries. A retrospective radiographic and a clinical analysis was performed. Results: At a mean follow-up of 33 months, the implant failure rate was significantly lower in the cement augmentation group (1% vs. 8%, P = .03). The overall complication rate was 21% (25% group 1, 15% group 2; P = .1). Global avascular necrosis was associated with sustaining a valgus impacted fracture (P = .02 odds ratio 5.7), but not to augmentation. Partial avascular necrosis occurred only in patients treated with cemented screws (3.8%). The overall revision rate was 9% in both groups. Forward elevation was 126 ± 36 degrees and external rotation was 44 ± 19 degrees. The mean Constant score was 70 ± 15 in group 1 and 76 ± 15 in group 2 (P = .03). Conclusion: Cement augmentation significantly decreased the rate of implant failure. Good results are expected for most patients treated with this technique. |
| first_indexed | 2024-12-17T21:40:25Z |
| format | Article |
| id | doaj.art-641a888b1c7c47a2ad648dfe577f893c |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-12-17T21:40:25Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-641a888b1c7c47a2ad648dfe577f893c2022-12-21T21:31:38ZengElsevierJSES International2666-63832021-11-01569921000Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patientsAntonio M. Foruria, MD, PhD0Natalia Martinez-Catalan, MD1María Valencia, MD, PhD2Diana Morcillo, MD3Emilio Calvo, MD, PhD, MBA4Corresponding author: Antonio M. Foruria, MD, PhD, Shoulder and Elbow Reconstructive Surgery Unit, Hospital Fundación Jiménez Diaz, Avenida Reyes Católicos 2, Madrid. Spain.; Fundación Jiménez Díaz University Hospital at Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery Department, Madrid, SpainFundación Jiménez Díaz University Hospital at Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery Department, Madrid, SpainFundación Jiménez Díaz University Hospital at Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery Department, Madrid, SpainFundación Jiménez Díaz University Hospital at Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery Department, Madrid, SpainFundación Jiménez Díaz University Hospital at Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery Department, Madrid, SpainBackground: Multiple studies have reported an unacceptable implant-related complication rate in proximal humeral fractures treated with locking plates, particularly in older patients. Our objective was to compare the fracture fixation failure rates in elderly patients, after a dedicated technique for locking plate fixation with cement augmentation or without it. Methods: A total of 168 open reduction and internal fixation with locking plates were performed for complex proximal humerus fractures by a single surgeon in 136 women and 32 men older than 65 years of age (average 76 years). Treatment groups included group 1 with noncemented screws (n = 90) and group 2 with cemented screws (n = 78). As per Mayo-FJD Classification, there were 74 (44%) varus posteromedial impaction, 41 (24%) algus impaction, 46 (28%) surgical neck, and 7 (4%) head dislocation injuries. A retrospective radiographic and a clinical analysis was performed. Results: At a mean follow-up of 33 months, the implant failure rate was significantly lower in the cement augmentation group (1% vs. 8%, P = .03). The overall complication rate was 21% (25% group 1, 15% group 2; P = .1). Global avascular necrosis was associated with sustaining a valgus impacted fracture (P = .02 odds ratio 5.7), but not to augmentation. Partial avascular necrosis occurred only in patients treated with cemented screws (3.8%). The overall revision rate was 9% in both groups. Forward elevation was 126 ± 36 degrees and external rotation was 44 ± 19 degrees. The mean Constant score was 70 ± 15 in group 1 and 76 ± 15 in group 2 (P = .03). Conclusion: Cement augmentation significantly decreased the rate of implant failure. Good results are expected for most patients treated with this technique.http://www.sciencedirect.com/science/article/pii/S2666638321001663Proximal humerusElderlyLocking plateCement augmentationCemented screwsImplant failure |
| spellingShingle | Antonio M. Foruria, MD, PhD Natalia Martinez-Catalan, MD María Valencia, MD, PhD Diana Morcillo, MD Emilio Calvo, MD, PhD, MBA Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients JSES International Proximal humerus Elderly Locking plate Cement augmentation Cemented screws Implant failure |
| title | Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients |
| title_full | Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients |
| title_fullStr | Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients |
| title_full_unstemmed | Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients |
| title_short | Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients |
| title_sort | proximal humeral fracture locking plate fixation with anatomic reduction and a short and cemented screws configuration dramatically reduces the implant related failure rate in elderly patients |
| topic | Proximal humerus Elderly Locking plate Cement augmentation Cemented screws Implant failure |
| url | http://www.sciencedirect.com/science/article/pii/S2666638321001663 |
| work_keys_str_mv | AT antoniomforuriamdphd proximalhumeralfracturelockingplatefixationwithanatomicreductionandashortandcementedscrewsconfigurationdramaticallyreducestheimplantrelatedfailurerateinelderlypatients AT nataliamartinezcatalanmd proximalhumeralfracturelockingplatefixationwithanatomicreductionandashortandcementedscrewsconfigurationdramaticallyreducestheimplantrelatedfailurerateinelderlypatients AT mariavalenciamdphd proximalhumeralfracturelockingplatefixationwithanatomicreductionandashortandcementedscrewsconfigurationdramaticallyreducestheimplantrelatedfailurerateinelderlypatients AT dianamorcillomd proximalhumeralfracturelockingplatefixationwithanatomicreductionandashortandcementedscrewsconfigurationdramaticallyreducestheimplantrelatedfailurerateinelderlypatients AT emiliocalvomdphdmba proximalhumeralfracturelockingplatefixationwithanatomicreductionandashortandcementedscrewsconfigurationdramaticallyreducestheimplantrelatedfailurerateinelderlypatients |