Osteosynthesis or arthroplasty in the management of complex fracture of the proximal humerus in elderly patients

Fractures of the upper end of the humerus pose a therapeutic problem, particularly for complex fractures with 3 or 4 fragments. It remains a big challenge for orthopedic surgery. The main purpose of our study was to compare the functional results and identify the factors for choosing between osteosynthesis and arthroplasty in the face of a displaced fracture with 3 or 4 fragments of the proximal humerus in elderly patients. 

It is a retrospective and descriptive study of 90 over 60 aged patients who underwent surgery for complex fracture of the proximal humerus collected between January 2019 and June 2024 in the orthopedic surgery department of de Casablanca High teaching hospital. 

A female predominance with a sex ratio of 0.36M/F was noticed in our study. The average age was 64 years. The most common mechanism injury was a simple fall (66% of cases).  (58.7%) benefited from osteosynthesis. (41.3%) benefited from arthroplasty. 

The treatment time was less than 72 hours in 60% of cases. The overall satisfaction rate was good to excellent in 90% of arthroplasties and 70% of osteosynthesis. The constant score at final follow-up was excellent too good in 92% of cases for arthroplasties and 84% of cases for osteosynthesis.