Internal Fixation Versus Shoulder Hemiarthroplasty for Displaced 4-part Proximal Humeral Fractures in Elderly Patients

The purpose of this single-center, randomized, controlled trial was to report on the 2-year outcomes of proximal humerus fractures in elderly patients treated with open reduction and internal fixation (ORIF) with either a locking plate or shoulder hemiarthroplasty. Thirty-two patients (87% women) with a mean age of 71.9 years (range, 67-86 years) were treated with ORIF with either a locking plate or shoulder hemiarthroplasty after shoulder injury. The main outcome measures were the Constant score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and health-related quality of life (HRQoL) according to the EQ-5D (EuroQol Group, Rotterdam, The Netherlands). At final 2-year follow-up, DASH and pain scores favored the shoulder hemiarthroplasty group. Mean flexion was 129° in the shoulder hemiarthroplasty group and 117° in the ORIF group (P=.27), and mean abduction was 123° in the shoulder hemiarthroplasty group and 111° in the ORIF group (P=.41). In the shoulder hemiarthroplasty group, the EQ-5D index score decreased from 0.85±0.21 before injury to 0.65±0.14 at 4 months postoperatively. The score was 0.79±0.24 at 12 months postoperatively and 0.81±0.17 at 24 months postoperatively. The results of this study indicate an advantage in functional outcomes and HRQoL favoring shoulder hemiarthroplasty compared with ORIF with a locking plate, although most outcomes were not significantly different.