[Intramedullary augmentation with bone cement for the treatment of osteoporotic proximal humeral fractures in elderly patients].

Objective: To compare the clinical efficacy of two internal fixation methods in the treatment of osteoporotic proximal humeral fractures(PHF) in elderly patients:anatomical locking plate combined with intramedullary bone cement augmentation versus plate combined with bone grafting.

Methods: A retrospective analysis was conducted on 59 elderly patients with osteoporotic PHF who underwent open reduction and anatomical locking plate and screw fixation between January 2019 and January 2022. Of these patients, 23 were treated with intramedullary augmentation using bone cement (bone cement group), including 7 males and 16 females, aged from 60 to 83 years with a mean of(66.52±5.30) years, with a time from injury to surgery of 2 (1, 3) days. Thirty-six patients were treated with bone grafting(bone graft group), including 11 males and 25 females, aged from 61 to 85 years with a mean of (69.22±6.55) years, with a time from injury to surgery of 2 (2, 4) days. The operation time, total incision length, number of intraoperative fluoroscopy times, intraoperative blood loss, and length of hospital stay were observed and recorded in both groups. The upper extremity joint function was evaluated using the Constant-Murley score and the disability of the arm, shoulder and hand(DASH) score. The humeral neck shaft angle and adverse imaging findings were also documented.

Results: All patients were followed up for a period of 18 to 54 months, with a mean±standard deviation of (30.8±9.2) months. Operations were successfully performed in all patients of both groups, and no statistically significant differences were observed between the two groups in terms of operation time, total incision length, number of intraoperative fluoroscopies, intraoperative blood loss, or length of hospital stay (all P>0.05). At the final follow-up, the mean Constant-Murley score was(73.00±5.25) points in the bone cement group and (64.25±5.60) points in the bone graft group, while the mean DASH score was (13.91±4.62) points and (18.47±8.14) points in the two groups, respectively. The bone cement group exhibited significantly better upper extremity joint function than the bone graft group, with statistically significant differences (both P<0.05). Regarding imaging findings, the humeral neck-shaft angle in the bone graft group was (134.61±1.75)° on the first day postoperatively and (132.86±1.84)° at the final follow-up, showing a statistically significant decrease (P<0.001). In contrast, the humeral neck-shaft angle in the bone cement group was(135.35±1.47)° on the first day postoperatively and (135.42±1.68)° at the final follow-up, with no statistically significant difference(P=0.128). At the final follow-up, the humeral neck-shaft angle was significantly smaller in the bone graft group than in the bone cement group(P<0.001). No statistically significant difference was noted in postoperative adverse imaging findings between the two groups (P=0.117).

Conclusion: Compared with plate fixation combined with bone grafting, the technique of intramedullary augmentation with bone cement combined with plate-screw fixation yields better shoulder joint function and less loss of humeral neck-shaft angle in the treatment of osteoporotic proximal humeral fractures in elderly patients.