Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications

Lópiz Morales, María Yaiza; Garríguez Pérez, Daniel; Martínez Illán, Marina; García Fernández, Carlos; Marco Martínez, Fernando

Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications

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Third.generation intramedullary nailing for displaced proximal humeral fractures in the elderly- quality of life, clinical results, and complications. Published.pdf (1.19 MB)

Official URL

https://doi.org/10.1007/s00402-020-03678-y

Publication date

2020

Authors

Lópiz Morales, María Yaiza

Garríguez Pérez, Daniel

Martínez Illán, Marina

García Fernández, Carlos

Marco Martínez, Fernando

Publisher

Springuer

Citations

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URI

https://hdl.handle.net/20.500.14352/107400

Citation

Lopiz Y, Garríguez-Pérez D, Martínez-Illán M, García-Fernández C, Marco F. Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications. Arch Orthop Trauma Surg. 2022 Feb;142(2):227-238. doi: 10.1007/s00402-020-03678-y. Epub 2020 Nov 11. PMID: 33175196.

Abstract

Introduction: Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. Methods: A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12 months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. Results: Mean age was 82.1 (range 80-90) and mean follow-up was 45.6 months (range 16-53 months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively. Conclusion: Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population. Elderly; Multiloc; Proximal humeral fracture; Proximal humeral nail; Quality of life.