Abstract
Purpose
Avascular necrosis (AVN) of the humeral head is a devastating complication of proximal humeral fracture (PHF) that often results in long-term morbidity for the patient. Rates of AVN depend on the number of fracture fragments and are highly variable. The literature suggests that timely stable and anatomic reduction may decrease the rate at which AVN develops after PHF. To our knowledge, there is no literature published investigating a temporal relationship between the timing of PHF fixation and rates of AVN.
Methods
Operative records of one orthopedic trauma surgeon were used to identify patients that underwent open reduction internal fixation for PHF at our institution between 2007 and 2012. Radiographs at presentation were reviewed and used to classify the fractures into two, three or four parts. Date and time of the initial radiograph were recorded as were the date and time of available intra-operative fluoroscopic images. The time from presentation radiograph to operative fixation was calculated (hours). Available follow-up plain films were then reviewed and evaluated for the presence or absence of humeral head AVN.
Results
Time to surgery (less than or greater than 72 h) and patient age did not correlate with development of AVN after PHF (p > 0.26). Notably, the number of fracture fragments did influence the rate of AVN identified in patients with PHF (p = 0.002).
Conclusion
Early operative intervention does not appear to decrease the rate of development of avascular necrosis after PHF.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cadet E, Ahmad C (2012) Hemiarthroplasty for three- and four-part proximal humerus fractures. J Am Acad Orthop Surg 20(1):17–27
Schlegel TF, Hawkins RJ (1994) Displaced proximal humeral fractures: evaluation and treatment. J Am Acad Orthop Surg 2:54–66
Neer CS (1970) Displaced proximal humera fractures. II. Treatment of three-part and four-part displacement. J Bone Jt Surg Am 52(6):1090–1103
Carter M, Mikuls T, Nayak S, Fehringer E, Michaud K (2012) Impact of total shoulder arthroplasty on generic and shoulder-specific health-related quality-of-life measures: a systematic literature review and meta-analysis. J Bone Jt Surg Am. 94(17):e127
Besch L, Daniels-Wredenhagen M, Mueller M, Varoga D, Hilgert R-E, Seekamp A (2009) Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a long-term analysis of 34 cases. J Trauma 66(1):211–214
Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elb Surg. 7(6):586–590
Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg. 13(4):427–433
Harrison AK, Gruson KI, Zmistowski B, Keener J, Galatz L, Williams G et al. (2012) Intermediate outcomes following percutaneous fixation of proximal humeral fractures. J Bone Jt Surg Am 94-A(13):1223–1228
Wijgman A, Roolker W, Patt T, Raaymakers E, Marti R (2002) Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Jt Surg Am 84-S(11):1919–1925
Browner B, Jupiter J, Levine A, Trafton P, Krettek C (eds) (2008) Skeletal trauma: basic science, management and reconstruction, 4th edn. W.B. Saunders Company, Philadelphia
Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M (2012) The PHILOS plate for proximal humeral fractures—risk factors for complications at one year. J Trauma Acute Care Surg. 72(3):783–792
Soliman OA, Koptan WMT (2013) Four-part fracture dislocations of the proximal humerus in young adults: results of fixation. Int J Care Inj 44(4):442–7
Cushner MA, Friedman RJ (1997) Osteonecrosis of the humeral head. J Am Acad Orthop Surg 5(6):339–346
Mouradian WH (1986) Displaced proximal humerus fractures: seven years’ experience with a modified Zickel supracondylar device. Clin Orthop Relat Res 212:209–218
Tauber M, Karpik S, Matis N, Schwartz M, Resch H (2007) Shoulder arthroplasty for traumatic avascular necrosis. Clin Orthop Relat Res 465:208–214
Grose AW, Gardner MJ, Sussmann PS, Helfet DL, Lorich DG (2008) The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip. J Bone Joint Surg Br 90(10):1298–1303
Ricci WM, Gallagher B, Brandt A, Schwappach J, Tucker M, Leighton R (2009) Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study. J Bone Joint Surg Am 91(9):2067–2072
Lee CK, Hansen HR (1981) Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures. J Trauma 21(9):788–791
Greiner S, Kaab M, Haas N, Bail H (2009) Humeral head necrosis rate at mid-term follow-up after open reduction and angular stable plate fixation for proximal humeral fractures. Inj Int J Care Inj. 40:186–191
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No author has declared conflict of interest related to the enclosed manuscript.
Rights and permissions
About this article
Cite this article
Archer, L.A., Furey, A. Rate of avascular necrosis and time to surgery in proximal humerus fractures. Musculoskelet Surg 100, 213–216 (2016). https://doi.org/10.1007/s12306-016-0425-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-016-0425-0