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Os eosyn hesis o a h oplas y in he managemen o complex ac u e o he
p oximal hume us in elde ly pa ien s
Conco de Muneze o 1, Yassine El Qadi i 1, 2, Bien enu Jean Celien. Okouango 1, *, Oussama El Adaoui 1, 2, Ahmed
Reda Haddoun 1, 2, D iss Bennouna 1, 2 and Mus apha Fadili 1, 2
1 Uni e si y hospi al cen e Ibn Rochd, Casablanca, Mo occo.
2 Facul y o Medicine and Pha macy o Casablanca, Hassan II Uni e si y, Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2271-2275
Publica ion his o y: Recei ed on 03 Ap il 2025; e ised on 11 May 2025; accep ed on 13 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1873
Abs ac
F ac u es o he uppe end o he hume us pose a he apeu ic p oblem, pa icula ly o complex ac u es wi h 3 o 4
agmen s. I emains a big challenge o o hopedic su ge y. The main pu pose o ou s udy was o compa e he
unc ional esul s and iden i y he ac o s o choosing be ween os eosyn hesis and a h oplas y in he ace o a
displaced ac u e wi h 3 o 4 agmen s o he p oximal hume us in elde ly pa ien s.
I is a e ospec i e and desc ip i e s udy o 90 o e 60 aged pa ien s who unde wen su ge y o complex ac u e o
he p oximal hume us collec ed be ween Janua y 2019 and June 2024 in he o hopedic su ge y depa men o de
Casablanca High eaching hospi al.
A emale p edominance wi h a sex a io o 0.36M/F was no iced in ou s udy. The a e age age was 64 yea s. The mos
common mechanism inju y was a simple all (66% o cases). (58.7%) bene i ed om os eosyn hesis. (41.3%) bene i ed
om a h oplas y.
The ea men ime was less han 72 hou s in 60% o cases. The o e all sa is ac ion a e was good o excellen in 90%
o a h oplas ies and 70% o os eosyn hesis. The cons an sco e a inal ollow-up was excellen oo good in 92% o
cases o a h oplas ies and 84% o cases o os eosyn hesis.
Keywo ds: Os eosyn hesis; A h oplas y; P oximal; Elde ly
1. In oduc ion
F ac u es o he p oximal hume us a e among he mos common ac u es in adul s, i ep esen s he 3 d mos common
ac u e in pa ien s o e 60 yea s old. Complex ac u es ca y a signi ican isk o nec osis which wo sens hei
p ognosis. The apeu ic managemen o hese ac u es emains a subjec o con o e sy [1, 2].
The main pu pose o he s udy is o compa e he unc ional esul s and iden i y he ac o s o choosing be ween
os eosyn hesis and a h oplas y in he ace o a displaced ac u e wi h 3 o 4 agmen s o he p oximal hume us in
elde ly pa ien s.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2271-2275
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2. Ma e ials and me hods
This is a e ospec i e and desc ip i e s udy o 90 o e 60 aged pa ien s who unde wen su ge y o complex ac u e
o he p oximal hume us collec ed be ween Janua y 2019 and June 2024 in he o hopedic su ge y depa men o de
Casablanca High eaching hospi al.
The unc ional assessmen was done by he pa ien sa is ac ion a e, he e alua ion o pos -ope a i e mobili y, he
absolu e cons an sco e is a adiog aphic e alua ion in he immedia e pos -ope a i e pe iod, du ing ex e nal
consul a ions and a las ollow-up.
2.1. S udy popula ion
Elde ly man o woman, ha ing bene i ed om he implemen a ion o os eosyn hesis o a h oplas y o a displaced
aged o e 60 complex cephalo- ube ous ac u e o he uppe end o he hume us du ing he pe iod s udy.
2.2. Judgmen c i e ia
• Objec i e unc ional esul s (measu emen o join ampli udes, Cons an sco e) and subjec i e esul s acco ding
quali y o li e sco es, pa ien sa is ac ion;
• Radiological esul s based on he ube osi y consolida ion, hume al adiolucen lines and loosening, scapula
no ches);
• Non ope a i e cases we e no conce ned by he s udy
3. Resul s
In ou s udy he e was a emale p edominance wi h a sex a io o 0.36M/F. The a e age age was 64 yea s.
The mos common mechanism inju y was a simple all (66% o cases). (58.7%) bene i ed om os eosyn hesis. (41.3%)
bene i ed om a h oplas y. The ea men ime was less han 72 hou s in 60% o cases.
The o e all sa is ac ion a e was good o excellen in 90% o a h oplas ies and 70% o os eosyn hesis. The cons an
sco e a inal ollow-up was excellen o good in 92% o cases o a h oplas ies and 84% o cases o os eosyn hesis.
A F on al incidence X- ay image
B P o ile incidence X- ay image
Figu e 1 P eope a i e adiological assessmen o p oximal hume us ac u es
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2271-2275
2273
A on al cu o he ac u e wi h 3
agmen s
B, C, D 3D incidence o he ac u e wi h 4 agmen s
Figu e 2 Compu ed omog aphy scan images
A Ins alla ion in beach chai posi ion
B, C pe ope a i e iew o he del opec o al ou e
Figu e 3 In aope a i e images ia del opec o al app oach o he shoulde
A pos -ope a i e adiological
con ol a e philos pla e
B pos -ope a i e adiological
con ol a e in amedulla y nailing
C pos -ope a i e adiological con ol
a e a h oplas y
Figu e 4 Immedia e pos -ope a i e adiological con ol
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A Compa a i e
an e pulsion o he
shoulde a e
os eosyn hesis
B Compa a i e
ex e nal o a ion o
he shoulde a e
os eosyn hesis
C Shoulde abduc ion
in compa ison wi h
heal hy a ing a e
a h oplas y
D Shoulde ex e nal in
compa ison wi h heal hy
a ing a e a h oplas y
E Shoulde in e nal
o a ion in
compa ison wi h
heal hy a ing a e
a h oplas y
Figu e 5 Images showing he unc ional esul s o he 6-mon h ollow-up se ies
4. Discussion
The e is no consensus on he su gical ea men o uns able ac u es o he p oximal hume us in he elde ly. Two
he apeu ic choices cu en ly oppose each o he . The i s , de ended by nume ous au ho s [ 1, 2], is os eosyn hesis. I
p o es di icul gi en he o en-poo quali y o he bone in he elde ly and he isk o os eonec osis o he hume al head
is no negligible [3], [4].
The second, ini ia ed by Nee in he 1950s, is o pe o m a p os he ic eplacemen o he glenohume al join [ 9].
Hemia h oplas y using an ana omical p os hesis equi ing einse ion o he ube osi ies is exposed o equen
complica ions wi h a ca as ophic impac on he unc ional u u e o he shoulde [4].
Teams [5], [ 6] a e u ning o he e e se shoulde p os hesis (G ammon ype), which makes i possible o do wi hou
he ube osi ies, and he e o e he o a o cu . The os eosyn hesis o ac u es o he p oximal end o he hume us
p o ided by an ana omical pla e is mo e a o able, i has he ad an age o a mo e s able assembly compa ed o pinning
echniques and o allowing ea ly mobiliza ion compa ed o nails and cup-and-ball implan s. Gicquel concluded ha he
ana omical pla e p esen s a simila and sa is ac o y o e all mechanical esis ance o axial p essu e and seemed o be
mo e mechanically adap ed and allows ea ly mobiliza ion o he shoulde ; i bes opposed he la e aliza ion o he head
and he sepa a ion o he ube osi ies [ 7, 8].
T ea men by a h oplas y o displaced ac u es o h ee o ou agmen s o he p oximal hume us does no cu en ly
gua an ee ha he pa ien will egain he shoulde he had be o e he auma. The he apeu ic choice he e o e lies in
he mos ep oducible op ion ha quickly es o es he bes possible com o o li e o he elde ly pa ien . Ana omical
hemia h oplas y gi es good unc ional esul s despi e o en p olonged immobiliza ion, bu also unce ain depending
on he ube osi y educ ion. Re e se a h oplas y p o ides eliable, apid and ep oducible esul s ega ding abduc ion,
an e ele a ion and pain. Bu he e emains he p oblem o o a ion de iciency a ec ing he quali y o li e o pa ien s and
he long- e m ou come o he implan (glenoid no ches).
The e e se p os hesis can he e o e p o ide an ad an age in he su gical ea men o complex ac u e o he uppe
end o he hume us, once hese wo p oblems ha e been esol ed, hus allowing i s implan a ion o be alida ed, which
o he momen does no seem easonable o us unde 70 yea s o age.
The esul s o su gical ea men a y in he li e a u e om one se ies o ano he . Fo Robinson and al. [ 9], excellen
esul s wi h ela i ely low complica ion a es can be ob ained wi h philos pla e os eosyn hesis, e en in elde ly subjec s.
FRASER and al. [10] ound in hei s udies esul s ha ac i ely mean be e in pa ien s who ha e bene i ed om an
a h oplas y: e e se o al shoulde p os hesis.
The decision-making algo i hm o a 75-yea -old pa ien di e s om ha o a 60-yea -old pa ien , especially i he la e
is an ac i e and heal hy manual wo ke .
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5. Conclusion
The managemen o ac u es o he p oximal hume us in he elde ly emains a challenge o he o hopedic su geon.
Randomized con ols and expensi e analyzes a e needed o de e mine he op imal me hod o ea ing hese ac u es.
The choice will he e o e lie in he mos eliable he apeu ic op ion, in he acquisi ion o a use ul mobili y sec o , in a
ep oducible manne and quickly es o ing he bes possible com o o li e o he pa ien he olde he pa ien .
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic s decla ed by he au ho s.
Re e ences
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