# Osteosynthesis of Three- and Four-Part Proximal Humerus Fractures in Elderly Patients Using Locking Plates and Synthetic Bone Grafts: A Clinical and Radiographic Evaluation

## TL;DR

This study evaluates the effectiveness of using locking plates and calcium sulfate grafts to treat complex shoulder fractures in elderly patients, finding satisfactory results with low complication rates.

## Contribution

The novel contribution is the clinical evaluation of angular locking plates combined with calcium sulfate paste grafts for three- and four-part proximal humerus fractures in elderly patients.

## Key findings

- Clinical scores at 12 months showed moderate to good functional outcomes in elderly patients.
- Complication and reoperation rates were relatively low at 13.3% and 6.0%, respectively.
- Radiographic parameters like head-shaft angle and humeral height remained stable over time.

## Abstract

Objectives: To evaluate clinical and radiographic outcomes and complications of three- and four-part proximal humerus fractures (PHF) in elderly patients treated with angular locking plate (LP) combined with calcium sulfate (CaSO4) paste graft.

Materials and methods: A prospective case series evaluating patients aged ≥ 60 years with three- or four-part PHF treated with LP and 10 ml of CaSO4 paste graft. Primary outcome was clinical evaluation using the Constant-Murley (CM) score at 12 months. Secondary outcomes included scores from the University of California, Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Elbow (DASH), bilateral active range of motion (ROM), abduction strength, Constant Relative Index (CRI), radiographic findings, and complications.

Results: Thirty patients were evaluated. At 12 months, the mean scores were: 67.7 (CM), 30.5 (UCLA), 86.5 (ASES), 0.7 (VAS), and 18.9 (DASH). The mean active ROM was 121° (flexion), 109° (abduction), 53° (external rotation), and thumb-T12, with abduction strength of 5.7 kg. The mean head-shaft angle (HSA) on the first postoperative day was 133°, with minimal change to 129° at 12 months, and the mean humeral height (HH) remained unchanged (11 mm). There were five complications in four patients (13.3%): three cases of severe varus collapse (difference between the neck-shaft angle (NSA) on the first postoperative day and the 12th month postoperative > 20°), and two cases of cutout. Two reoperations (6.0%) were performed to remove screws that had penetrated the joint.

Conclusion: Clinical and radiographic outcomes of three- or four-part PHF in elderly patients treated with LP and CaSO4 paste graft are satisfactory, with relatively low complications and reoperation rates.