Bone quality measured by the radiogrammetric parameter “cortical index” and reoperations after locking plate osteosynthesis in patients sustaining proximal humerus fractures

  • Pierre Hepp
  • Jan Theopold
  • Georg Osterhoff
  • Bastian Marquass
  • Christine Voigt
  • Christoph Josten
Osteoporotic Fracture Management

Abstract

Aim

To analyse the radiogrammetric parameter “cortical index” (CI) and its predictive value for proximal humerus fractures. Furthermore, to investigate the reoperations and the cause of reoperations after locking plate osteosynthesis of displaced proximal humerus fractures.

Patients and methods

113 consecutive patients (73 women and 40 men) with a median age of 66 years (range 18–100 years) were included in this study. The median follow-up time in our database was 4.7 years (range 45–72 months). For a comparative matched-group analysis of the CI, patients with a fall on the shoulder without fracture were selected. Demographic data and all reoperations were recorded after median 58 months postoperatively. The CI was measured at the proximal humeral diaphysis.

Results

The CI showed to be significant lower in the fracture group (mean 0.28) when compared to the matched group (mean 0.47, p < 0.01). 39% patients underwent a reoperation within 40 months postoperatively. 24% were reoperated within the first 12 months postoperatively, and 15% were reoperated after 12 months or later. The reoperation was independent of bone quality (p = 0.85).

Conclusions

The risk for reoperation is independent of the CI even though the CI may be a predictor for proximal humerus fracture. Younger patients should be aware that surgical treatment of proximal humerus fractures might be a two-stage surgery. Regular follow-up visits for older patients during the first postoperative year must be assured.

Keywords

Proximal humerus fracture Bone quality Osteoporosis Locking plate Reoperation 

References

  1. 1.
    Athwal GS, Sperling JW, Rispoli DM, Cofield RH (2007) Acute deep infection after surgical fixation of proximal humeral fractures. J Shoulder Elbow Surg 16(4):408–412PubMedCrossRefGoogle Scholar
  2. 2.
    Bach-Mortensen P, Hyldstrup L, Appleyard M, Hindso K, Gebuhr P, Sonne-Holm S (2006) Digital X-ray radiogrammetry identifies women at risk of osteoporotic fracture: results from a prospective study. Calcif Tissue Int 79(1):1–6PubMedCrossRefGoogle Scholar
  3. 3.
    Björkenheim JM, Pajarinen J, Savolainen V (2004) Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand 75(6):741–745PubMedCrossRefGoogle Scholar
  4. 4.
    Bloom RA, Laws JW (1970) Humeral cortical thickness as an index of osteoporosis in women. Br J Radiol 43(512):522–527PubMedCrossRefGoogle Scholar
  5. 5.
    Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, Marynissen H (2007) Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127(3):205–210PubMedCrossRefGoogle Scholar
  6. 6.
    Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371PubMedCrossRefGoogle Scholar
  7. 7.
    Diederichs G, Korner J, Goldhahn J, Linke B (2006) Assessment of bone quality in the proximal humerus by measurement of the contralateral site: a cadaveric analyze. Arch Orthop Trauma Surg 126(2):93–100PubMedCrossRefGoogle Scholar
  8. 8.
    Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res 430:176–181PubMedCrossRefGoogle Scholar
  9. 9.
    Hente R, Kampshoff J, Kinner B, Fuchtmeier B, Nerlich M (2004) Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate. Unfallchirurg 107(9):769–782PubMedCrossRefGoogle Scholar
  10. 10.
    Hepp P, Lill H, Bail H, Korner J, Niederhagen M, Haas NP, Josten C, Duda GN (2003) Where should implants be anchored in the humeral head? Clin Orthop Relat Res 415:139–147PubMedCrossRefGoogle Scholar
  11. 11.
    Hepp P, Theopold J, Voigt C, Engel T, Josten C, Lill H (2008) The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elbow Surg 17(1):21–28PubMedCrossRefGoogle Scholar
  12. 12.
    Jergas M, Schmid G (1999) Konventionelle Radiologie der Osteoporose und Röntgenabsorptiometrie. Radiologe 39(3):174–185PubMedCrossRefGoogle Scholar
  13. 13.
    Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I (2000) Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 71(5):465–470PubMedCrossRefGoogle Scholar
  14. 14.
    Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A (2006) Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res 442:115–120PubMedCrossRefGoogle Scholar
  15. 15.
    Lill H, Hepp P, Gowin W, Oestmann JW, Korner J, Haas NP, Josten C, Duda GN (2002) Age- and gender-related distribution of bone mineral density and mechanical properties of the proximal humerus. Röfo 174(12):1544–1550PubMedGoogle Scholar
  16. 16.
    Monoot P, Ashwood N, Hamlet M (2007) Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br 89:1206–1209CrossRefGoogle Scholar
  17. 17.
    Neer CS 2nd (2002) Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 11(4):389–400PubMedCrossRefGoogle Scholar
  18. 18.
    Noh SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD (2007) Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 89(Suppl 3):44–58Google Scholar
  19. 19.
    Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17(1):25–50PubMedCrossRefGoogle Scholar
  20. 20.
    Smith AM, Mardones RM, Sperling JW, Cofield RH (2007) Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg 16(1):14–24PubMedCrossRefGoogle Scholar
  21. 21.
    Strohm PC, Köstler W, Südkamp NP (2005) Locking plate fixation of proximal humerus fractures. Techn Shoulder Elbow Surg 6(1):8–13Google Scholar
  22. 22.
    Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85(4):611–617PubMedCrossRefGoogle Scholar
  23. 23.
    Tingart MJ, Bouxsein ML, Zurakowski D, Warner JP, Apreleva M (2003) Three-dimensional distribution of bone density in the proximal humerus. Calcif Tissue Int 73(6):531–536PubMedGoogle Scholar
  24. 24.
    Voigt C, Woltmann A, Partenheimer A, Lill H (2007) Management of complications after angularly stable locking proximal humerus plate fixation. Chirurg 78(1):40–46PubMedCrossRefGoogle Scholar
  25. 25.
    Yamada M, Briot J, Pedrono A, Sans N, Mansat P, Mansat M, Swider P (2007) Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg 16(5):596–602PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Pierre Hepp
    • 1
  • Jan Theopold
    • 1
  • Georg Osterhoff
    • 1
  • Bastian Marquass
    • 1
  • Christine Voigt
    • 2
  • Christoph Josten
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryUniversity of LeipzigLeipzigGermany
  2. 2.Department of Trauma and Reconstructive SurgeryFriederikenstift HospitalHannoverGermany

Personalised recommendations