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Risk factors for intra-articular involvement in proximal humeral fractures

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

Abstract

Introduction

Identification of intra-articular involvement in proximal humeral fractures is important for operative decision making. The aim of this study was to identify the risk factors associated with intra-articular involvement in proximal humeral fractures.

Materials and methods

One hundred consecutive three-dimensional computed tomography reconstructions of proximal humeral fractures were identified. The fracture lines were then accurately transcribed onto a two-dimensional superior view of the humeral head and each fracture was assessed for intra-articular involvement. Statistical analyses were undertaken to identify risk factors for intra-articular involvement and extent of involvement. Furthermore, for each risk factor, common fracture patterns were identified and compared to anatomical landmarks.

Results

Overall, 58% of the fractures involved the articular surface. High-energy mechanism, female gender, age ≥ 65, and posterior dislocation were risk factors for intra-articular involvement. Low-energy mechanism, female gender, age ≥ 65, varus angulation, and posterior dislocation were risk factors for increased extension of the fracture onto the articular surface.

Conclusion

Intra-articular involvement in proximal humeral fractures is influenced by demographics and fracture characteristics (mechanism of injury, angulation, and dislocation). Patients with identified risk factors should be appropriately evaluated for intra-articular fractures during preoperative planning to assist in operative decision making.

Level of evidence

Basic science; anatomy study.

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Funding

The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, SA, Australia

    Owain Critchley & Gregory Bain

  2. Department of Orthopaedic Surgery, Tauranga Hospital, Tauranga South, Bay of Plenty, New Zealand

    Simon MacLean

  3. Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, SA, Australia

    Afsana Hasan & Gregory Bain

  4. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA, Australia

    Richard Woodman

  5. Department of Orthopaedics, Barwon Health, University Hospital, Geelong, VIC, Australia

    Owain Critchley

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  1. Owain Critchley
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  2. Simon MacLean
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  5. Gregory Bain
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Correspondence to Owain Critchley.

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All the authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Southern Adelaide Human Research Ethics Committee [SAC HREC EC00188; application number OFR # 416.15]) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Critchley, O., MacLean, S., Hasan, A. et al. Risk factors for intra-articular involvement in proximal humeral fractures. Arch Orthop Trauma Surg 143, 1341–1351 (2023). https://doi.org/10.1007/s00402-021-04293-1

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  • DOI: https://doi.org/10.1007/s00402-021-04293-1

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