Complex fractures of the proximal humerus in the elderly—outcome and complications after locking plate fixation

Schliemann, Benedikt; Siemoneit, J; Theisen, Christina; Kösters, Clemens; Weimann, André; Raschke, Michael J.

doi:10.1007/s12306-012-0181-8

Cited by 102 publications

(65 citation statements)

References 26 publications

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“…Mechanical complications (11%) was the most common surgical cause of readmission after ORIF which is consistent with reports indicating that even with the use of periarticular locked plating, screw cutout after ORIF is still one of the most common causes of surgical failure [24,35]. Although shoulder arthroplasty components have been revised and advancements in techniques have shown improved clinical outcomes [32], our results indicate that instability after hemiarthroplasty or reverse total shoulder arthroplasty remains a concern.…”

Section: Discussionsupporting

confidence: 86%

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Zhang

Schairer

Feeley

2014

Clinical Orthopaedics &Amp; Related Research

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Background With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission. Questions/purposes We measured (1) the frequency of unplanned hospital readmissions after surgical treatment of proximal humerus fractures, (2) the medical and surgical causes of readmission, and (3) the risk factors associated with unplanned readmissions. Methods The State Inpatient Database from seven different states was used to identify patients who underwent treatment for a proximal humerus fracture with open reduction and internal fixation (ORIF), hemiarthroplasty of the humeral head, or reverse total shoulder arthroplasty from 2005 through 2010. The database was used to measure the 30-day and 90-day readmission rates and identify causes and risk factors for readmission. Multivariate modeling and a Cox proportional hazards model were used for statistical analysis. Results A total of 27,017 patients were included with an overall 90-day readmission rate of 14% (15% for treatment with ORIF, 15% for reverse total shoulder arthroplasty, and 13% for hemiarthroplasty). The majority of readmissions were associated with medical diagnoses (75%), but treatment with ORIF was associated with the most readmissions from surgical complications, (29%) followed by reverse total shoulder arthroplasty (20%) and hemiarthroplasty (16%) (p \ 0.001). Risk of readmission was greater for patients who were female, African American, discharged to a nursing facility, or had Medicaid insurance. Conclusions As the majority of unplanned hospital readmissions were associated with medical diagnoses, it is important to consider patient medical comorbidities before surgical treatment of proximal humerus fractures and during the postoperative care phase. Level of Evidence Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 86%

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Zhang

Schairer

Feeley

2014

Clinical Orthopaedics &Amp; Related Research

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“…Accounting for up to 22%, screw cutout is known to be another common complication following surgical treatment of proximal humeral fractures [21]. In our study, we did observe one screw cut-through, but no screw cutout, backing out, or any other obvious signs of implant failure.…”

Section: Discussionsupporting

confidence: 46%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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Purpose Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this Bproximal anchoring point^(PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Methods Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Results Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20°abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). Conclusions The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the Bproximal anchoring point's^rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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“…Despite the more complex nature of the metadiaphyseal fractures treated in our case series, DASH outcomes were at least equivalent to those seen for ORIF of isolated proximal humerus fractures. [3][4][5][6][7] Further, Hunsaker et al 8 report the mean DASH score of the general population at 10.1 (SD 14.7), and the Institute for Work & Health reports the minimal clinically detectable change (MDC95) in the DASH as 8 to 17 points. As such, the average DASH score of 21 (median 12) observed in our sample could be considered clinically indistinguishable from scores in the general population.…”

Section: Discussionmentioning

confidence: 99%

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

James

Farrell

Evans

et al. 2014

Geriatr Orthop Surg Rehabil

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Purpose: A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications. Methods: From 2008 to 2012, 21 such operations were performed; 18 were considered ''fragility'' fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation (ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative. Results: The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean ¼ 21, standard deviation ¼ 20, n ¼ 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15). Conclusion: Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.

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Complex fractures of the proximal humerus in the elderly—outcome and complications after locking plate fixation

Cited by 102 publications

References 26 publications

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

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