J Shoulder Elbow Surg (2015) 24, 889-896
www.elsevier.com/locate/ymse
Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation Richard M. Hinds, MDa,*, Matthew R. Garner, MDb, Wesley H. Tran, MDa, Lionel E. Lazaro, MDb, Joshua S. Dines, MDc, Dean G. Lorich, MDa,d a
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA c Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA d Orthopaedic Trauma Service, New York Presbyterian Hospital, New York, NY, USA b
Background: Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged 65 years) and non-geriatric proximal humeral fracture patients treated via locked plating with endosteal fibular strut allograft augmentation. Methods: From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes. Results: Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147 vs 159 , P ¼ .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery. Conclusions: Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age.
Institutional review board approval was received for this study (Weill Cornell Medical College/New York Presbyterian Hospital Institutional Review Board No. 1104011657R003).
*Reprint requests: Richard M. Hinds, MD, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. E-mail address: [email protected] (R.M. Hinds).
1058-2746/$ - see front matter Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2014.10.019
890
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Level of evidence: Level III, Retrospective Cohort Design, Treatment Study. Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Proximal humerus; fracture; geriatric; outcome; prognosis; allograft; locking plate
Proximal humeral fractures, the third most common geriatric fracture after distal radius and hip fractures, have a reported incidence of 105 per 100,000 persons per year.3,14,22 The incidence of these injuries is expected to increase as the geriatric population continues to grow.12 However, successful treatment of these injuries poses unique challenges when considering patient medical comorbidities, poor bone quality, overall conditioning, and impaired baseline mobility. Although several studies have evaluated the effect of age on proximal humeral fracture outcomes after locked-plate fixation,10,11,23,24 recent biomechanical investigations have reported enhanced fixation strength of locked-plate constructs augmented with endosteal fibular strut allograft.1,6,17 To our knowledge, the current investigation is the first to compare clinical outcomes in geriatric versus non-geriatric cohorts treated via locked plating with endosteal fibular strut allograft augmentation. We hypothesize that geriatric patients show equivalent postoperative clinical outcomes to non-geriatric patients.
Materials and methods Our clinical database of proximal humeral fractures surgically treated by the senior author (D.G.L) from March 2007 to January 2013 was reviewed. We initially identified 163 patients. The inclusion criteria included patients aged 18 years or older treated surgically via open reduction–internal fixation (ORIF) with a locked-plate construct and fibular allograft augmentation and a minimum of 12 months of clinical follow-up including the Disabilities of the Arm, Shoulder and Hand (DASH) score. Excluded patients included 6 patients treated with a construct other than a locked plate with fibular allograft, 1 patient younger than 18 years at the time of surgery, 19 patients with no follow-up, and 66 patients with incomplete follow-up. Seventy-one patients met the inclusion criteria and were included in the analysis. Patients with 2-, 3-, and 4-part fractures according to the Neer classification were initially indicated for surgical treatment. Patients who were notable for limited overhead activities before injury or were unwilling or incapable of participating in a structured postoperative therapy regimen were excluded from surgical treatment. Operative fixation used the anterolateral deltoid–splitting approach and the established fixation protocol of locked-plating osteosynthesis with endosteal fibular strut allograft augmentation.8,9 The fresh-frozen fibular allograft was cut and shaped to the appropriate form (approximately 4 to 6 cm in length) intraoperatively for each individual fracture. The strut was then positioned and tamped into the subchondral bone of the humeral head in a retrograde fashion. The position of the fibula was fracture dependent, with the fibular strut placed to fill the bony
void laterally in valgus fractures and medially along the calcar in varus fractures. The allograft was then secured in place with subchondral screws placed through the laterally based proximal humeral fracture plate. The fibular strut was used to aid in reduction, provide a stable endosteal support, and offer more robust bone stock for improved locked-plate fixation of proximal humeral fractures.4 By placing the subchondral screws through the fibular strut, the working length of the screws is shortened, further enhancing the fixation strength. Complete chronic rotator cuff tears were also repaired if present. A formal therapy regimen consisting of active and passive range of motion (ROM) without restriction, as well as forward flexion using a continuous passive motion machine, was instituted on the first postoperative day. Full weight bearing, as well as rotator cuff– and deltoid–strengthening exercises, was initiated at the 6-week follow-up visit. Patients were seen postoperatively at 2, 6, 12, 24, and 52 weeks. Patients aged 65 years or older were classified as geriatric, whereas patients younger than 65 years were classified as nongeriatric (Figs. 1 and 2). Injury characteristics included mechanism of injury, Neer classification, and AO/Orthopaedic Trauma Association classification.16,19 All fractures were assessed using preoperative plain shoulder radiographs and shoulder computed tomography scans. Subjective outcomes were the DASH; University of California, Los Angeles (UCLA) shoulder rating; and Constant-Murley outcome scores obtained at latest follow-up. Objective outcomes included ROM, as well as the incidence of wound complications and postoperative infections. The initial and latest postoperative radiographs were compared by a single trained orthopaedic trauma research fellow to determine rates of screw cutout, loss of reduction, and osteonecrosis of the humeral head. Fractures with a loss of humeral head height greater than 3 mm were considered to have sustained a loss of reduction.20 Outcome comparison between geriatric and non-geriatric patients was performed.
Statistical methods Differences in continuous variables were evaluated with the Mann-Whitney U test. Differences in categorical variables were determined using the c2 or Fisher exact test. For all analyses, P < .05 indicated the level of significance. Descriptive statistics are given as means standard deviations for continuous variables and frequencies and percentages for categorical variables.
Results The mean age of all patients was 63 years (range, 26-85 years), with women accounting for 66% of the fractures (47 of 71). The mean duration of follow-up was 34 months (range, 12-83 months). The geriatric group comprised 48%
Postoperative geriatric proximal humeral fracture outcomes
891
Figure 1 (A) Anteroposterior shoulder radiograph and (B) 3-dimensional computed tomography reconstruction of a right Neer 4-part proximal humeral fracture in a geriatric patient. (C) Anteroposterior shoulder radiograph 12 months postoperatively.
Figure 2 (A) Anteroposterior shoulder radiograph and (B) 3-dimensional computed tomography reconstruction of a left Neer 4-part proximal humeral fracture in a non-geriatric patient. (C) Anteroposterior shoulder radiograph 6 months postoperatively.
of the study cohort (34 of 71), with the non-geriatric group accounting for 52% (37 of 71). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed a significantly higher rate of chronic rotator cuff tears than non-geriatric patients (32.4% vs 8.1%, P ¼ .01). There were no other statistically significant differences between the 2 cohorts regarding demographic data and injury characteristics. A summary of these data is shown in Table I. The geriatric cohort showed statistically and clinically equivalent DASH (16.4 vs 15.2, P ¼ .28), UCLA shoulder rating (29.5 vs 28.9, P ¼ .63), and Constant-Murley (82.7 vs 86.3, P ¼ .12) scores to the non-geriatric cohort. A statistically significant reduction in postoperative forward flexion was noted in the geriatric group compared with the
non-geriatric group (147 vs 159 , P ¼ .04); however, there was no significant difference in external rotation. No patients in the geriatric or non-geriatric group had wound complications or postoperative infections. Subjective and objective outcome data are summarized in Tables II and III, respectively. The geriatric and non-geriatric cohorts showed a mean loss of humeral head height of 1.6 mm and 1.7 mm, respectively. Radiographic outcomes were statistically equivalent between the 2 cohorts, with outcome data summarized in Table IV. In 1 patient in the geriatric cohort, osteonecrosis with collapse developed and screw cutout was present at 37 months postoperatively despite minimal humeral head cystic changes and excellent clinical examination findings at the 2-year follow-up visit (Figs. 3-5).
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Table I Summary of patient demographic data and injury characteristics Geriatric Non-geriatric P value (n ¼ 34) (n ¼ 37)
Data summary Demographic data Female, n (%) Mean age (SD), y Chronic rotator cuff tear, n (%) Mechanism of injury, n (%) Mechanical fall Pedestrian struck MVC High energy NOS Unknown Neer classification, n (%) 2 part 3 part 4 part AO/OTA classification, n (%) 11-A2 11-A3 11-B1 11-B2 11-B3 11-C1 11-C2
24 (70.6) 23 (62.2) 74 (5.9) 53 (9.4) 11 (32.4) 3 (8.1)
.45 .99 .48 .48
(0.9) (0.0) (2.9) (2.9)
(0.9) (0.0) (0.0) (0.0)
LHHH, loss of humeral head height.
Discussion .82
10 (29.4) 10 (27.0) 17 (50.0) 17 (45.9) 7 (20.6) 10 (27.0) .95 8 2 15 6 0 3 0
(23.5) (5.9) (44.1) (17.6) (0.0) (8.8) (0.0)
8 2 17 7 1 1 1
(21.6) (5.4) (45.9) (18.9) (2.7) (2.7) (2.7)
Subjective outcome
Geriatric
Non-geriatric
P value
Mean DASH score (SD) Mean UCLA score (SD) Mean Constant-Murley score (SD)
16.4 (14.8) 29.6 (4.7) 82.7 (8.2)
15.2 (17.7) 29.1 (6.7) 86.3 (8.3)
.28 .63 .12
DASH, disabilities of the arm, shoulder and hand; UCLA, University of California, Los Angeles.
ROM and complications Geriatric
Non-geriatric P value
Mean ROM (SD), Forward flexion 147 (24.4) 158 (17.7) External rotation 57 (10.0) 58 (10.3) Complications, n (%) Wound complications 0 (0.0) 0 (0.0) Postoperative infections 0 (0.0) 0 (0.0) ROM, range of motion. ) Statistically significant.
Radiographic outcome
Shoulder arthroplasty was proposed, but the patient declined.
(62.2) (5.4) (0.0) (2.7) (24.3)
Table II DASH, UCLA shoulder rating, and Constant-Murley outcome scores
Objective outcome
Radiographic outcomes
.39 27 2 0 1 4
MVC, motor vehicle collision; NOS, not otherwise specified; OTA, Orthopaedic Trauma Association. ) Statistically significant.
Table III
Table IV
.04) .77 >.99 >.99
The objective of this investigation was to compare clinical outcomes in geriatric and non-geriatric proximal humeral fracture cohorts treated with ORIF with fibular strut allograft via an anterolateral approach. Our study showed equivalent radiographic outcomes, as well as DASH, UCLA, and Constant-Murley outcome scores, in geriatric and non-geriatric patients, supporting our hypothesis. We also found higher rates of chronic rotator cuff tears, as well as decreased forward flexion, in the geriatric cohort. As demonstrated in this study, geriatric and nongeriatric proximal humeral fracture patients can show equivalent postoperative outcomes when patients are appropriately indicated for surgery based on preinjury functional status and willingness to adhere to a structured postoperative therapy regimen. Our findings are supported by the literature. Grawe et al10 reported no statistically significant difference in Constant-Murley and DASH scores between patients younger than 65 years and patients aged 65 years or older in their review of postoperative outcomes in 17 proximal humeral fracture patients. Similarly, both Shulman et al24 (comparing patients aged 65 years or
www.elsevier.com/locate/ymse
Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation Richard M. Hinds, MDa,*, Matthew R. Garner, MDb, Wesley H. Tran, MDa, Lionel E. Lazaro, MDb, Joshua S. Dines, MDc, Dean G. Lorich, MDa,d a
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA c Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA d Orthopaedic Trauma Service, New York Presbyterian Hospital, New York, NY, USA b
Background: Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged 65 years) and non-geriatric proximal humeral fracture patients treated via locked plating with endosteal fibular strut allograft augmentation. Methods: From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes. Results: Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147 vs 159 , P ¼ .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery. Conclusions: Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age.
Institutional review board approval was received for this study (Weill Cornell Medical College/New York Presbyterian Hospital Institutional Review Board No. 1104011657R003).
*Reprint requests: Richard M. Hinds, MD, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. E-mail address: [email protected] (R.M. Hinds).
1058-2746/$ - see front matter Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2014.10.019
890
R.M. Hinds et al.
Level of evidence: Level III, Retrospective Cohort Design, Treatment Study. Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Proximal humerus; fracture; geriatric; outcome; prognosis; allograft; locking plate
Proximal humeral fractures, the third most common geriatric fracture after distal radius and hip fractures, have a reported incidence of 105 per 100,000 persons per year.3,14,22 The incidence of these injuries is expected to increase as the geriatric population continues to grow.12 However, successful treatment of these injuries poses unique challenges when considering patient medical comorbidities, poor bone quality, overall conditioning, and impaired baseline mobility. Although several studies have evaluated the effect of age on proximal humeral fracture outcomes after locked-plate fixation,10,11,23,24 recent biomechanical investigations have reported enhanced fixation strength of locked-plate constructs augmented with endosteal fibular strut allograft.1,6,17 To our knowledge, the current investigation is the first to compare clinical outcomes in geriatric versus non-geriatric cohorts treated via locked plating with endosteal fibular strut allograft augmentation. We hypothesize that geriatric patients show equivalent postoperative clinical outcomes to non-geriatric patients.
Materials and methods Our clinical database of proximal humeral fractures surgically treated by the senior author (D.G.L) from March 2007 to January 2013 was reviewed. We initially identified 163 patients. The inclusion criteria included patients aged 18 years or older treated surgically via open reduction–internal fixation (ORIF) with a locked-plate construct and fibular allograft augmentation and a minimum of 12 months of clinical follow-up including the Disabilities of the Arm, Shoulder and Hand (DASH) score. Excluded patients included 6 patients treated with a construct other than a locked plate with fibular allograft, 1 patient younger than 18 years at the time of surgery, 19 patients with no follow-up, and 66 patients with incomplete follow-up. Seventy-one patients met the inclusion criteria and were included in the analysis. Patients with 2-, 3-, and 4-part fractures according to the Neer classification were initially indicated for surgical treatment. Patients who were notable for limited overhead activities before injury or were unwilling or incapable of participating in a structured postoperative therapy regimen were excluded from surgical treatment. Operative fixation used the anterolateral deltoid–splitting approach and the established fixation protocol of locked-plating osteosynthesis with endosteal fibular strut allograft augmentation.8,9 The fresh-frozen fibular allograft was cut and shaped to the appropriate form (approximately 4 to 6 cm in length) intraoperatively for each individual fracture. The strut was then positioned and tamped into the subchondral bone of the humeral head in a retrograde fashion. The position of the fibula was fracture dependent, with the fibular strut placed to fill the bony
void laterally in valgus fractures and medially along the calcar in varus fractures. The allograft was then secured in place with subchondral screws placed through the laterally based proximal humeral fracture plate. The fibular strut was used to aid in reduction, provide a stable endosteal support, and offer more robust bone stock for improved locked-plate fixation of proximal humeral fractures.4 By placing the subchondral screws through the fibular strut, the working length of the screws is shortened, further enhancing the fixation strength. Complete chronic rotator cuff tears were also repaired if present. A formal therapy regimen consisting of active and passive range of motion (ROM) without restriction, as well as forward flexion using a continuous passive motion machine, was instituted on the first postoperative day. Full weight bearing, as well as rotator cuff– and deltoid–strengthening exercises, was initiated at the 6-week follow-up visit. Patients were seen postoperatively at 2, 6, 12, 24, and 52 weeks. Patients aged 65 years or older were classified as geriatric, whereas patients younger than 65 years were classified as nongeriatric (Figs. 1 and 2). Injury characteristics included mechanism of injury, Neer classification, and AO/Orthopaedic Trauma Association classification.16,19 All fractures were assessed using preoperative plain shoulder radiographs and shoulder computed tomography scans. Subjective outcomes were the DASH; University of California, Los Angeles (UCLA) shoulder rating; and Constant-Murley outcome scores obtained at latest follow-up. Objective outcomes included ROM, as well as the incidence of wound complications and postoperative infections. The initial and latest postoperative radiographs were compared by a single trained orthopaedic trauma research fellow to determine rates of screw cutout, loss of reduction, and osteonecrosis of the humeral head. Fractures with a loss of humeral head height greater than 3 mm were considered to have sustained a loss of reduction.20 Outcome comparison between geriatric and non-geriatric patients was performed.
Statistical methods Differences in continuous variables were evaluated with the Mann-Whitney U test. Differences in categorical variables were determined using the c2 or Fisher exact test. For all analyses, P < .05 indicated the level of significance. Descriptive statistics are given as means standard deviations for continuous variables and frequencies and percentages for categorical variables.
Results The mean age of all patients was 63 years (range, 26-85 years), with women accounting for 66% of the fractures (47 of 71). The mean duration of follow-up was 34 months (range, 12-83 months). The geriatric group comprised 48%
Postoperative geriatric proximal humeral fracture outcomes
891
Figure 1 (A) Anteroposterior shoulder radiograph and (B) 3-dimensional computed tomography reconstruction of a right Neer 4-part proximal humeral fracture in a geriatric patient. (C) Anteroposterior shoulder radiograph 12 months postoperatively.
Figure 2 (A) Anteroposterior shoulder radiograph and (B) 3-dimensional computed tomography reconstruction of a left Neer 4-part proximal humeral fracture in a non-geriatric patient. (C) Anteroposterior shoulder radiograph 6 months postoperatively.
of the study cohort (34 of 71), with the non-geriatric group accounting for 52% (37 of 71). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed a significantly higher rate of chronic rotator cuff tears than non-geriatric patients (32.4% vs 8.1%, P ¼ .01). There were no other statistically significant differences between the 2 cohorts regarding demographic data and injury characteristics. A summary of these data is shown in Table I. The geriatric cohort showed statistically and clinically equivalent DASH (16.4 vs 15.2, P ¼ .28), UCLA shoulder rating (29.5 vs 28.9, P ¼ .63), and Constant-Murley (82.7 vs 86.3, P ¼ .12) scores to the non-geriatric cohort. A statistically significant reduction in postoperative forward flexion was noted in the geriatric group compared with the
non-geriatric group (147 vs 159 , P ¼ .04); however, there was no significant difference in external rotation. No patients in the geriatric or non-geriatric group had wound complications or postoperative infections. Subjective and objective outcome data are summarized in Tables II and III, respectively. The geriatric and non-geriatric cohorts showed a mean loss of humeral head height of 1.6 mm and 1.7 mm, respectively. Radiographic outcomes were statistically equivalent between the 2 cohorts, with outcome data summarized in Table IV. In 1 patient in the geriatric cohort, osteonecrosis with collapse developed and screw cutout was present at 37 months postoperatively despite minimal humeral head cystic changes and excellent clinical examination findings at the 2-year follow-up visit (Figs. 3-5).
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R.M. Hinds et al.
Table I Summary of patient demographic data and injury characteristics Geriatric Non-geriatric P value (n ¼ 34) (n ¼ 37)
Data summary Demographic data Female, n (%) Mean age (SD), y Chronic rotator cuff tear, n (%) Mechanism of injury, n (%) Mechanical fall Pedestrian struck MVC High energy NOS Unknown Neer classification, n (%) 2 part 3 part 4 part AO/OTA classification, n (%) 11-A2 11-A3 11-B1 11-B2 11-B3 11-C1 11-C2
24 (70.6) 23 (62.2) 74 (5.9) 53 (9.4) 11 (32.4) 3 (8.1)
.45 .99 .48 .48
(0.9) (0.0) (2.9) (2.9)
(0.9) (0.0) (0.0) (0.0)
LHHH, loss of humeral head height.
Discussion .82
10 (29.4) 10 (27.0) 17 (50.0) 17 (45.9) 7 (20.6) 10 (27.0) .95 8 2 15 6 0 3 0
(23.5) (5.9) (44.1) (17.6) (0.0) (8.8) (0.0)
8 2 17 7 1 1 1
(21.6) (5.4) (45.9) (18.9) (2.7) (2.7) (2.7)
Subjective outcome
Geriatric
Non-geriatric
P value
Mean DASH score (SD) Mean UCLA score (SD) Mean Constant-Murley score (SD)
16.4 (14.8) 29.6 (4.7) 82.7 (8.2)
15.2 (17.7) 29.1 (6.7) 86.3 (8.3)
.28 .63 .12
DASH, disabilities of the arm, shoulder and hand; UCLA, University of California, Los Angeles.
ROM and complications Geriatric
Non-geriatric P value
Mean ROM (SD), Forward flexion 147 (24.4) 158 (17.7) External rotation 57 (10.0) 58 (10.3) Complications, n (%) Wound complications 0 (0.0) 0 (0.0) Postoperative infections 0 (0.0) 0 (0.0) ROM, range of motion. ) Statistically significant.
Radiographic outcome
Shoulder arthroplasty was proposed, but the patient declined.
(62.2) (5.4) (0.0) (2.7) (24.3)
Table II DASH, UCLA shoulder rating, and Constant-Murley outcome scores
Objective outcome
Radiographic outcomes
.39 27 2 0 1 4
MVC, motor vehicle collision; NOS, not otherwise specified; OTA, Orthopaedic Trauma Association. ) Statistically significant.
Table III
Table IV
.04) .77 >.99 >.99
The objective of this investigation was to compare clinical outcomes in geriatric and non-geriatric proximal humeral fracture cohorts treated with ORIF with fibular strut allograft via an anterolateral approach. Our study showed equivalent radiographic outcomes, as well as DASH, UCLA, and Constant-Murley outcome scores, in geriatric and non-geriatric patients, supporting our hypothesis. We also found higher rates of chronic rotator cuff tears, as well as decreased forward flexion, in the geriatric cohort. As demonstrated in this study, geriatric and nongeriatric proximal humeral fracture patients can show equivalent postoperative outcomes when patients are appropriately indicated for surgery based on preinjury functional status and willingness to adhere to a structured postoperative therapy regimen. Our findings are supported by the literature. Grawe et al10 reported no statistically significant difference in Constant-Murley and DASH scores between patients younger than 65 years and patients aged 65 years or older in their review of postoperative outcomes in 17 proximal humeral fracture patients. Similarly, both Shulman et al24 (comparing patients aged 65 years or
