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Clinical and radiological evaluation of minimally displaced proximal humeral fractures

  • Trauma Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this prospective study was to assess the Constant score and radiographic outcome in 66 patients (mean age 58.7 years/mean follow-up 51 months) with a minimally displaced and/or impacted fracture of the proximal humerus treated with early mobilization.

Method

Special attention was paid to analyze the specific intrinsic parameters (age, gender, ASA grade and length of physiotherapy), injury-related parameters (classification, osteoporosis) and therapy-related parameters (initial fracture displacement, residual bony-deformity after healing, secondary fracture displacement during healing period, non-union, humeral head necrosis and omarthrosis) that may influence the final score.

Patients

There were 31 A (47%), 22 B (33%) and 13 C-fractures (19%). The median Constant score for the fractured shoulder was 89 points.

Results

All fractures healed without non-union. The radiological assessment showed in 80% a fracture-displacement with <15° angulation and/or <5-mm displacement of the greater tuberosity. At time of follow-up, the residual bony-deformity was perfect and good in 88% of cases. There was a significant association between the final Constant score and the age, ASA classification, AO (ABC) classification and initial fracture displacement.

Conclusion

Early physiotherapy, with a short period of immobilization is a sufficient therapy for management of minimally displaced and/or impacted fractures of the proximal humerus.

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References

  1. Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I (1996) Increasing number and incidence of osteoporotic fractures of the proximal humerus in elderly people. BMJ 313(7064):1051–1052

    CAS  PubMed  Google Scholar 

  2. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92

    Article  PubMed  Google Scholar 

  3. 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):465–470

    CAS  PubMed  Google Scholar 

  4. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371

    Article  CAS  PubMed  Google Scholar 

  5. Neer CS 2nd (2006) Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res 442:77–82

    Article  PubMed  Google Scholar 

  6. Siebenrock KA, Gerber C (1992) Classification of fractures and problems in proximal humeral fractures. Orthopade 21(2):98–105

    CAS  PubMed  Google Scholar 

  7. Jakob RP, Kristiansen T, Mayo K, Ganz R, Muller ME (1984) Classifications and aspects of treatment of fractures of the proximal humerus. In: Bateman JE, Welsh RP (eds) Surgery of the shoulder. CV Mosby Co., Philadelphia, pp 330–343

    Google Scholar 

  8. Court-Brown CM, McQueen MM (2004) The impacted varus (A2.2) proximal humeral fracture: prediction of outcome and results of nonoperative treatment in 99 patients. Acta Orthop Scand 75(6):736–740

    Article  PubMed  Google Scholar 

  9. Lefevre-Colau MM, Babinet A, Fayad F, Fermanian J, Anract P, Roren A, Kansao J, Revel M, Poiraudeau S (2007) Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. J Bone Joint Surg Am 89(12):2582–2590

    Article  CAS  PubMed  Google Scholar 

  10. Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD (1997) Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am 79(2):203–207

    CAS  PubMed  Google Scholar 

  11. Gaebler C, McQueen MM, Court-Brown CM (2003) Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand 74(5):580–585

    Article  PubMed  Google Scholar 

  12. Rasmussen S, Hvass I, Dalsgaard J, Christensen BS, Holstad E (1992) Displaced proximal humeral fractures: results of conservative treatment. Injury 23(1):41–43

    Article  CAS  PubMed  Google Scholar 

  13. Clifford PC (1980) Fractures of the neck of the humerus: a review of the late results. Injury 12(2):91–95

    Article  CAS  PubMed  Google Scholar 

  14. Zyto K, Kronberg M, Brostrom LA (1995) Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg 4(5):331–336

    Article  CAS  PubMed  Google Scholar 

  15. Zyto K (1998) Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury 29(5):349–352

    Article  CAS  PubMed  Google Scholar 

  16. Zyto K, Ahrengart L, Sperber A, Tornkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79(3):412–417

    Article  CAS  PubMed  Google Scholar 

  17. Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4):239–243

    Article  CAS  PubMed  Google Scholar 

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

  19. 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):611–617

    Article  PubMed  Google Scholar 

  20. Cruess RL (1981) Steroid-induced osteonecrosis. J R Coll Surg Edinb 26(2):69–77

    CAS  PubMed  Google Scholar 

  21. Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7(6):586–590

    Article  CAS  PubMed  Google Scholar 

  22. Ashton WD (1972) The logit transformation : with special reference to its uses in bioassay. Griffin’s statistical monographs and courses; Number 32, VIII, 87 S(ISBN 85264-212-1)

  23. Kristiansen B, Angermann P, Larsen TK (1989) Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization. Arch Orthop Trauma Surg 108(6):339–341

    Article  CAS  PubMed  Google Scholar 

  24. Hodgson SA, Mawson SJ, Stanley D (2003) Rehabilitation after two-part fractures of the neck of the humerus. J Bone Joint Surg Br 85(3):419–422

    Article  CAS  PubMed  Google Scholar 

  25. Tejwani NC, Liporace F, Walsh M, France MA, Zuckerman JD, Egol KA (2008) Functional outcome following one-part proximal humeral fractures: a prospective study. J Shoulder Elbow Surg 17(2):216–219

    Article  PubMed  Google Scholar 

  26. Court-Brown CM, Cattermole H, McQueen MM (2002) Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br 84(4):504–508

    Article  CAS  PubMed  Google Scholar 

  27. Young TB, Wallace WA (1985) Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Br 67(3):373–377

    CAS  PubMed  Google Scholar 

  28. Kristiansen B, Christensen SW (1987) Proximal humeral fractures. Late results in relation to classification and treatment. Acta Orthop Scand 58(2):124–127

    Article  CAS  PubMed  Google Scholar 

  29. Hodgson SA, Mawson SJ, Saxton JM, Stanley D (2007) Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elbow Surg 16(2):143–145

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Christian Bahrs.

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

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  • DOI: https://doi.org/10.1007/s00402-009-0975-9

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