Skip to main content

Advertisement

SpringerLink
Log in

The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

After surgical fixation, osteoporotic proximal humeral fractures often show high impaction and loss of reduction. This study aims at assessing the amount of impaction and loss of reduction at a short and medium follow-up. We found an alarming percentage of cases showing these complications in the first postoperative months.

Introduction

This study seeks to quantify the amount of humeral head impaction and loss of reduction in a consecutive series of osteoporotic proximal humerus fractures treated with a locking plate.

Methods

A series of displaced proximal humerus fractures were prospectively treated with minimally invasive reduction and ostheosynthesis using a locking plate. Diagnosis and classification of fractures were based on X-ray examination and CT scan. Proximal humerus cortical bone thickness (CBTAVG) was studied to assess osteoporosis. Amount of loss of reduction and head fragment impaction were noted at 3 and 18 months of follow-up. Constant score was calculated at 6 and 18 months of follow-up.

Results

Thirty-one osteoporotic fractures were studied. Most of the fractures (21, 67.7 %) had a CBTAVG of less than 4 mm. At 3 months of follow-up, 7 cases (22.5 %) had significant loss of reduction and the mean amount of impaction was 2.8 mm. At 18 months of follow-up, only 1 additional fracture showed loss of reduction and mean impaction was 3 mm (p < 0.05). At 6 months follow-up, the mean Constant score was 58 %; while at 18 months, it was 70 % (p = 0.02). Amount of impaction was significantly correlated to age of patients (p = 0.031), female sex (p = 0.011), CBTAVG (p = 0.019), and metaphyseal comminution (p = 0.013).

Conclusions

Osteoporotic proximal humerus fractures may present an important impaction and loss of reduction in the first 3 months after surgery even if treated with a rigid device and multiple head screws. Surgeons treating these osteoporotic fractures should be aware of these complications even when using a rigid device.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Roux A, Decroocq L, El BAtti S, Bonnevialle N, Moineau G, Trojani C, Boileau P, de Peretti F (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719. doi:10.1016/j.otsr.2012.05.013

    Article  CAS  PubMed  Google Scholar 

  2. Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM (2015) Epidemiology of proximal humerus fractures. Arch Osteoporos 10:209. doi:10.1007/s11657-015-0209-4, Epub 2015 Feb 13

    Article  PubMed  Google Scholar 

  3. 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 430:176–181

    Article  PubMed  Google Scholar 

  4. Rouleau DM, Laflamme GY, Berry GK, Harvey EJ, Delisle J, Girard J (2009) Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res 95:56–62. doi:10.1016/j.otsr.2008.09.003

    Article  PubMed  Google Scholar 

  5. Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M (2012) Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS® and hemiarthroplasty. Clin Orthop Relat Res 470:2035–2042. doi:10.1007/s11999-011-2207-1

    Article  PubMed Central  PubMed  Google Scholar 

  6. Bogner R, Hubner C, Matis N, Auffarth A, Lederer S, Resch H (2008) Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg (Br) 90:1602–1607

    Article  CAS  Google Scholar 

  7. Resch H, Beck E, Bayley J (1995) Reconstruction of valgus impacted humeral head fractures—indication, technique and long term results. J Shoulder Elb Surg 4:73–80

    Article  CAS  Google Scholar 

  8. Owsley KC, Gorczyca JT (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am 90:233–240. doi:10.2106/JBJS.F.01351

    Article  PubMed  Google Scholar 

  9. Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91:1320–1328. doi:10.2106/JBJS.H.00006

    Article  PubMed  Google Scholar 

  10. Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elb Surg 22:542–549. doi:10.1016/j.jse.2012.06.008

    Article  Google Scholar 

  11. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. doi:10.1016/j.injury.2011.01.017

    Article  PubMed  Google Scholar 

  12. Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C (2013) Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elb Surg 22:e8–14. doi:10.1016/j.jse.2012.04.002

    Article  Google Scholar 

  13. Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T (2006) Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristol, Avon) 21:1027–1031. doi:10.1016/j.clinbiomech.2006.06.005

    Article  Google Scholar 

  14. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of the medial support in locked plating of proximal humerus fracture. J Orthop Trauma 21:185–191

    Article  PubMed  Google Scholar 

  15. Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697. doi:10.2106/JBJS.H.00133

    Article  PubMed  Google Scholar 

  16. Resch H (2011) Proximal humeral fractures: current controversies. J Shoulder Elb Surg 20:827–832

    Article  Google Scholar 

  17. Majed A, Macleod I, Bull AM, Zyto K, Resch H, Hertel R, Reilly P, Emery RJ (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elb Surg 20:1125–1132. doi:10.1016/j.jse.2011.01.020

    Article  Google Scholar 

  18. Carbone S, Moroder P, Arceri V, Postacchini R, Gumina S (2014) The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock® device. Int Orthop 38:1451–1459. doi:10.1007/s00264-014-2327-9

    Article  PubMed Central  PubMed  Google Scholar 

  19. Mather J, MacDermid JC, Faber KJ, Athwal GS (2013) Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. J Shoulder Elb Surg 22:732–738. doi:10.1016/j.jse.2012.08.018, Epub 2012 Nov 22

    Article  Google Scholar 

  20. 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 13:427–433

    Article  CAS  Google Scholar 

  21. Gardner MJ, Griffith MH, Dines JS, Briggs SM, Weiland AJ, Lorich DG (2010) The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res 434:123–129

    Google Scholar 

  22. Bahrs C, Rolauffs B, Dietz K, Eingartner C, Weise K (2010) Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg 130:673–679. doi:10.1007/s00402-009-0975-9

    Article  PubMed  Google Scholar 

  23. Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  24. Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V (2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elb Surg 22:1650–1655. doi:10.1016/j.jse.2013.05.002

    Article  Google Scholar 

  25. Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  26. Lill H, Hopp P, Korner J, Kassi J, Verheyda A, Josten C et al (2004) Proximal humerus fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123:74–81

    Google Scholar 

  27. Russo R, Cautiero F, Della Rotonda G (2012) The classification of complex 4-part humeral fractures revisited: the missing fifth fragment and indications for surgery. Musculoskelet Surg 96(Suppl 1):S13–19. doi:10.1007/s12306-012-0195-2

    Article  PubMed  Google Scholar 

  28. Liew AS, Johnson JA, Patterson SD et al (2000) Effect of screw placement on fixation in the humeral head. J Shoulder Elb Surg 9:423–426

    Article  Google Scholar 

  29. Robinson CM, Page RS (2004) Severely impacted valgus proximal humeral fractures. J Bone Joint Surg Am 86-A(Suppl 1(Pt 2)):143–155

    PubMed  Google Scholar 

  30. Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD (2012) Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elb Surg 21:741–748. doi:10.1016/j.jse.2011.09.017

    Article  Google Scholar 

  31. Bengard MJ, Gardner MJ (2011) Screw depth sounding in proximal humerus fractures to avoid iatrogenic intra-articular penetration. J Orthop Trauma 25:630–633

    Article  PubMed  Google Scholar 

  32. Hertel R, Knothe U, Ballmer FT (2002) Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elb Surg 11:331–338

    Article  Google Scholar 

Download references

Conflicts of interest

None.

IRB

In light of the Italian law, the authors are not required to have this type of study approved. However, each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Author information

Authors and Affiliations

  1. Department Of Molecular Medicine, Sapienza University of Rome, Rome, Italy

    S. Carbone

  2. Department Of Orthopaedics and Traumatology, Clinica Nuova Itor, Rome, Italy

    M. Papalia

Authors
  1. S. Carbone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Papalia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Carbone.

Additional information

Level of evidence:

Level IV, case series with no control group

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carbone, S., Papalia, M. The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation. Osteoporos Int 27, 627–633 (2016). https://doi.org/10.1007/s00198-015-3304-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3304-x

Keywords

Search

Navigation