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Proximal humeral fracture-dislocation: Outcome analysis in osteosynthesis and arthroplasties

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Proximal humeral fracture-dislocations (PHFD) are challenging to treat. In older patients, usually arthroplasty is performed. In younger patients, osteosynthesis is chosen. This study presents functional outcomes of these different treatment modalities.

Methods

All patients operated for PHFD from 2010 until 2017 were included. Osteosynthesis was performed in younger patients and if reconstruction was possible. Either an open deltopectoral approach or a minimal invasive plate osteosynthesis (MIPO) was performed. Hemiarthroplasty (HA) was done if reconstruction of the tubercles was possible, age was below 63 years and no signs of osteoarthritis were present. In all other cases, a reverse total shoulder arthroplasty (rTSA) was done. The primary endpoint was functional outcome assessed with the QuickDASH Score (QDS). Secondary outcomes were subjective shoulder value (SSV), complications, revisions, and conversion into arthroplasty.

Results

The mean follow-up of 40 patients was 56 ± 24 months. The mean QDS was 4.5 (0.6–9.1) and the mean SSV was 90 (80–98.6). Of these, 33 patients (mean age: 50) had an osteosynthesis, 25 were treated with MIPO. Only 18% were converted into an arthroplasty after a mean of 22 months. Among them, 7 patients received a primary arthroplasty (mean age: 68), no revisions were recorded.

Subgroup analysis showed functional outcome deficits in avascular necrosis (AVN) compared to no AVN (p = 0.021), revision surgery compared to no revision (p = 0.040) and in HA compared to rTSA (p = 0.007).

Conclusion

Both osteosynthesis and primary arthroplasty after PHFD can lead to good or even excellent functional outcome. Revision rates in osteosynthesis are high. Revision procedures or secondary conversion into arthroplasty after failed osteosynthesis decrease outcome scores significantly.

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Availability of data and material

The data are not available in public storage.

Code availability

Custom software was used for statistics (SPSS).

References

  1. Neer CS, 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52 (6):1077–1089

  2. Trikha V, Singh V, Choudhury B, Das S (2017) Retrospective analysis of proximal humeral fracture-dislocations managed with locked plates. J Shoulder Elbow Surg 26(10):e293–e299. https://doi.org/10.1016/j.jse.2017.03.035

    Article  PubMed  Google Scholar 

  3. Soliman OA, Koptan WM (2013) Four-part fracture dislocations of the proximal humerus in young adults: results of fixation. Injury 44(4):442–447. https://doi.org/10.1016/j.injury.2012.09.005

    Article  PubMed  Google Scholar 

  4. Haupt S, Frima H, Sommer C (2020) Operative treatment of proximal humeral fracture-dislocations through an anterolateral deltoid split approach. Arch Bone Jt Surg 8(5):589–597. https://doi.org/10.22038/abjs.2020.42728.2162

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kokkalis ZT, Iliopoulos ID, Antoniou G, Antoniadou T, Mavrogenis AF, Panagiotopoulos E (2017) Posterior shoulder fracture-dislocation: an update with treatment algorithm. Eur J Orthopaedic Surg Traumatol: Orthopedie Traumatologie 27(3):285–294. https://doi.org/10.1007/s00590-016-1840-5

    Article  PubMed  Google Scholar 

  6. Robinson CM, Khan LA, Akhtar MA (2006) Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation. J Bone Joint Surg Br 88(4):502–508. https://doi.org/10.1302/0301-620X.88B4.17195

    Article  CAS  PubMed  Google Scholar 

  7. 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. https://doi.org/10.1016/s1058-2746(98)90005-2

    Article  CAS  PubMed  Google Scholar 

  8. Spross C, Meester J, Mazzucchelli RA, Puskas GJ, Zdravkovic V, Jost B (2019) Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. J Shoulder Elbow Surg 28(6):1022–1032. https://doi.org/10.1016/j.jse.2019.02.015

    Article  PubMed  Google Scholar 

  9. Robinson CM, Aderinto J (2005) Posterior shoulder dislocations and fracture-dislocations. J Bone Joint Surg Am 87(3):639–650. https://doi.org/10.2106/JBJS.D.02371

    Article  PubMed  Google Scholar 

  10. Spross C, Kaestle N, Benninger E, Fornaro J, Erhardt J, Zdravkovic V, Jost B (2015) Deltoid tuberosity index: a simple radiographic tool to assess local bone quality in proximal humerus fractures. Clin Orthop Relat Res 473(9):3038–3045. https://doi.org/10.1007/s11999-015-4322-x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23 (10):1419–1426. https://doi.org/10.1016/j.jse.2014.06.035

  12. Robinson CM, Stirling PHC, Goudie EB, MacDonald DJ, Strelzow JA (2019) Complications and long-term outcomes of open reduction and plate fixation of proximal humeral fractures. J Bone Joint Surg Am 101(23):2129–2139. https://doi.org/10.2106/JBJS.19.00595

    Article  PubMed  Google Scholar 

  13. Ru\edi TP, Buckley RE, Moran CG (2007) AO principles of fracture management. 2nd expanded ed./[edited by] Thomas P. Rüedi, Richard E. Buckley, Christopher G. Moran. edn. AO Pub., Davos Platz, [Switzerland]

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

    Article  Google Scholar 

  15. Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J (2011) Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken) 63(Suppl 11):S174-188. https://doi.org/10.1002/acr.20630

    Article  PubMed  Google Scholar 

  16. Jost B, Pfirrmann CW, Gerber C, Switzerland Z (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82(3):304–314

    Article  CAS  PubMed  Google Scholar 

  17. Audige L, Goldhahn S, Daigl M, Goldhahn J, Blauth M, Hanson B (2014) How to document and report orthopedic complications in clinical studies? A proposal for standardization. Arch Orthop Trauma Surg 134(2):269–275. https://doi.org/10.1007/s00402-011-1384-4

    Article  PubMed  Google Scholar 

  18. Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, Athanasou NA, Ochsner PE, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates SL, Zalavras C, Giannoudis PV, Richards RG, Verhofstad MHJ (2018) Fracture-related infection: a consensus on definition from an international expert group. Injury 49(3):505–510. https://doi.org/10.1016/j.injury.2017.08.040

    Article  CAS  PubMed  Google Scholar 

  19. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of A (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):e1–e25. https://doi.org/10.1093/cid/cis803

    Article  PubMed  Google Scholar 

  20. Cruess RL (1978) Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip. Clin Orthop Relat Res 130:86–93

    Google Scholar 

  21. Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ (2017) High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 475(2):532–539. https://doi.org/10.1007/s11999-016-5113-8

    Article  PubMed  Google Scholar 

  22. Beaton DE, Wright JG, Katz JN, Group UEC (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87(5):1038–1046. https://doi.org/10.2106/JBJS.D.02060

    Article  Google Scholar 

  23. Dezfuli B, King JJ, Farmer KW, Struk AM, Wright TW (2016) Outcomes of reverse total shoulder arthroplasty as primary versus revision procedure for proximal humerus fractures. J Shoulder Elbow Surg 25(7):1133–1137. https://doi.org/10.1016/j.jse.2015.12.002

    Article  PubMed  Google Scholar 

  24. Mata-Fink A, Meinke M, Jones C, Kim B, Bell JE (2013) Reverse shoulder arthroplasty for treatment of proximal humeral fractures in older adults: a systematic review. J Shoulder Elbow Surg 22(12):1737–1748. https://doi.org/10.1016/j.jse.2013.08.021

    Article  PubMed  Google Scholar 

  25. Grubhofer F, Wieser K, Meyer DC, Catanzaro S, Schurholz K, Gerber C (2017) Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg 26(1):92–100. https://doi.org/10.1016/j.jse.2016.05.020

    Article  PubMed  Google Scholar 

  26. Frima H, Michelitsch C, Beks RB, Houwert RM, Acklin YP, Sommer C (2018) Long-term follow-up after MIPO Philos plating for proximal humerus fractures. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3063-1

    Article  PubMed  Google Scholar 

  27. Falez F, Papalia M, Greco A, Teti A, Favetti F, Panegrossi G, Casella F, Necozione S (2016) Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study. Int Orthop 40(3):579–585. https://doi.org/10.1007/s00264-015-3069-z

    Article  PubMed  Google Scholar 

  28. Cuff DJ, Pupello DR (2013) Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am 95(22):2050–2055. https://doi.org/10.2106/JBJS.L.01637

    Article  PubMed  Google Scholar 

  29. Sohn HS, Jeon YS, Lee J, Shin SJ (2017) Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: a prospective randomized controlled trial. Injury 48(6):1175–1182. https://doi.org/10.1016/j.injury.2017.03.027

    Article  PubMed  Google Scholar 

  30. Bastian JD, Hertel R (2008) Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 17(1):2–8. https://doi.org/10.1016/j.jse.2007.03.026

    Article  PubMed  Google Scholar 

  31. 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 Elbow Surg 22(4):542–549. https://doi.org/10.1016/j.jse.2012.06.008

    Article  PubMed  Google Scholar 

  32. Acklin YP, Michelitsch C, Sommer C (2016) Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome. BMC Musculoskelet Disord 17:119. https://doi.org/10.1186/s12891-016-0977-z

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dimitriou D, Waldmann S, Antoniadis A, Liebhauser M, Helmy N, Riede U (2020) Early locking plate removal following open reduction and internal fixation of proximal humeral fractures could prevent secondary implant-related complications. J Orthop 17:106–109. https://doi.org/10.1016/j.jor.2019.06.011

    Article  PubMed  Google Scholar 

  34. Farshad M, Gerber C (2010) Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop 34(8):1075–1082. https://doi.org/10.1007/s00264-010-1125-2

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

There was no external source of funding for this study.

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland

    Samuel Haupt & Christoph Sommer

  2. Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland

    Samuel Haupt, Sabrina Weber, René Hutter & Holger Grehn

  3. Department of Trauma Surgery, Northwest Hospitalgroup, Wilhelminalaan 12, 1815 JD, Alkmaar, Netherlands

    Herman Frima

Authors
  1. Samuel Haupt
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Correspondence to Samuel Haupt.

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Informed consent was obtained from all individual participants included in the study.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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All procedures performed involving human participants were in accordance with the ethical standards of the institutional and regional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Swiss ethics committee (Basec Nr: 2017–00554 and 2020–00550).

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Haupt, S., Weber, S., Frima, H. et al. Proximal humeral fracture-dislocation: Outcome analysis in osteosynthesis and arthroplasties. Eur J Orthop Surg Traumatol 33, 305–314 (2023). https://doi.org/10.1007/s00590-021-03183-x

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