Ateş Mahmuti1, Ekin Kaya Şimşek2, Bahtiyar Haberal2

1Department of Orthopedics and Traumatology, Başkent University Istanbul Hospital, Istanbul, Türkiye
2Department of Orthopedics and Traumatology, Başkent University Faculty of Medicine, Ankara, Türkiye

Keywords: Elderly, failure, fixation, medial cortical ratio, proximal humerus.


Objectives: This study aims to investigate whether the medial cortical ratio (MCR) is associated with fixation failure in patients undergoing plate-screw fixation due to proximal humeral fracture.

Patients and methods: Between May 2011 and October 2020, a total of 93 patients (25 males, 68 females; mean age: 74.2±5.3 years; range, 65 to 92 years) who were operated for a proximal humeral fracture were retrospectively analyzed. The patients were divided into two groups during follow-up: patients with fixation failure (n=18) and patients with intact fixation (n=75). After radiological analysis, the MCR and fracture type were recorded. The effects of MCR and fracture type on the development of failure were evaluated.

Results: The mean follow-up was 41.3±4.7 (range, 18 to 66) months. There was no significant correlation between fixation failure and MCR in either group (p=0.535). However, the risk of fixation failure increased by seven-fold in patients with MCR greater than 0.09 compared to the other patients. In addition, the fracture type was significantly more severe in the failed fixation group than the intact fixation group (p<0.001).

Conclusion: Surgical treatment of proximal humeral fractures in elderly patients still remains a challenge for surgeons due to the high failure rate. In elderly patients scheduled for surgery to treat a proximal humerus fracture, a reverse shoulder arthroplasty may be a reasonable choice to avoid reoperation due to fixation failure in elderly with three-part or more fragmented fractures and high MCR.

Citation: Mahmuti A, Şimşek EK, Haberal B. The medial cortical ratio as a risk factor for failure after surgical fixation of proximal humerus fractures in elderly patients. Jt Dis Relat Surg 2023;34(2):432- 438. doi: 10.52312/jdrs.2023.1073.

Ethics Committee Approval

The study protocol was approved by the Başkent University Medical and Health Sciences Research Board (date: 30.11.2021, no: KA21/466). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea and concept, data collection and processing, literature review, writing the article: A.M.; Study design, data collection, writing the article, materials: E.K.Ş.; Control and supervision, critical review, references and fundings: B.H.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.