Open reduction and internal fixation of displaced head-split type humeral fractures and role of the rotator-interval approach.
avascular necrosis
constant-score
head-split
humerus fracture
osteosynthesis
Journal
Shoulder & elbow
ISSN: 1758-5732
Titre abrégé: Shoulder Elbow
Pays: United States
ID NLM: 101506589
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
07
07
2021
revised:
11
11
2021
accepted:
15
11
2021
medline:
11
4
2023
entrez:
10
4
2023
pubmed:
11
4
2023
Statut:
ppublish
Résumé
Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome. 37 patients (mean age: 59 ± 16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores. In group DP, "anatomic" reduction was achieved in 9 cases (45%), "acceptable" in 5 cases (25%), and "malreduced" in 6 cases (30%). In group RI, "anatomic" reduction was seen in 12 cases (71%), "acceptable" in 5 cases (29%), and "malreduced" in none (p = 0.04). In the DP group, the CS was 60.2 ± 16.2 and the %CS was 63.9 ± 22.3, while in the RI group, the CS was 74.5 ± 17.4 and the %CS was 79.1 ± 24.1 (p = 0.07, p = 0.08). DASH score was 22.8 ± 19.5 in DP compared to RI: 25.2 ± 20.6 (p = 0.53). The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly. Retrospective, level III.
Sections du résumé
Background
UNASSIGNED
Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome.
Methods
UNASSIGNED
37 patients (mean age: 59 ± 16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores.
Results
UNASSIGNED
In group DP, "anatomic" reduction was achieved in 9 cases (45%), "acceptable" in 5 cases (25%), and "malreduced" in 6 cases (30%). In group RI, "anatomic" reduction was seen in 12 cases (71%), "acceptable" in 5 cases (29%), and "malreduced" in none (p = 0.04). In the DP group, the CS was 60.2 ± 16.2 and the %CS was 63.9 ± 22.3, while in the RI group, the CS was 74.5 ± 17.4 and the %CS was 79.1 ± 24.1 (p = 0.07, p = 0.08). DASH score was 22.8 ± 19.5 in DP compared to RI: 25.2 ± 20.6 (p = 0.53).
Conclusions
UNASSIGNED
The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly.
Type of study and level of proof
UNASSIGNED
Retrospective, level III.
Identifiants
pubmed: 37035612
doi: 10.1177/17585732211065449
pii: 10.1177_17585732211065449
pmc: PMC10078818
doi:
Types de publication
Journal Article
Langues
eng
Pagination
159-165Informations de copyright
© The Author(s) 2021.
Déclaration de conflit d'intérêts
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
J Bone Joint Surg Am. 2016 Nov 2;98(21):1777-1785
pubmed: 27807109
Unfallchirurg. 2013 Aug;116(8):684-90
pubmed: 23934531
Injury. 2012 Feb;43(2):153-8
pubmed: 21570073
Arch Orthop Trauma Surg. 2017 Dec;137(12):1685-1692
pubmed: 28929389
J Shoulder Elbow Surg. 2013 Jan;22(1):e8-14
pubmed: 22818893
Injury. 2015 Oct;46 Suppl 4:S58-62
pubmed: 26542867
HSS J. 2018 Feb;14(1):34-40
pubmed: 29398992
J Shoulder Elbow Surg. 2008 May-Jun;17(3):399-409
pubmed: 18282724
J Bone Joint Surg Am. 2009 Jul;91(7):1689-97
pubmed: 19571092
J Bone Joint Surg Br. 2004 Apr;86(3):413-25
pubmed: 15125131
J Bone Joint Surg Am. 2010 Apr;92(4):943-8
pubmed: 20360519
J Shoulder Elbow Surg. 2013 Apr;22(4):542-9
pubmed: 22959524
Clin Orthop Relat Res. 2006 Jan;442:87-92
pubmed: 16394745
J Bone Joint Surg Am. 1970 Sep;52(6):1077-89
pubmed: 5455339
Arthritis Care Res (Hoboken). 2012 Mar;64(3):407-14
pubmed: 22162357
J Shoulder Elbow Surg. 2014 Aug;23(8):1223-31
pubmed: 24548438
J Orthop Trauma. 2007 Nov-Dec;21(10):676-81
pubmed: 17986883
J Bone Joint Surg Am. 2007 Oct;89 Suppl 3:44-58
pubmed: 17908870
J Bone Joint Surg Am. 2009 Jun;91(6):1320-8
pubmed: 19487508
J Bone Joint Surg Br. 1993 Jan;75(1):132-6
pubmed: 8421010
BMC Musculoskelet Disord. 2016 Oct 28;17(1):448
pubmed: 27793135