Outcomes After Hemiarthroplasty for Proximal Humerus Fracture Are Significantly Affected by Hand Dominance

LeBlanc, Justin; MacDermid, Joy C.; Faber, Kenneth J.; Drosdowech, Darren S.; Athwal, George S.

doi:10.1097/bot.0000000000000294

Cited by 12 publications

(13 citation statements)

References 26 publications

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“…These data coincide with the observations of Diklić et al [10] whose research showed that the dominant hand was affected in 62% of 29 patients, as well as with other literature data where a fracture of the proximal humerus frequently occurs in the dominant hand [9,14]. LeBlanc et al [15] in their work wondered whether there was a difference in the treatment outcome of fractures of the proximal humeral treated with hemiarthroplasty in relation to whether the dominant or non-dominant arm was affected. Their study included 61 patients with a multifragmented fracture of the proximal humerus.…”

Section: Discussionsupporting

confidence: 90%

“…The maximum score for the presence and intensity of pain is 15 points, 20 points for the activity level, 40 points for the range of motion and 25 points for the strength of abduction. The difference in the Constant shoulder score between the healthy and operated limb represents a Constant's result which can be excellent (<11), good (12)(13)(14)(15)(16)(17)(18)(19)(20), fair (21-30) and poor (> 31).…”

Section: Methodsmentioning

confidence: 99%

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The use of partial prosthesis in shoulder surgery

et al. 2016

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Introduction. Indications for the use of partial shoulder prosthesis are dislocated four-part fractures and multi-part and four-part fractures-dislocations, impressive fractures of the humeral head (including involvement of more than 40% of the articular surface) and "head splitting" fractures of humerus. The aim of this study was to present the results of the application of partial shoulder prosthesis at the Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina in Novi Sad and identify risk groups among the participants. Material and Methods. The study, which was retrospective, included 22 patients who had undergone the partial shoulder arthroplasty in the period from 2005 to 2015 at the Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The functional results were evaluated on the basis of the Constant Shoulder Score. Results. The study sample consisted of 15 women and 7 men, whose mean age was 64.9 ± 9.1 years. The average time from the injury to surgery was 13.3 days. According to the Constant scoring scale, the result was excellent in 6 (27%) patients, good in 3 (14%), fair in 7 (32%), and poor in 6 (27%) participants. 75% of participants said they were satisfied with the results of the operation. Conclusion. Partial shoulder prosthesis gives good functional results and allows resumption of activities of daily living. Better results were obtained within the subjective segments (pain, daily activities, vitality), which points out a greater subjective patient's satisfaction in relation to the measured functional outcome.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

The use of partial prosthesis in shoulder surgery

et al. 2016

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“…Brostrom et al 16 in 1992 stated that TSA performed in the DO extremity fared worse compared to the ND extremity without further data analysis. LeBlanc et al 17 found poorer outcomes in the dominant extremity when a hemiarthroplasty was performed for proximal humerus fractures. Conversely, Cvetanovich et al 19 found that dominant shoulders attain increased FE compared to their nondominant cohort when an anatomic TSA was performed.…”

Section: Discussionmentioning

confidence: 99%

“…15 Additionally, previous studies analyzing shoulder arthroplasty surgery have commented on hand dominance and its association with inferior clinical outcomes. 16,17 To our knowledge, no studies have evaluated the effects of hand dominance on patient outcomes and postoperative range of motion (ROM) after rTSA. We hypothesize that surgery for the dominant (DO) or nondominant (ND) extremity will result in equivalent changes in patient outcomes and shoulder ROM.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hand Dominance on Range of Motion and Outcomes Following Reverse Total Shoulder Arthroplasty

Ding

Wong

Lee

et al. 2017

Journal of Shoulder and Elbow Arthroplasty

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Introduction: Upper extremity hand dominance greatly impacts the functional ability to perform activities of daily living. No studies have evaluated the effects of hand dominance on patient outcomes and postoperative range of motion (ROM) after reverse total shoulder arthroplasty (rTSA). Methods: From 2009 to 2014, functional data and patient-reported outcomes were prospectively collected from patients who underwent rTSA at a single institution. Baseline characteristics were assessed and patients were stratified based on whether surgery was performed on the dominant extremity. A repeated-measures ANOVA was performed to determine differences in outcomes between cohorts. Results: Eighty-seven rTSAs were performed on the patients' dominant (DO) shoulder and 53 on the nondominant (ND) shoulder. Both groups had similar age, hospital length of stay, body mass index, and Charlson Comorbidity Index. Prior to surgery, the ND group had significantly lower active forward elevation (FE) (68 ) compared to the DO group (87 , P ¼.04). Both groups had significant increases in FE ROM at both 1 and 2 years compared to preoperatively (P <.001). At 2 years, both groups had equivalent FE but the ND group gained significantly more than the DO group (67 vs 43 ) (P ¼.005), mainly due to the preoperative FE. This finding was similar for shoulder abduction. Both groups had significant improvements in American Shoulder and Elbow Surgeons scores (P <.001) and Visual Analog Scale pain scores (P <.001) at 1 and 2 years postoperatively, with no significant differences between the groups. Conclusion: rTSA is a reliable operation which consistently improves patient ROM, function, and pain scores at 2 years. However, baseline FE is higher in patients undergoing surgery for the DO extremity, which indicates an inability to tolerate as much functional deficiency compared to the ND extremity.

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“…Further, other factors that are associated with outcomes after HA include age, hand dominance, rotator cuff status, and implant type. [25][26][27][28][29] Because proximal humerus fracture-dislocations and head-split fractures have a notoriously high rate of osteonecrosis and hardware complications, 11,13,30 they often present a treatment dilemma for surgeons, especially in young patients where preservation of native anatomy and avoidance of arthroplasty is preferable. This study sought to evaluate the clinical outcomes and health-related quality of life scores when treating patients with these injuries.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation Versus Hemiarthroplasty in the Management of Complex Articular Fractures and Fracture-dislocations of the Proximal Humerus

Thorsness

Shields

Chen

et al. 2017

Journal of Shoulder and Elbow Arthroplasty

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Background: This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of proximal humerus fracture-dislocations and complex articular humeral head fractures. Methods: The records of consecutive patients with Neer 3-and 4-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant-Murley scores, Disability of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder (ASES), and Short Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results: Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 AE 15 vs 54 AE 19; P ¼.007), DASH score (13 AE 17 vs 29 AE 18; P ¼.006), ASES score (87 AE 13 vs 66 AE 22; P ¼.003), and SF-36 physical composite score (PCS) (50 AE 11 vs 40 AE 11; P ¼.02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion: Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.

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Outcomes After Hemiarthroplasty for Proximal Humerus Fracture Are Significantly Affected by Hand Dominance

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 12 publications

References 26 publications

The use of partial prosthesis in shoulder surgery

The use of partial prosthesis in shoulder surgery

Effect of Hand Dominance on Range of Motion and Outcomes Following Reverse Total Shoulder Arthroplasty

Open Reduction and Internal Fixation Versus Hemiarthroplasty in the Management of Complex Articular Fractures and Fracture-dislocations of the Proximal Humerus

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