# Assessment of fracture stability following modified minimally invasive reduction osteosynthesis system (MIROS) fixation for Neer 2 and 3-Part proximal humeral fractures

## TL;DR

This study compares modified MIROS surgery to non-surgery for treating shoulder fractures in elderly patients, finding better outcomes with the surgical method.

## Contribution

The study introduces modified MIROS as a minimally invasive alternative to conservative treatment for specific shoulder fractures in elderly patients.

## Key findings

- Modified MIROS showed significantly better functional outcomes and lower complication rates compared to non-surgical treatment.
- Modified MIROS resulted in better radiological stability with less change in humeral head height and shaft angle.
- Modified MIROS allows early shoulder motion and satisfactory recovery in elderly patients.

## Abstract

Conservative management for elderly proximal humeral fractures is an acceptable option, but the fracture stability is dubious. The purpose of this study was to investigate fracture stability and functional outcomes after modified minimally invasive reduction osteosynthesis system (MIROS) and non-surgical treatment for Neer two and three-part proximal humeral fractures in elderly patients.

Elderly Patients with two and three-part proximal humeral fractures who underwent modified MIROS fixation and non-operative management were retrospectively included. The Constant-Murley score, and the range of shoulder forward elevation were measured for functional assessment, while the radiological humeral head height (HHH) and humeral shaft angle (HSA) were used to verify the fracture stability. The variables in both treatment groups were compared using a two-tailed t test for independent means, with a p value of less than 0.05 denoting a significant difference.

Forty-two patients were consecutively included, with a mean follow-up of 24.05 ± 3.9 months for the modified MIROS group and 24.67 ± 4.5 months for the non-operative group. The modified MIROS group had statistically significant improvements in the Constant score and shoulder forward flexion (p = 0.0001), with a lower complication rate (14.3% vs. 52.3%). Moreover, the average changes in the radiological HSA and HHH were lower in the modified MIROS group at the one-year follow-up (p = 0.00001).

Modified MIROS is recommended as an alternative to conservative treatment for Neer 2 and 3-part proximal humeral fractures in elderly, medically unfit patients. It is a minimally invasive procedure that provides adequate fracture stability and permits early shoulder motion, with satisfactory functional and radiologic outcomes and fewer complications.

Retrospective comparative cohort; level of evidence (III).