wetenschapsdag 2023 | 37 Sessie 1b: Ticks, Checks and Balances 5 Auteurs L.S. Blaas, R.L.O.M.A. Bent, T.D.W. Alta, A van Noort, R.J. Derksen Abstract titel Hemiarthroplasty versus ORIF for complex, severely displaced proximal humerus fractures in middle-aged patients Background The optimal treatment for complex proximal humerus fractures (PHFs) remains unknown. Conservative treatment is standard for minimally displaced fractures, while reverse shoulder arthroplasty is increasingly popular for complex fractures in elderly. However, for middle-aged patients with highly complex fractures, sound evidence for treatment is missing. Treatment with open reduction and internal fixation (ORIF) can be challenging and literature opts for hemiarthroplasty (HA) as a viable treatment option, nevertheless, HA is becoming less popular. Therefore, we hypothesized that in patients with a complex PHF with an intact rotator cuff, a wellperformed fracture HA could be the best available option, as opposed to ORIF. Methods In this retrospective, multicenter comparative cohort-study, 30 patients with complex PHFs were included. Ten patients underwent HA and those were matched to 20 with an ORIF. All patients had at least one-year follow-up. Patient-reported outcome measures (PROMs) were assessed: Constant-Murley Score (CMS), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the pain was assessed with the Visual Analogue Score (VAS). In addition, the range of motion (ROM) and complications were evaluated. Results The mean age for HA and ORIF treated patients was 55.4 vs. 56.3 years. The HA group had a statistically significant higher number of patients with head-split fractures. For PROMs, the following means (CI-95%) for HA versus ORIF were, respectively 26.8 (6.2 – 47.4) vs 28.6 (22.1 – 35.1) for DASH, 37.3 (28.5 – 46.1) vs 37.4 (34.1 – 40.6) for OSS, 25.9 (7.9 – 43.9) vs 21.4 (13.0 – 29.7) for CMS, 64.2 (44.7 – 83.7) vs 71.0 (63.8 – 78.2) for CMS fracture side. No statistically significant differences were found. For ROM, forward flexion 110.5 (80.7 – 140.3) vs 116.2 (98.0 – 134.4), abduction 107.4 (73.9 – 140.9) vs 105.3 (83.0 – 127.6) and external rotation 26.3 (2.4 – 50.2) vs 27.4 (18.7 – 36.1) also showed no statistically significant differences. However, in both groups, high complication and revision rates were found. With more revisions in the HA group (50%) compared to the ORIF group (30%).
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