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Outcome after operative treatment of proximal humeral fractures in elderly patients

Outcome nach operativer Versorgung von Humeruskopffrakturen beim älteren Menschen

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Abstract

Background

The proximal humeral fracture (PHF) (5 %) of the elderly is the third most common fracture after proximal femoral and distal radius fractures. Proximal femoral fractures often lead to a loss of autonomy.

Objectives

The aim of this study is to show how PHF changes the patient’s autonomy and the coping with everyday life as well as which factors influence the outcome 1 year (y) after surgery.

Materials and methods

Data of 62 patients with surgical treatment of a PHF ≥ 60 y was prospectively collected. With a telephone interview Short Form (SF) 12 (physical and mental health; PH, MH), Barthel Index (BI), range of motion, pain, and satisfaction was observed after 3 and 12 months. The dependence of outcome on different factors was investigated.

Results

The mean age was 73.3 y (median 73, 60–94). Mortality after 3 months was 3 % and after 1 y 11 %. The PH before the injury (47.9) was significantly better than after 3 months (37.1) and after 1 y (42.6). The MH showed no difference. The BI before the injury (92) was significantly better than after 3 months (86), but the same after 1 y (91). After 1 y > 50 % were able to abduct and flex the arm > 90°. More than two-thirds were able to perform everyday life activities for body care and nutrition after 1 y. Approximately, 73 % of the patients had little or no pain, and 84 % were satisfied with the result after 1 y. Good score values before the fracture resulted in better outcome. Higher severity in fracture led to a higher level of pain.

Discussion

A surgically treated PHF in the elderly does not lead to a relevant impairment in quality of life. Despite the lack of complete retrieval of range of motion patients achieve a good to very good result in coping with everyday life.

Zusammenfassung

Hintergrund

Die Humeruskopffraktur (HKF) des älteren Menschen ist mit ca. 5 % die Dritthäufigste nach den hüftgelenknahen Femur- und den distalen Radiusfrakturen. Hüftgelenknahe Femurfrakturen führen häufig zu einem Verlust der Selbständigkeit.

Ziel der Arbeit

Es sollte untersucht werden, wie sich eine HKF auf die Selbständigkeit und Alltagsbewältigung auswirkt und welche Faktoren das Outcome 1Jahr(a) nach operativer Versorgung beeinflussen.

Material und Methoden

Daten von 62 Patienten ≥ 60a mit operativ versorgter HKF wurden prospektiv erhoben. In einem telefonischen Interview wurden nach 3 und 12 Monaten Short Form (SF) 12 (Physical und Mental Health; PH, MH) Barthel-Index (BI), Bewegungsausmass, Schmerzen und Zufriedenheit abgefragt. Die Abhängigkeit des Outcomes von verschiedenen Faktoren wurde untersucht.

Ergebnisse

Das mittlere Alter betrug 73,3a (Median 73, 60–94), die Mortalität nach 3 Monaten 3 % nach 1a 11 %. Der PH vor dem Unfall (47,9) war signifikant besser als der 3 Monate (37,1) und der 1a (42,6) später. Der MH zeigten keinen Unterschied. Der BI vor dem Unfall (92) war signifikant besser als der nach 3 Monaten (86) jedoch gleich nach 1a (91). Nach 1a waren > 50 % fähig den Arm > 90° zu abduzieren und antevertieren. Die Bewältigung von Alltagstätigkeiten zur Körperpflege und Ernährung nach 1a gelang weit mehr als 2 Drittel. 73 % der Patienten hatten nach 1a nur geringe oder keine Schmerzen, 84 % waren mit dem Ergebnis zufrieden. Gute Scorewerte vor der Fraktur ergaben ein besseres Outcome. Höhere Frakturschwere bedingte ein höheres Schmerzniveau.

Diskussion

Eine operativ versorgte HKF führt beim älteren Menschen nicht zu einer relevanten Einschränkung der Lebensqualität. Trotz nicht vollkommen wiederhergestelltem Bewegungsumfang wird eine gute Alltagsbewältigung erreicht.

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Authors and Affiliations

  1. Department for Trauma and Orthopedic Surgery I, Westpfalz-Klinikum Kaiserslautern, Academic Educational Hospital, Heidelberg University and Mainz University, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Germany

    Markus Muhm, Christoph Lahr, Hartmut Winkler & Thomas Ruffing

  2. Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

    Markus Muhm & Hartmut Winkler

  3. Department for Trauma and Orthopedic Surgery, Municipal Hospital, Pirmasens, Germany

    Julia Bott

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  1. Markus Muhm
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  2. Julia Bott
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  3. Christoph Lahr
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  4. Hartmut Winkler
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  5. Thomas Ruffing
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Corresponding author

Correspondence to Markus Muhm.

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Conflict of interest

There is no conflict of interest.

This study is consistent with medical confidentiality and privacy including written consent of the patients. The data used are results from routinely patient-centered care and have not been acquired explicitly for this study.

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Muhm, M., Bott, J., Lahr, C. et al. Outcome after operative treatment of proximal humeral fractures in elderly patients. Z Gerontol Geriat 49, 505–511 (2016). https://doi.org/10.1007/s00391-015-0954-4

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  • DOI: https://doi.org/10.1007/s00391-015-0954-4

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