Articles Vol. 65 No. CĐ 1 - Liên chi hội Phẫu thuật bàn tay 12/03/2024

38. FACTORS AFFECTING THE OUTCOMES OF SURGICAL TREATMENT WITH INTERNAL FIXATION USING LOCKING PLATE FOR THREE- TO FOUR-PART PROXIMAL HUMERUS FRACTURES IN OLDER ADULTS

Le Gia Anh Thy1,2, Hoang Manh Cuong1,2, Nguyen Van Thai1,2, Pham Thanh Tan1,2, Nguyen Viet Tan1,2, Dinh Ngoc Minh1,2, Diep Minh Quan1,2, Le Minh Khoa1,2, Bui Hong Thien Khanh3,4, Do Phuoc Hung3,4, Phan Tri Nguyen3,4
1 Hospital for Traumatology and Orthopaedics, Ho Chi Minh city
2 Bệnh viện Chấn thương chỉnh hình TP. Hồ Chí Minh
3 University of Medicine and Pharmacy, Ho Chi Minh City
4 Đại học Y Dược Thành phố Hồ Chí Minh
Corresponding author: thymd2011@gmail.com
DOI: 10.52163/yhc.v65iCD1.999
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Keywords
Proximal humerus fracture, open reduction internal fixation, osteoporosis, calcar margin.
Abstract

Background: Surgery for internal fixation using locking plate or shoulder arthroplasty remains a controversial issue in the treatment of complex 3-4 fragment fractures of the proximal humerus, especially in elderly patients. Despite the wider use of locking plate systems for the proximal humerus compared to head replacement, the complication rate after internal fixation with locking plates remains high. Risk factors such as low bone density, advanced age, loss of medial cortical support, and comminuted fractures can negatively impact treatment outcomes. The objective of this study is to evaluate the functional outcomes and imaging of the shoulder joint when using locking plates for the treatment of complex 3-4 fragment fractures of the proximal humerus in elderly patients, as well as the factors that may affect outcomes and complication rates at the Ho Chi Minh Hospital for Traumalogy and Orthopeadics.

Method: A descriptive study was conducted on a series of cases involving 58 patients over 50 years old with 3-4 fragment proximal humerus fractures who underwent surgical correction combined with internal fixation using locking plate and screw at the Ho Chi Minh City Orthopedic Hospital.

Result: 58 patients with a mean age of 62,78 ± 7,73 were followed up for an average of 26,24 ± 5,93 months after surgery. Among them, 41 cases had 3 fragment fractures, accounting for 70,68%, and 17 cases had 4 fragment fractures, accounting for 29,32%. At the final follow-up, the average Constant score for the patients was 70,81 ± 9,15, and the average DASH score was 8,33 ± 2,77. There were 6 cases of complications (10,34%). Among them, there was 1 case of avascular necrosis of the humeral head leading to screw penetration complication. The remaining cases included 1 cases of screw penetration, 3 cases of subacromial impingement, 1 case of avascular necrosis and 1 case of loss of reduction of greater tuberosity. The complexity of fractures, such as 4-fragment fractures, displacement greater than 2mm, and larger calcar fragment size resulted in lower Constant scores and higher DASH scores (p<0,05). Age, gender, bone density as measured by deltoid tuberosity index (DTI), bone grafting, and the use of rotator cuff suture also showed similar results, but the differences were not statistically significant.

Conclusion: Open reduction and internal fixation (ORIF) provide good bone healing and functional outcomes in cases of 3-4 fragment proximal humerus fractures. Age, gender, bone density, bone grafting and rotator cuff suture do not significantly affect the functional results after surgery. Therefore, osteoporosis should not be considered a contraindication for ORIF with locking plate in treating 3-4 fragment proximal humerus fractures in elderly patients. More complex fractures, with multiple fragments, displacement, complete dislocation, calcar hinge less than 2mm, and dislocation with detached fragment often result in poor functional outcomes and a higher rate of complications after surgery.

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