{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T10:31:04Z","timestamp":1791109864969,"version":"4.1.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2014,2,11]],"date-time":"2014-02-11T00:00:00Z","timestamp":1392076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Geriatr Orthop Surg Rehabil"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>From 2008 to 2012, 21 such operations were performed; 18 were considered \u201cfragility\u201d fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation ( ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean = 21, standard deviation = 20, n = 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2151458514520701","type":"journal-article","created":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T22:19:14Z","timestamp":1392243554000},"page":"9-13","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus"],"prefix":"10.1177","volume":"5","author":[{"given":"Isaac B.","family":"James","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana J.","family":"Farrell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Siska","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan S.","family":"Tarkin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,2,11]]},"reference":[{"key":"bibr1-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1080\/000164701753542023"},{"key":"bibr2-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000224148.73016.30"},{"key":"bibr3-2151458514520701","doi-asserted-by":"publisher","DOI":"10.3944\/AOTT.2010.2270"},{"key":"bibr4-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1935-6"},{"key":"bibr5-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.11.046"},{"key":"bibr6-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-012-0181-8"},{"key":"bibr7-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.11.058"},{"key":"bibr8-2151458514520701","doi-asserted-by":"crossref","unstructured":"Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments\u2014normative values from the general population. J Bone Joint Surg. 2002;84A(2):208\u2013215. http:\/\/jbjs.org\/. Accessed January 28, 2012.","DOI":"10.2106\/00004623-200202000-00007"},{"key":"bibr9-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181920e5b"},{"key":"bibr10-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200604000-00004"},{"key":"bibr11-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e31819344bf"},{"key":"bibr12-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2010.05342.x"},{"key":"bibr13-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1080\/00016470410004120"},{"key":"bibr14-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-006-0256-9"},{"key":"bibr15-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-006-1165-7"},{"key":"bibr16-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000194678.87258.6e"},{"issue":"1","key":"bibr17-2151458514520701","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-2004-44870","volume":"129","author":"Lill H","year":"2004","journal-title":"Zentralbl Chir"},{"key":"bibr18-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-37368"},{"key":"bibr19-2151458514520701","doi-asserted-by":"crossref","unstructured":"Muckter H, Herzog L, Becker M, Vogel W, Meeder PJ, Buchholz J. Angle and rotation-stable internal fixation of proximal humerus fractures with the humerus fixator plate. early clinical experience with a newly developed implant. Chirurg. 2001;72(11):1327\u20131335. http:\/\/link.springer.com\/article\/10.1007\/s001040170039. Accessed March 03, 2013.","DOI":"10.1007\/s001040170039"},{"key":"bibr20-2151458514520701","unstructured":"Ruedi T, Moshfegh A, Pfeiffer KM, Allgower M. Fresh fractures of the shaft of the humerus. Conservative or operative treatment? Reconstr Surg Traumatol. 1974;14(0):65\u201374. http:\/\/www.karger.com\/BookSeries\/Home\/223957. Accessed March 03, 2013."},{"issue":"10","key":"bibr21-2151458514520701","first-page":"2258","volume":"88","author":"Edwards SL","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"bibr22-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181b2b74d"},{"key":"bibr23-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.07.235"},{"key":"bibr24-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-006-0242-4"},{"key":"bibr25-2151458514520701","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181694f7d"}],"container-title":["Geriatric Orthopaedic Surgery &amp; Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2151458514520701","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2151458514520701","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2151458514520701","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:10:07Z","timestamp":1777446607000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2151458514520701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,11]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1177\/2151458514520701"],"URL":"https:\/\/doi.org\/10.1177\/2151458514520701","relation":{},"ISSN":["2151-4593","2151-4593"],"issn-type":[{"value":"2151-4593","type":"print"},{"value":"2151-4593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,11]]}}}