Effects of fracture type, bone mineral density, and surgical technique on clinical outcomes of proximal humeral fracture surgery

V. B. Makarov; M. O. Korzh

doi:10.15421/0225031

V. B. Makarov Municipal Non-Profit Enterprise “City Clinical Hospital No. 16” of the Dnipro City Council
M. O. Korzh Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine

Keywords: arthroplasty, shoulder, bone density, treatment outcome, Constant–Murley score, aged.

Abstract

As the proportion of elderly individuals in Ukraine’s population rises, optimizing the treatment of proximal humeral fra c tures is becoming increasingly important, given their significant impact on quality of life. Surgical treatment was performed using one of three methods in three patient groups (aged 45–78 years, total n = 102) with reduced bone mineral density fo l lowing a three- or four-fragment proximal humerus fracture: open reduction and internal fixation with a proximal humeral locking plate with angular stability; open reduction and internal fixation with a plate using 3D-printed porous polylactide implants; primary reverse total shoulder arthroplasty using an advanced endoprosthesis or porous elements made from tit a nium powder via 3D printing and novel friction pairs. The Constant-Murley Score was used to evaluate functional outcomes at 3, 6, and 12 months postoperatively. Functional outcomes were analyzed based on individual preoperative parameters, treatment methods, and the presence of complications to identify risk factors for poor functional outcomes within 12 months postoperatively. At each follow-up period (3, 6, and 12 months), no statistically significant differences in mean Constant-Murley Score values were observed based on sex, age, or time between trauma and surgery. It was established that functional treatment outcomes showed a positive trend across all analyzed subgroups as the postoperative period increased from 3 to 12 months. Fracture type, cortical index value, and the presence of postoperative complications were the primary factors influe n cing functional outcomes in the studied sample. At all follow-up stages (3, 6, and 12 months), patients with four-fragment fractures had worse functional outcomes than those with three-fragment fractures. Similarly, patients with a cortical index value ≤ 0.36 demonstrated poorer outcomes than those with values of 0.38–0.40, as did patients with postoperative complic a tions compared to those without. The presence of a four -fragment fracture and a cortical index ≤ 0.36 in patients aged 55–78 years in the studied sample may be considered risk factors for an unsatisfactory functional outcome within 12 months postop e ratively. To determine both qualitative and quantitative relationships between initial patient conditions and functional ou t comes over time, further studies are required in larger patient groups. Specifically, reverse prosthetics may offer a more a d vanced solution for older individuals with reduced bone density in cases of three- and f our -fragment fractures, necessitating a longer follow-up period.

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