BACKGROUND: We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. METHODS: Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. RESULTS: The mean neck shaft angles were 133.6degrees (range, 100degrees to 116degrees) at immediate postoperative, 129.8degrees (range, 99degrees to 150degrees) at 3 months postoperative and 128.4degrees (range, 97degrees to 145degrees) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8degrees as compared to 1.3degrees in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. CONCLUSIONS: The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.
Aged ; Aged, 80 and over ; Analysis of Variance ; *Bone Plates ; Female ; Fracture Fixation, Internal/instrumentation/methods ; Humans ; Humerus/radiography/*surgery ; Male ; Shoulder Fractures/radiography/*surgery

OBJECTIVETo explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus.

METHODSA total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer's classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years+/-7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases.

RESULTSDuring the follow-up period (range: 12-72 months, mean: 37.3 months+/-4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients (97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found.

CONCLUSIONSShoulder arthroplasty is a dependable method to restore the comfort and function of the shoulder joints of the patients with 3- or 4-part fractures of the proximal humerus.

Adult ; Aged ; Arthroplasty ; methods ; Female ; Humans ; Joint Prosthesis ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; Patient Satisfaction ; Radiography ; Range of Motion, Articular ; Shoulder Fractures ; complications ; diagnostic imaging ; surgery ; Treatment Outcome