Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 07 2023
01 07 2023
Historique:
accepted:
16
02
2023
medline:
16
6
2023
pubmed:
19
4
2023
entrez:
19
04
2023
Statut:
ppublish
Résumé
To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively. Retrospective multicenter analysis. Five level-one trauma centers. Two hundred ten patients (152 F; 58 M), average age 64, with 112 left- and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C). All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with ≥80% anterior humeral translation were compared with those with <80% anterior translation, including those with no or posterior translation. The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion. Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery ( P = 0.012). In addition, of those with anterior translation, having ≥80% anterior translation compared with <80% was also associated with surgery ( P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 ( P = 0.0001). In a multicenter series of proximal humerus fractures, anterior translation of >80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 37074809
doi: 10.1097/BOT.0000000000002585
pii: 00005131-202307000-00010
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
366-369Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72:365–371.
Okike K, Lee OC, Makanji H, et al. Factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly. Injury. 2013;44:448–455.
von Keudell A, Vrahas MS, Weaver MJ. Surgical versus nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. J Orthop Trauma. 2016;30:e143.
Krieg JC. Surgical and nonsurgical treatment produced similar outcomes for proximal humeral fractures. J Bone Jt Surg Am. 2015;97:1890.
Iyengar JJ, Devcic Z, Sproul RC, et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma. 2011;25:612–617.
Bell JE, Leung BC, Spratt KF, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Jt Surg Am. 2011;93:121–131.
Capriccioso CE, Zuckerman JD, Egol KA. Initial varus displacement of proximal humerus fractures results in similar function but higher complication rates. Injury. 2016;47:909–913.
Chandrappa MH, Hajibandeh S. Postoperative outcomes of initial varus versus initial valgus proximal humerus fracture: a systematic review and meta-analysis. J Clin Orthop Trauma. 2017;8:14–20.
Davids S, Allen D, Desarno M, et al. Comparison of locked plating of varus displaced proximal humeral fractures with and without fibula allograft augmentation. J Orthop Trauma. 2020;34:186–192.
Broadbent MR, Will E, McQueen MM. Prediction of outcome after humeral diaphyseal fracture. Injury. 2010;41:572–577.
Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13:427–433.
Duparc F. Malunion of the proximal humerus. Orthop Traumatol Surg Res. 2013;99(1 suppl):S1–S11.
Pinkas D, Wanich TS, DePalma AA, et al. Management of malunion of the proximal humerus: current concepts. J Am Acad Orthop Surg. 2014;22:491–502.
Tapscott DC, Paxton ES. Decision-making and management of proximal humerus nonunions. Orthop Clin North Am. 2021;52:369–379.
Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(suppl 1):S1–S170.
Marongiu G, Leinardi L, Congia S, et al. Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems. J Orthop Traumatol. 2020;21:4.
Neer CS. Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987:3–10.
Neer CS. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg. 2002;11:389–400.
Kristiansen B, Andersen UL, Olsen CA, et al. The Neer classification of fractures of the proximal humerus. An assessment of interobserver variation. Skeletal Radiol. 1988;17:420–422.
Kruithof RN, Formijne Jonkers HA, van der Ven DJC, et al. Functional and quality of life outcome after non-operatively managed proximal humeral fractures. J Orthop Traumatol. 2017;18:423–430.
Park TS, Choi IY, Kim YH, et al. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis. 1997;56:171–176.
Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005;36:1185–1189.