{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:43:37Z","timestamp":1762069417803,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AO Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The treatment of proximal humerus fractures in elderly patients is challenging, with reported high complication rates mostly related to implant failure involving screw cut-out and penetration. Metaphyseal defects are common in osteoporotic bone and weaken the osteosynthesis construct. A novel technique for augmentation with polymethylmethacrylate (PMMA) bone cement was developed for the treatment of patients in advanced age with complex proximal humerus fractures and metaphyseal voids, whereby the cement was allowed to partially cure for 5\u20137 min after mixing to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window with a volume of 4\u20136 mL per patient. The aim of this retrospective clinical study was to assess this technique versus autologous bone graft augmentation and no augmentation. Materials and Methods: The outcomes of 120 patients with plated Neer three- and four-part fractures, assigned to groups of 63 cases with no augmentation, 28 with bone graft augmentation and 29 with cement augmentation, were assessed in this study. DASH, CS, pain scores and range of motion were analyzed at 3, 6 and 12 months. Statistical analysis was performed with factors for treatment and age groups, Neer fracture types and follow-up periods, and with the consideration of age as a covariate. Results: DASH and CS improved following cement augmentation at three and six months compared to bone grafting, being significant when correcting for age as a covariate (p \u2264 0.007). While the age group had a significant effect on both these scores with worsened values at a higher age for non-augmented and grafted patients (p \u2264 0.044), this was not the case for cement augmented patients (p \u2265 0.128). Cement augmentation demonstrated good clinical results at 12 months with a mean DASH of 10.21 and mean CS percentage of 84.83% versus the contralateral side, not being significantly different among the techniques (p \u2265 0.372), despite the cement augmented group representing the older population with more four-part fractures. There were no concerning adverse events specifically related to the novel technique. Conclusions: This study has detailed a novel technique for the treatment of metaphyseal defects with PMMA cement augmentation in elderly patients with complex proximal humerus fractures and follow-up to one year, whereby the cement was allowed to partially cure to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window. The results demonstrate clinically equivalent short-term results to 6 months compared to augmentation with bone graft or no augmentation\u2014despite the patient group being older and with a higher rate of more severe fracture patterns. The technique appears to be safe with no specifically related adverse events and can be added in the surgeon\u2019s armamentarium for the treatment of these difficult to manage fractures.<\/jats:p>","DOI":"10.3390\/medicina58101424","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T21:07:11Z","timestamp":1665436031000},"page":"1424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6118-315X","authenticated-orcid":false,"given":"Stoyan","family":"Hristov","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Visscher","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"School of Medicine, Queensland University of Technology, Brisbane 4000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Winkler","sequence":"additional","affiliation":[{"name":"Cantonal Hospital Graubuenden, 7000 Chur, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Zhelev","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria"},{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-2766","authenticated-orcid":false,"given":"Stoyan","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deyan","family":"Veselinov","sequence":"additional","affiliation":[{"name":"Bulgarian Academy of Sciences, Institute of Metal Science \u2018Acad. A. Balevski\u2019, 1574 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asen","family":"Baltov","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine \u2018N. I. Pirogov\u2019, 1606 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Varga","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-1810","authenticated-orcid":false,"given":"Till","family":"Berk","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"},{"name":"Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-3626","authenticated-orcid":false,"given":"Karl","family":"Stoffel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz","family":"Kralinger","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Trauma and Sports Department, Teaching Hospital Medical University of Vienna, Ottakring Clinic, 1160 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, 7270 Davos, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.2106\/JBJS.M.00028","article-title":"The Influence of Local Bone Density on the Outcome of One Hundred and Fifty Proximal Humeral Fractures Treated with a Locking Plate","volume":"96","author":"Kralinger","year":"2014","journal-title":"J. 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