PAPER 13: FUNCTIONAL OUTCOMES FOR THREE- AND FOUR-PART PROXIMAL HUMERUS FRACTURES TREATED WITH A LOCKING PLATE OR HEMIARTHROPLASTY

Purpose: With the advent of the locking precontoured proximal humerus plate, fixation of three- and four-part proximal humerus fractures has become an attractive option. The purpose of this study was to report the surgical and functional outcomes of locked plate fixation verses hemiarthroplasty in these fractures. Methods: This study included 56 patients with three-part and four-part proximal humerus fractures from 2002–2005 with a mean follow-up time of 35 months. The mean patient age was 58.8 years for the ORIF group (n=42) and 68.7 years for hemiarthroplasty group (n=14). IRB approval was obtained and functional outcomes questionnaires were sent out with an invitation to return to the office for a physical exam. Range of Motion (ROM), the Constant score, the American Shoulder and Elbow Surgeons score (ASES), the Simple Shoulder Test (SST), the Euroqol EQ-50, a visual analog pain scale (VAS), and the UCLA shoulder score were used to evaluate the patients. Results: Radiological review of the ORIF group showed union in 41 patients and avascular necrosis (AVN) in one patient who underwent subsequent hemiarthroplasty. Plate removal was performed in 1 patient after three months from the initial surgery, because of impingement symptoms. The scores of Euroqol EQ-50 (73±24 vs. 63.2±21, p=0.169) and VAS (2±2 vs. 3.1±2.8, p=0.135) were not statistically significant. Validated functional scores are given below. Function ORIF Hemiarthroplasty p-value (ANOVA) ROM 140o(100–165 o) 90o (20–165 o) 0.002 Mean Abduction 126 o (90–160) 100o (21–160 o) 0.001 ASES 71.6% (18–100) 56.9% (23–82) 0.023 Mean Constant Score 70 44.8 0.008 SST score (max 12) 7 4 0.001 UCLA (max 35) 26 17 0.01 Satisfaction 83% 53% 0.001 Conclusion and Significance: Open reduction with internal fixation of three- and four-part proximal humerus fractures using a locking proximal humerus plate provides stable fixation that encourages bony healing and allows for early range of motion and also better functional results, and satisfaction when compared to hemiarthroplasty.