Outcomes of Locking Plate Fixation With Spine Cage for Unstable Proximal Humeral Fractures in Elderly Patients.

Objective: To compare the clinical and radiological results of locking plate fixation with and without spine cage for the treatment of unstable proximal humeral fractures in elderly patients.
Design: Retrospective study.
Setting: Level 1 Trauma Center.
Patients/participants: A total of 62 patients with a mean age of 72.68 (60-88) years were included. Thirty-nine patients were treated with only a locking compression plate (LCP group), whereas 23 patients were treated with a locking compression plate and a spine cage (SC group). The mean follow-up was 32.26 (24-46) months.
Main Outcome Measures: Radiological outcomes were assessed using the humeral head height and neck-shaft angle. The clinical results were evaluated using a visual analog scale for pain, the Constant-Murley score, the American Shoulder and Elbow score, and shoulder range of motion.
Results: The average radiological changes in the humeral head height and neck-shaft angle were significantly higher in the LCP group than in the SC group ( P < 0.001 and P < 0.001, respectively). The final outcome scores were lower in the LCP group than in the SC group (Constant-Murley score of 73.26 vs. 78.91 [ P = 0.028] and American Shoulder and Elbow score of 72.36 vs. 78.57 [ P = 0.011]). The SC group showed better forward elevation ( P = 0.005) and abduction ( P = 0.001); however, no significant differences were observed for shoulder external or internal rotation. The number of complications was higher in the LCP group (38.5%) than in the SC group (13.0%) ( P = 0.033).
Conclusions: For unstable proximal humeral fractures with medial comminution in elderly patients, locking plate with an SC is a reasonable option to ensure satisfactory results and lower the postoperative complications.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: The authors report no conflict of interest.
(Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)