DOI: https://doi.org/10.15674/0030-59872020344-53

The results of open reduction and plate fixation with angular stability of the proximal humerus fractures in patients with osteoporosis

Mykola Korzh, Vasyl Makarov, Alexander Sabsay, Оleksiy Tankut, Olga Pidgayska

Abstract


Objective: a retrospective study of anatomical and functional results of open reduction and plate osteosynthesis in patients older than 50 years with of the proximal humerus fractures type AO/OTA 11-B, 11-C and osteoporosis, who were treated with plate PHILOS taking into account the surgical treatment of adverse results with reverse total shoulder arthroplasty (RTSA). Methods: we analyzed case histories of 58 patients (age older 50 years) with osteoporosis and three- and four-fragment fractures of the proximal umerus according to the Neer classification (type AO/OTA 11-B, 11-C). In group I — 20 patients (age from 50 to 76 years, 8 men and 12 women) — we made open reduction, ORIF with plate PHILOS; II — 38 patients (aged 54 to 78 years, all women) — had surgeries ORIF with PHILOS plate and 3D polylactide implants. Results: according to the Constant Murley Shoulder Score system in 11 (55 %) patients of group I excellent and good results were obtained, in 5 (25 %) — satisfactory, in 4 cases (20%) are unsatisfactory. At the last cases we made RTSA in terms from 6 to 12 months after the primary surgery, one of them had revision RTSA due to fracture of the humeral shaft and instability of the stem implant. According to the Constant Murley Shoulder Score system, the average score after 12 months in group I was 78, in II — 87. No signs of avascular necrosis of the humeral head were observed. Conclusions: the use of PHILOS plates with additional reinforcement with 3D polylactide implants allowed us to obtain positive results in 34 (89.5 %) patients after 6–12 months after the surgery with a lower complications rate compare to known techniques. If ORIF method gives an unfavorable result then RTSA gives the possibility to achieve positive results within 3 years after the surgery.

Keywords


proximal humerus fractures; plate with angular stability PHILOS; 3D polylactide implants; osteoporosis; reverse total shoulder arthroplasty

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Copyright (c) 2020 Mykola Korzh, Vasyl Makarov, Alexander Sabsay, Оleksiy Tankut, Olga Pidgayska

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