{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:49:30Z","timestamp":1793663370614,"version":"4.5.1"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The purpose of this study was to compare adverse events and clinical outcomes of geriatric proximal humerus fractures (PHF) involving the anatomical neck (type C according to AO classification) treated with open reduction and internal fixation (ORIF) using locking plate vs. arthroplasty. In this retrospective cohort study, geriatric patients (&gt;64 years) who underwent operative treatment using ORIF or arthroplasty for type C PHFs were included. Complications, revisions and clinical outcomes using Constant Murley Score (CMS) and Disabilities of the Arm, Shoulder and Hand (DASH) Score were assessed and compared between groups. At a mean follow up of 2.7 \u00b1 1.7 years, 59 patients (mean age 75.3 \u00b1 5.5 years) were included. In 31 patients ORIF was performed and 29 patients underwent arthroplasty. Complications and revision surgeries were significantly more frequent after ORIF (32.6% vs. 7.1%, p = 0.023 and 29.0% vs. 7.1%, p = 0.045). In contrast, clinical outcomes showed no significant differences (DASH 39.9 \u00b1 25.7 vs. 39.25 \u00b1 24.5, p = 0.922; CMS 49.7 \u00b1 29.2 vs. 49.4 \u00b1 25.2, p = 0.731). ORIF of type C PHFs in geriatric patients results in significantly more complications and revision surgery when compared to arthroplasty. Therefore, osteosynthesis of geriatric intraarticular fractures of the proximal humerus must be critically evaluated.<\/jats:p>","DOI":"10.3390\/jcm10050979","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T01:49:44Z","timestamp":1614649784000},"page":"979","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["More Adverse Events after Osteosyntheses Compared to Arthroplasty in Geriatric Proximal Humeral Fractures Involving Anatomical Neck"],"prefix":"10.3390","volume":"10","author":[{"given":"Felix","family":"Porschke","sequence":"first","affiliation":[{"name":"BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Stra\u00dfe 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Bockmeyer","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Stra\u00dfe 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip-Christian","family":"Nolte","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Stra\u00dfe 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Studier-Fischer","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Stra\u00dfe 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Guehring","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstra\u00dfe 38, 70176 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Schnetzke","sequence":"additional","affiliation":[{"name":"BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Stra\u00dfe 13, 67071 Ludwigshafen, Germany"},{"name":"German Joint Center, Atos Clinic Heidelberg, Bismarckstra\u00dfe 9-15, 69115 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/01.blo.0000194672.79634.78","article-title":"Update in the epidemiology of proximal humeral fractures","volume":"442","author":"Palvanen","year":"2006","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.jse.2015.07.015","article-title":"Proximal humerus fragility fractures: Recent trends in nonoperative and operative treatment in the Medicare population","volume":"25","author":"Han","year":"2016","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jse.2010.12.018","article-title":"Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: A randomized controlled trial","volume":"20","author":"Olerud","year":"2011","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1302\/0301-620X.83B6.0830799","article-title":"The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient","volume":"83","author":"Garg","year":"2001","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_6","first-page":"1","article-title":"The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial\u2014A pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults","volume":"19","author":"Handoll","year":"2015","journal-title":"Health Technolassess"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jse.2007.03.016","article-title":"Proximal humeral fractures: A systematic review of treatment modalities","volume":"17","author":"Lanting","year":"2008","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2151458517750516","DOI":"10.1177\/2151458517750516","article-title":"Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient","volume":"9","author":"Schumaier","year":"2018","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.injury.2010.11.058","article-title":"A systematic review of locking plate fixation of proximal humerus fractures","volume":"42","author":"Sproul","year":"2011","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.2106\/JBJS.H.00006","article-title":"Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study","volume":"91","author":"Bayer","year":"2009","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.injury.2007.08.013","article-title":"Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures","volume":"38","author":"Ring","year":"2007","journal-title":"Injury"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.2106\/JBJS.19.00595","article-title":"Complications and Long-Term Outcomes of Open Reduction and Plate Fixation of Proximal Humeral Fractures","volume":"101","author":"Robinson","year":"2019","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1007\/s11999-015-4345-3","article-title":"Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis","volume":"473","author":"Jiang","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.2106\/JBJS.16.01247","article-title":"Nationwide Analysis of Femoral Neck Fractures in Elderly Patients: A Receding Tide","volume":"99","author":"Ju","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1007\/s00264-016-3227-y","article-title":"Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly","volume":"40","author":"Savin","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1067\/mse.2002.124527","article-title":"Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus","volume":"11","author":"Boileau","year":"2002","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1302\/0301-620X.86B2.14553","article-title":"Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients","volume":"86","author":"Kralinger","year":"2004","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.2106\/00004623-200307000-00006","article-title":"Primary hemiarthroplasty for treatment of proximal humeral fractures","volume":"85","author":"Robinson","year":"2003","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2106\/JBJS.19.01071","article-title":"Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial","volume":"102","author":"Fraser","year":"2020","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jse.2013.10.003","article-title":"Reverse shoulder arthroplasty for proximal humeral fractures: Update on indications, technique, and results","volume":"23","author":"Acevedo","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.injury.2019.09.019","article-title":"Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients","volume":"50","author":"Luciani","year":"2019","journal-title":"Injury"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1097\/BOT.0000000000001465","article-title":"Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures","volume":"33","author":"Wright","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/00005131-200711101-00001","article-title":"Fracture and dislocation classification compendium\u20142007: Orthopaedic Trauma Association classification, database and outcomes committee","volume":"21","author":"Marsh","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jse.2004.01.034","article-title":"Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus","volume":"13","author":"Hertel","year":"2004","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Constant, C.R., and Murley, A.H. (1987). A clinical method of functional assessment of the shoulder. Clin. Orthop. Relat. Res., 160\u2013164.","DOI":"10.1097\/00003086-198701000-00023"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jse.2004.07.003","article-title":"The Constant score in normal shoulders","volume":"14","author":"Yian","year":"2005","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L","article-title":"Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG)","volume":"29","author":"Hudak","year":"1996","journal-title":"Am. J. Ind. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.2106\/JBJS.16.00112","article-title":"Quality of Reduction Influences Outcome After Locked-Plate Fixation of Proximal Humeral Type-C Fractures","volume":"98","author":"Schnetzke","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s11678-019-0510-8","article-title":"Die komplexe proximale Humerusfraktur","volume":"14","author":"Ockert","year":"2019","journal-title":"Obere Extremit\u00e4t."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1749-799X-9-31","article-title":"Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: A meta-analysis","volume":"9","author":"Xu","year":"2014","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.jse.2014.03.010","article-title":"Does the timing of surgery for proximal humeral fracture affect inpatient outcomes?","volume":"23","author":"Menendez","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1016\/S0020-1383(15)30019-X","article-title":"Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures","volume":"46","author":"Helfen","year":"2015","journal-title":"Injury"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rienm\u00fcller, A., Maffiuletti, N.A., Schwyzer, H.K., and Eggsp\u00fchler, A. (2020). Shoulder Muscle Strength and Neuromuscular Activation 2 Years after Reverse Shoulder Prosthesis-An Experimental Case Control Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020365"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jse.2014.08.003","article-title":"Biomechanics of reverse total shoulder arthroplasty","volume":"24","author":"Berliner","year":"2015","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1016\/j.jse.2014.06.035","article-title":"Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study","volume":"23","year":"2014","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1001\/jama.2015.1629","article-title":"Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: The PROFHER randomized clinical trial","volume":"313","author":"Rangan","year":"2015","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e982","DOI":"10.3928\/01477447-20170925-01","article-title":"Increasing Use of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures in Elderly Patients","volume":"40","author":"Rajaee","year":"2017","journal-title":"Orthopedics"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/5\/979\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:31:10Z","timestamp":1760160670000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/5\/979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,2]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["jcm10050979"],"URL":"https:\/\/doi.org\/10.3390\/jcm10050979","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,2]]}}}