Hemiarthroplasty vs. locking plate osteosynthesis – what is the better solution for displaced proximal humerus fractures?

Abstract

Introduction: Displaced proximal humerus fractures pose significant clinical problems. The aim of this study was to compare treatment results between open reduction and internal fixation (ORIF) and hemiarthroplasty (HA). Material and methods: The study was a retrospective assessment. Sixtythree patients (30 HA, 33 ORIF) met the inclusion criteria; mean age: 64.5 years. The Constant-Murley scale, DASH score and VAS surveys for pain and satisfaction were used to evaluate the results. Results: The HA group: the constant score was 44 points, and the DASH score was 57 points; 53% of patients had osteolysis of the greater tubercle; none of the patients had revision surgery. ORIF group: the constant score was59 points, and the DASH score was 38 points; 21% of patients had a vascular necrosis; revision surgery was performed in 18% of cases. A significant correlation between good functional outcomes and young age of patients was found in the ORIF group (p-value < 0.048). Patients who started physical therapy earlier achieved better results. DASH scores were better compared to ones from the objective Constant-Murley score. There was no difference in satisfaction between HA and ORIF groups (p-value < 0.1). Conclusions: The ORIF should be considered for patients < 60 years old, but gives increased risk of urgent revision, due to screw protrusion. The HA provides fewer complications, lower risk of revision and can be better for patients between 60 and 70 years old. When choosing the treatment method, we should avoid focusing only on fracture configuration, but should also consider patient-related factors, such as age and lifestyle.