Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate.
Fracture
Humerus
Nail
Necrosis
Plate
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
21
02
2021
accepted:
10
09
2021
pubmed:
24
9
2021
medline:
12
11
2021
entrez:
23
9
2021
Statut:
ppublish
Résumé
The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
Identifiants
pubmed: 34554308
doi: 10.1007/s00264-021-05217-9
pii: 10.1007/s00264-021-05217-9
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2917-2926Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
Références
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697. https://doi.org/10.1016/j.injury.2006.04.130
doi: 10.1016/j.injury.2006.04.130
pubmed: 16814787
Maravic M, Briot K, Roux C (2014) Burden of proximal humerus fractures in the French National Hospital Database. Orthop Traumatol Surg Res 100:931–934. https://doi.org/10.1016/j.otsr.2014.09.017
doi: 10.1016/j.otsr.2014.09.017
pubmed: 25453923
Burkhart KJ, Dietz SO, Bastian L et al (2013) The treatment of proximal humeral fracture in adults. Dtsch Arzteblatt Int 110:591–597. https://doi.org/10.3238/arztebl.2013.0591
doi: 10.3238/arztebl.2013.0591
Roux A, Decroocq L, El Batti S et al (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res OTSR 98:715–719. https://doi.org/10.1016/j.otsr.2012.05.013
doi: 10.1016/j.otsr.2012.05.013
pubmed: 23000039
Neer C (1970) Displaced proximal humeral fractures: PART II. Treatment of three-part and four-part displacement. J Bone Jt Surg 52:1090–1103
doi: 10.2106/00004623-197052060-00002
Gadea F, Favard L, Boileau P et al (2016) Fixation of 4-part fractures of the proximal humerus: can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases. Orthop Traumatol Surg Res OTSR 102:963–970. https://doi.org/10.1016/j.otsr.2016.09.015
doi: 10.1016/j.otsr.2016.09.015
pubmed: 27818186
Rangan A, Handoll H, Brealey S et al (2015) Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 313:1037–1047. https://doi.org/10.1001/jama.2015.1629
doi: 10.1001/jama.2015.1629
pubmed: 25756440
Boileau P, Alta TD, Decroocq L et al (2019) Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities? J Shoulder Elbow Surg 28:437–444. https://doi.org/10.1016/j.jse.2018.08.025
doi: 10.1016/j.jse.2018.08.025
pubmed: 30573429
Schliemann B, Siemoneit J, Theisen C et al (2012) Complex fractures of the proximal humerus in the elderly–outcome and complications after locking plate fixation. Musculoskelet Surg 96(Suppl 1):S3-11. https://doi.org/10.1007/s12306-012-0181-8
doi: 10.1007/s12306-012-0181-8
pubmed: 22287062
Hao TD, Huat AWT (2017) Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design. J Orthop Surg 25:2309499017713934. https://doi.org/10.1177/2309499017713934
doi: 10.1177/2309499017713934
Kanchanatawan W, Suppauksorn S, Chobpenthai T et al (2017) Surgical technique for open reduction–internal fixation of an unstable displaced 3-part proximal humeral fracture using a proximal humeral locking plate. Arthrosc Tech 6:e807–e813. https://doi.org/10.1016/j.eats.2017.02.008
doi: 10.1016/j.eats.2017.02.008
pubmed: 28706835
pmcid: 5495907
Harris JD, Brand JC, Cote MP et al (2017) Research pearls: the significance of statistics and perils of pooling. Part 1: clinical versus statistical significance. Arthroscopy 33:1102–1112. https://doi.org/10.1016/j.arthro.2017.01.053
doi: 10.1016/j.arthro.2017.01.053
pubmed: 28454999
Bockmann B, Buecking B, Franz D et al (2015) Mid-term results of a less-invasive locking plate fixation method for proximal humeral fractures: a prospective observational study. BMC Musculoskelet Disord 16:160. https://doi.org/10.1186/s12891-015-0618-y
doi: 10.1186/s12891-015-0618-y
pubmed: 26141352
pmcid: 4491200
Gracitelli MEC, Malavolta EA, Assunção JH et al (2016) Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial. J Shoulder Elbow Surg 25:695–703. https://doi.org/10.1016/j.jse.2016.02.003
doi: 10.1016/j.jse.2016.02.003
pubmed: 27085296
Konrad G, Hirschmüller A, Audige L et al (2012) Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures–results of an international multicentre study. Int Orthop 36:1051–1058. https://doi.org/10.1007/s00264-011-1410-8
doi: 10.1007/s00264-011-1410-8
pubmed: 22127383
Lange M, Brandt D, Mittlmeier T, Gradl G (2016) Proximal humeral fractures: non-operative treatment versus intramedullary nailing in 2-, 3- and 4-part fractures. Injury 47(Suppl 7):S14–S19. https://doi.org/10.1016/S0020-1383(16)30848-8
doi: 10.1016/S0020-1383(16)30848-8
pubmed: 28040071
Thomazeau H, Richou J, Benkalfalte T et al (2012) Is it worth fixing proximal humeral fractures at increased vascular risk? Orthop Traumatol Surg Res OTSR 98:383–389. https://doi.org/10.1016/j.otsr.2012.01.008
doi: 10.1016/j.otsr.2012.01.008
pubmed: 22609176
Cuny C, Goetzmann T, Dedome D et al (2015) Antegrade nailing evolution for proximal humeral fractures, the Telegraph IV(®): a study of 67 patients. Eur J Orthop Surg Traumatol Orthop Traumatol 25:287–295. https://doi.org/10.1007/s00590-014-1493-1
doi: 10.1007/s00590-014-1493-1
Schliemann B, Hartensuer R, Koch T et al (2015) Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate. J Shoulder Elbow Surg 24:1282–1288. https://doi.org/10.1016/j.jse.2014.12.028
doi: 10.1016/j.jse.2014.12.028
pubmed: 25704209
Aguado HJ, Mingo J, Torres M et al (2016) Minimally invasive polyaxial locking plate osteosynthesis for 3–4 part proximal humeral fractures: our institutional experience. Injury 47(Suppl 3):S22–S28. https://doi.org/10.1016/S0020-1383(16)30602-7
doi: 10.1016/S0020-1383(16)30602-7
pubmed: 27692102
Cuny C, Baumann C, Mayer J et al (2013) AST classification of proximal humeral fractures: introduction and interobserver reliability assessment. Eur J Orthop Surg Traumatol 23:35–40. https://doi.org/10.1007/s00590-011-0916-5
doi: 10.1007/s00590-011-0916-5
pubmed: 23412405
Wanzl M, Foehr P, Schreiber U et al (2016) Biomechanical testing to evaluate the cut-through resistance of intramedullary nails for the proximal humerus. Injury 47(Suppl 7):S20–S24. https://doi.org/10.1016/S0020-1383(16)30849-X
doi: 10.1016/S0020-1383(16)30849-X
pubmed: 28040072
Boileau P, d’Ollonne T, Bessière C et al (2019) Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing. J Shoulder Elbow Surg 28:276–287. https://doi.org/10.1016/j.jse.2018.07.010
doi: 10.1016/j.jse.2018.07.010
pubmed: 30429058
Muccioli C, Chelli M, Caudal A et al (2020) Rotator cuff integrity and shoulder function after intra-medullary humerus nailing. Orthop Traumatol Surg Res OTSR 106:17–23. https://doi.org/10.1016/j.otsr.2019.11.004
doi: 10.1016/j.otsr.2019.11.004
pubmed: 31882328
Ortmaier R, Mattiassich G, Pumberger M et al (2015) Comparison between reverse shoulder arthroplasty and Humerusblock in three- and four-part proximal humerus fractures in elderly patients. Int Orthop 39:335–342. https://doi.org/10.1007/s00264-014-2433-8
doi: 10.1007/s00264-014-2433-8
pubmed: 25038969
Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 22:542–549. https://doi.org/10.1016/j.jse.2012.06.008
doi: 10.1016/j.jse.2012.06.008
pubmed: 22959524
Baron JA, Barrett JA, Karagas MR (1996) The epidemiology of peripheral fractures. Bone 18:S209–S213. https://doi.org/10.1016/8756-3282(95)00504-8
doi: 10.1016/8756-3282(95)00504-8
Neer C (1987) Displaced proximal hurneral fractures: Part I. Classification and evaluation Clin Orthop 223:3–10
Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194:S3-11. https://doi.org/10.1016/j.ajog.2005.08.047
doi: 10.1016/j.ajog.2005.08.047
pubmed: 16448873
Südkamp N, Bayer J, Hepp P et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate: results of a prospective, multicenter, observational study. J Bone Jt Surg 91:1320–1328. https://doi.org/10.2106/JBJS.H.00006
doi: 10.2106/JBJS.H.00006
Du S, Ye J, Chen H et al (2017) Interventions for treating 3- or 4-part proximal humeral fractures in elderly patient: a network meta-analysis of randomized controlled trials. Int J Surg Lond Engl 48:240–246. https://doi.org/10.1016/j.ijsu.2017.09.002
doi: 10.1016/j.ijsu.2017.09.002
Grubhofer F, Wieser K, Meyer DC et al (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25:1690–1698. https://doi.org/10.1016/j.jse.2016.02.024
doi: 10.1016/j.jse.2016.02.024
pubmed: 27090009
Roberson TA, Granade CM, Hunt Q et al (2017) Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg 26:1017–1022. https://doi.org/10.1016/j.jse.2016.10.013
doi: 10.1016/j.jse.2016.10.013
pubmed: 28139385
Ohl X, Bonnevialle N, Gallinet D et al (2018) How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 27:2139–2144. https://doi.org/10.1016/j.jse.2018.05.030
doi: 10.1016/j.jse.2018.05.030
pubmed: 30082121