Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level-1 trauma center

Abstract

BackgroundThe aims of this study were to evaluate treatment failure and revision rates of proximal humeral fracture (PHF) treatment with a standardized treatment algorithm within the reality of a level-1 trauma center and to identify predictors of subsequent surgery.Materials and methodsThe medical database of a level-1 trauma center was screened for all primary treatments of PHFs between January 2009 and June 2012. Medical records and imaging were analyzed to identify the fracture morphology, pre-existing diseases, revision surgeries and treatment failures (conversion to another treatment). The patients were asked about subsequent surgeries by phone. A functional outcome questionnaire was mailed to participating patients.ResultsFollow-up data were available for 423 of 521 patients (312 females, 111 males). The mean age at the time of primary treatment was 68.3 years; mean follow-up was 24.6 ± 12.3 months. The overall rate of mandatory re-operations was 15.6%, including a failure rate of 8.3%; another 7.6% of patients had additional arthroscopic surgeries. Treatment with anatomic hemi-prostheses was associated with the highest re-operation rates, and lowest outcomes. Involvement of the medial calcar region, complex fracture morphologies, cigarette smoking and alcohol-abuse were predictors for subsequent surgery. Patients without subsequent surgery had significantly higher functional outcome scores than patients with additional surgery.ConclusionsWith the use of a standardized treatment algorithm no treatment modality was at significantly higher risk for having additional surgery. Complex fracture types, involvement of the medial calcar, cigarette-smoking and alcohol-abuse were associated with subsequent surgeries.Level of evidenceLevel IV case series.

Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures

“…Despite identification of several potential risk factors for fixation failure and regardless of the continuous development of implants with improved plate and screw design, the complication rate associated with locked plating of PHF is still high [ 2 , 7 , 8 ]. Especially in fragility fractures of the older population, loss of reduction with secondary articular screw perforation and varus displacement with loss of fixation can still be observed in up to 20% of cases within the first 12 months postoperatively [ 9 , 10 ].…”

Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes

“…Plate fixation for comminuted PHF poses a surgical challenge [ 5 ]. Even when anatomical reduction of the deformity with reconstruction of the humeral head is initially accomplished, a high risk for early and late complications can compromise the final outcome [ 23 , 24 ]. To overcome the mechanical limitations of plate fixation in the setting of poor bone biology and complex fractures, compensating for lack of structural integrity is mandatory.…”

“…In the treatment algorithm proposed by Katthagen et al, it was suggested that no attempt at locking plate reconstruction need be undertaken in the context of severe comminuted fractures in patients older than age 60 years [ 23 ]. The authors favor a shoulder hemiprosthesis in such patients.…”

Corrective Osteosynthesis in Failed Proximal Humeral Fractures

“…Based on results of endoprosthetics following fractures of the proximal humerus, the correction osteosynthesis indeed represents a real therapeutic alternative in patients that are below the age of 60, a good bone mass and with relative functional requirements. Im eigenen Patientengut wurden von 2009 bis 2012 423 von 566 Patienten (75 %) mit einem durchschnittlichen Alter von 68,3 ± 13,9 Jahren telefonisch kontaktiert und nach erneuter/weiterer Behandlung nach proximaler Humerusfraktur befragt [5].…”

“…Bei einem Follow-up von 23,4 Monaten wurde bei 94 Fällen (22,2 %) eine erneute/erstmalige operative Behandlung durchgeführt [5]. Bei 39 Patienten (9,2 %) zeigte sich ein Therapieversagen im Sinne von ▪ sekundärer OP nach konservativer Therapie, ▪ Verfahrenswechsel, ▪ sekundärem Gelenkersatz.…”