Proximal Humeral Fracture; Predictors of Functional and Radiologic Outcome
-
Mosayeb Soleymani
,
Mohammad hossein Nabian
,
Asma Mafhoumi
,
Behnam Panjavi
,
Leila Oriadi Zanjani
,
Saeed Reza Mehrpour
Abstract
Background: Despite the high prevalence of proximal humeral fracture, one of the most prevalent osteoporotic fractures, its treatment has always been challenging. Here we are going to determine the factors that affect the outcomes of such fractures. Methods: The present retrograde cohort study was conducted in a tertiary trauma center during 2015-2020. The Neer classification was used to classify fracture severity. Patients’ functional status was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley Score (CMS). Patients were selected thorough purposive sampling method.
Results: The study participants included 70 patients with a mean age of 50.47 ± 16.73 years. The 3 treatment options of open reduction and internal fixation (ORIF) (39 cases; 52%), hemiarthroplasty (3 cases; 4%), and conservative treatment (33 patients; 44%) were considered. Malunion was the most prevalent complication in the study population (9 cases; 12%). The mean DASH score of the participants was 29.91 ± 20.43. The mean DASH score in patients of over 65 years of age was higher than in those under 65 years (36.97 vs. 28.14; P = 0.136). The score in patients underwent surgery (ORIF and hemiarthroplasty) showed a significant difference compared to the patients who were treated non-surgically (P = 0.050). The mean CMS of participants was 64.09 ± 22.71. The mean age of patients classified as “poor” was significantly higher than the “excellent” group (P = 0.041). The mean visual analogue scale (VAS) score of the participants was 2.80 ± 2.49. The VAS score was significantly higher in patients with more severe fracture based on the Neer classification (P = 0.050).
Conclusion: The present study results showed the significant effect of age, fracture severity, and underlying disease on the proximal humeral fracture outcome. A longer follow-up period was observed in patients who had better functional outcomes. However, more studies with larger sample size are required to evaluate proximal humeral fracture outcomes in order to help us to improve outcomes and reduce complications.
2. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87-92. doi: 10.1097/01.blo.0000194672.79634.78. [PubMed: 16394745].
3. Konrad GG, Mehlhorn A, Kuhle J, Strohm PC, Sudkamp NP. Proximal humerus fractures - current treatment options. Acta Chir Orthop Traumatol Cech. 2008;75(6):413-21. [PubMed: 19149997].
4. Calvo E, Morcillo D, Foruria AM, Redondo-Santamaria E, Osorio-Picorne F, Caeiro JR. Nondisplaced proximal humeral fractures: High incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg. 2011;20(5):795-801. doi: 10.1016/j.jse.2010.09.008. [PubMed: 21195633].
5. Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: Report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12(1):24-35. doi: 10.1359/jbmr.1997.12.1.24. [PubMed: 9240722].
6. Schumaier A, Grawe B. Proximal humerus fractures: Evaluation and management in the elderly patient. Geriatr Orthop Surg Rehabil. 2018;9:2151458517750516. doi: 10.1177/2151458517750516. [PubMed: 29399372]. [PubMed Central: PMC5788098].
7. Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79(2):295-300. doi: 10.1302/0301-620x.79b2.6958. [PubMed: 9119860].
8. Zyto K, Ahrengart L, Sperber A, Tornkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br. 1997;79(3):412-7. doi: 10.1302/0301-620x.79b3.7419. [PubMed: 9180319].
9. Ko JY, Yamamoto R. Surgical treatment of complex fracture of the proximal humerus. Clin Orthop Relat Res. 1996;
(327):225-37.doi:10.1097/00003086-199606000-00028.
[PubMed: 8641068].
10. Kralinger F, Irenberger A, Lechner C, Wambacher M, Golser K, Sperner G. Comparison of open versus percutaneous treatment for humeral head fracture. Unfallchirurg. 2006;109(5):406-10. [In German]. doi: 10.1007/s00113-005-1053-6. [PubMed: 16705429].
11. Rath E, Alkrinawi N, Levy O, Debbi R, Amar E, Atoun E. Minimally displaced fractures of the greater tuberosity: Outcome of non-operative treatment. J Shoulder Elbow Surg. 2013;22(10):e8-e11. doi: 10.1016/j.jse.2013.01.033. [PubMed: 23639834].
12. Handa R, Ali KA, Maalouf G. Osteoporosis in developing countries. Best Pract Res Clin Rheumatol. 2008;22(4):693-708. doi: 10.1016/j.berh.2008.04.002. [PubMed: 18783745].
13. Maalouf G, Gannage-Yared MH, Ezzedine J, Larijani B, Badawi S, Rached A, et al. Middle East and North Africa consensus on osteoporosis. J Musculoskelet Neuronal Interact. 2007;7(2): 131-43. [PubMed: 17627082].
14. Al-Nuaim AR, Kremli M, Al-Nuaim M, Sandkgi S. Incidence of proximal femur fracture in an urbanized community in Saudi
Arabia. Calcif Tissue Int. 1995;56(6):536-8. doi:
10.1007/BF00298585. [PubMed: 7648482].
15. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-46. doi: 10.1016/S0140-6736(20)30367-6. [PubMed: 32738937]. [PubMed Central: PMC7392084].
16. Kennedy CA. The DASH and Quick DASH Outcome Measure User's Manual. Toronto, Canada: Institute for Work and Health; 2011.
17. Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S174-S188. doi: 10.1002/acr.20630. [PubMed: 22588743].
18. Thyagarajan DS, Haridas SJ, Jones D, Dent C, Evans R, Williams R. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures. Int J Shoulder Surg. 2009;3(3):57-62. doi: 10.4103/0973-6042.59971. [PubMed: 20671866]. [PubMed Central: PMC2907001].
19. Grawe B, Le T, Lee T, Wyrick J. Open reduction and internal fixation (ORIF) of complex 3- and 4-part fractures of the proximal humerus: Does age really matter? Geriatr Orthop Surg Rehabil. 2012;3(1):27-32. doi: 10.1177/2151458511430662. [PubMed: 23569694]. [PubMed Central: PMC3617900].
20. Kruithof RN, Formijne Jonkers HA, van der Ven DJC, van Olden GDJ, Timmers TK. Functional and quality of life outcome after
non-operatively managed proximal humeral fractures.
J Orthop Traumatol. 2017;18(4):423-30. doi: 10.1007/s10195-017-0468-
5. [PubMed: 28831589]. [PubMed Central: PMC5685986].
21. Hinds RM, Garner MR, Tran WH, Lazaro LE, Dines JS, Lorich DG. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation. J Shoulder Elbow Surg. 2015;24(6):889-96. doi: 10.1016/j.jse.2014.10.019. [PubMed: 25483905].
22. Guity MR, Yousef Sibdari S, Espandar R. Functional results after primary shoulder hemiarthroplasty for proximal humerus bone fractures. Tehran Univ Med J. 2010;68(4):231-7. [In Persian].
23. Olerud P, Ahrengart L, Söderqvist A, Saving J, Tidermark J. Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg. 2010;19(6):814-22. doi: 10.1016/j.jse.2009.11.046. [PubMed: 20303288].
| Files | ||
| Issue | Vol 9, No 2 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i2.12826 | |
| Keywords | ||
| Humerus Proximal Humeral Fracture Arthroplasty | ||
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