Outcomes of Locking Plate Fixation With Spine Cage for Unstable Proximal Humeral Fractures in Elderly Patients.

Abstract

To compare the clinical and radiological results of locking plate fixation with and without spine cage for the treatment of unstable proximal humeral fractures in elderly patients. Retrospective study. Level 1 Trauma Center. A total of 62 patients with a mean age of 72.68 (60-88) years were included. Thirty-nine patients were treated with only a locking compression plate (LCP group), whereas 23 patients were treated with a locking compression plate and a spine cage (SC group). The mean follow-up was 32.26 (24-46) months. Radiological outcomes were assessed using the humeral head height and neck-shaft angle. The clinical results were evaluated using a visual analog scale for pain, the Constant-Murley score, the American Shoulder and Elbow score, and shoulder range of motion. The average radiological changes in the humeral head height and neck-shaft angle were significantly higher in the LCP group than in the SC group ( P < 0.001 and P < 0.001, respectively). The final outcome scores were lower in the LCP group than in the SC group (Constant-Murley score of 73.26 vs. 78.91 [ P = 0.028] and American Shoulder and Elbow score of 72.36 vs. 78.57 [ P = 0.011]). The SC group showed better forward elevation ( P = 0.005) and abduction ( P = 0.001); however, no significant differences were observed for shoulder external or internal rotation. The number of complications was higher in the LCP group (38.5%) than in the SC group (13.0%) ( P = 0.033). For unstable proximal humeral fractures with medial comminution in elderly patients, locking plate with an SC is a reasonable option to ensure satisfactory results and lower the postoperative complications. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.