Retrospective single-center series of 173 patients over age 60 treated with locking plate ORIF for proximal humerus fractures from 2005 to 2015. Asks whether modern principle-based technique — liberal fibular allograft use, valgus reduction, calcar support — has reduced historically high failure rates in this population. Average follow-up was 6.1 years.
A 73-year-old woman with a displaced 3-part proximal humerus fracture sits across from you in clinic. The question is not whether you can fix it — you almost certainly can, with valgus reduction and calcar support 95-98% of the time. The question is whether fixation will hold.
This paper makes the answer uncomfortable: even at a high-volume center after the learning curve, 39% of 3-part and 45% of 4-part fractures fail in patients over 60. Most failures are biological. Progressive AVN that unfolds months after the plate has done its job. No amount of technique refinement prevents a head with compromised vascularity from collapsing.
When you see a displaced 3- or 4-part fracture in a patient in their 70s or 80s, these data support a direct conversation about primary rTSA. The authors' own practice shifted in that direction, citing an approximately 5% failure rate for rTSA in this setting versus 39-45% for ORIF.
Do not let a low reoperation rate (11%) reassure you. Most failures in this series went unrevised because patients refused further surgery, not because they recovered.
Locking Plate Fixation of Proximal Humerus Fractures in Patients Older Than 60 Years Continues to Be Associated with a High Complication Rate
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Retrospective single-center series of 173 patients over age 60 treated with locking plate ORIF for proximal humerus fractures from 2005 to 2015. Asks whether modern principle-based technique — liberal fibular allograft use, valgus reduction, calcar support — has reduced historically high failure rates in this population. Average follow-up was 6.1 years.
A 73-year-old woman with a displaced 3-part proximal humerus fracture sits across from you in clinic. The question is not whether you can fix it — you almost certainly can, with valgus reduction and calcar support 95-98% of the time. The question is whether fixation will hold.
This paper makes the answer uncomfortable: even at a high-volume center after the learning curve, 39% of 3-part and 45% of 4-part fractures fail in patients over 60. Most failures are biological. Progressive AVN that unfolds months after the plate has done its job. No amount of technique refinement prevents a head with compromised vascularity from collapsing.
When you see a displaced 3- or 4-part fracture in a patient in their 70s or 80s, these data support a direct conversation about primary rTSA. The authors' own practice shifted in that direction, citing an approximately 5% failure rate for rTSA in this setting versus 39-45% for ORIF.
Do not let a low reoperation rate (11%) reassure you. Most failures in this series went unrevised because patients refused further surgery, not because they recovered.