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Risk factors for nonunion following open reduction and internal fixation for proximal humerus fractures

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

Abstract

Purpose

The incidence of proximal humerus fractures (PHF) is rising and surgical intervention carries risk for fracture nonunion. The purpose was (1) to compare patient demographics of those that developed nonunion and (2) identify patient risk factors that predispose to nonunion following open reduction and internal fixation (ORIF) for PHF.

Methods

A retrospective review of the Medicare Claims Database from 2005 to 2014 for patients who underwent primary ORIF for PHFs. Patients who developed nonunion were identified as the study group (n = 1020) and compared to a control group (n = 51,209). Primary endpoints were to compare demographics of the study group and the comparison cohorts and to identify patient-related risk factors associated with nonunion within 6-months following the index procedure. A logistic regression model was constructed to determine the association of comorbid conditions on developing a nonunion. A p value of 0.001 was the significance threshold.

Results

Patients who developed nonunion were younger, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (7 vs. 5; p < 0.0001) when compared with controls. Iron deficiency anemia (OR: 1.32; p = 0.0001), tobacco use (OR: 1.32; p = 0.0004), rheumatoid arthritis (OR: 1.29; p = 0.0001), depression (OR: 1.28; p = 0.0002), and BMI range from 30–39 kg/m2 (OR: 1.21; p = 0.001) were significant risk factors for nonunion.

Conclusions

Certain patient risk factors including tobacco use, iron deficiency anemia, rheumatoid arthritis, depression, and a BMI in the range of 30–39 were associated with nonunion within 6 months of ORIF for PHF. This study may help in the risk stratification of these patients.

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References

  1. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. In: Clinical orthopaedics and related research. Lippincott Williams and Wilkins, pp 87–92

  2. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371. https://doi.org/10.1080/000164701753542023

    Article  CAS  PubMed  Google Scholar 

  3. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  PubMed  Google Scholar 

  4. 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. https://doi.org/10.1016/j.jse.2012.06.008

    Article  Google Scholar 

  5. Boesmueller S, Wech M, Gregori M et al (2016) Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures. Injury 47:350–355. https://doi.org/10.1016/j.injury.2015.10.001

    Article  PubMed  Google Scholar 

  6. Steen RG (2016) Biological risk factors for nonunion of bone fracture. BJS Rev 4:1–12

    CAS  Google Scholar 

  7. Klement MR, Nickel BT, Bala A et al (2021) Glenohumeral arthritis as a risk factor for proximal humerus nonunion. Injury 47:S36–S39. https://doi.org/10.1016/S0020-1383(16)30852-X

    Article  Google Scholar 

  8. Tian R, Zheng F, Zhao W et al (2020) Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis. J Orthop Surg Res 2:1–16

    Google Scholar 

  9. Olson JJ, Entezari V, Vallier HA (2020) Risk factors for nonunion after traumatic humeral shaft fractures in adults. JSES Int 4:734–738. https://doi.org/10.1016/J.JSEINT.2020.06.009

    Article  PubMed  PubMed Central  Google Scholar 

  10. Liska F, Haller B, Voss A et al (2018) Smoking and obesity influence the risk of nonunion in lateral opening wedge, closing wedge and torsional distal femoral osteotomies. Knee Surgery Sport Traumatol Arthrosc 26:2551–2557. https://doi.org/10.1007/S00167-017-4754-9

    Article  Google Scholar 

  11. Leroux T, Wasserstein D, Henry P et al (2014) Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in Ontario, Canada. J Bone Jt Surg Am 96:1119–1125. https://doi.org/10.2106/JBJS.M.00607

    Article  Google Scholar 

  12. Calori GM, Albisetti W, Agus A et al (2007) Risk factors contributing to fracture non-unions. Injury 38:S11–S18. https://doi.org/10.1016/S0020-1383(07)80004-0

    Article  PubMed  Google Scholar 

  13. Sloan A, Hussain I, Maqsood M et al (2010) The effects of smoking on fracture healing. Surg 8:111–116. https://doi.org/10.1016/j.surge.2009.10.014

    Article  CAS  Google Scholar 

  14. Toxqui L, Vaquero MP (2015) Chronic iron deficiency as an emerging risk factor for osteoporosis: a hypothesis, pp 2324–2344. Doi: https://doi.org/10.3390/nu7042324

  15. Krappinger D, Bizzotto N, Riedmann S et al (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. https://doi.org/10.1016/j.injury.2011.01.017

    Article  PubMed  Google Scholar 

  16. Hernandez RK, Do TP, Critchlow CW et al (2012) Patient-related risk factors for fracture-healing complications in the United Kingdom General Practice Research Database. Acta Orthop 83:653–660. https://doi.org/10.3109/17453674.2012.747054

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smith AM, Sperling JW, Cofield RH (2005) Complications of operative fixation of proximal humeral fractures in patients with rheumatoid arthritis, pp 55905. https://doi.org/10.1016/j.jse.2005.02.023

  18. Burrus MT, Werner BC, Cancienne JM et al (2015) Shoulder arthroplasty in patients with Parkinson ’ s disease is associated with increased complications. J Shoulder Elb Surg 24:1–7. https://doi.org/10.1016/j.jse.2015.05.048

    Article  Google Scholar 

  19. Calori G (2017) Non-unions. Clin Cases Miner Bone Metab 14:186. https://doi.org/10.11138/CCMBM/2017.14.1.186

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA

    Giovanni Sanchez, Marcos Vargas, Adam M. Gordon, Ivan Golub, Asad Ashraf, Keith Diamond, Kevin K. Kang & Afshin E. Razi

  2. College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA

    Giovanni Sanchez & Marcos Vargas

Authors
  1. Giovanni Sanchez
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  2. Marcos Vargas
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  3. Adam M. Gordon
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  4. Ivan Golub
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  5. Asad Ashraf
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  6. Keith Diamond
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  7. Kevin K. Kang
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  8. Afshin E. Razi
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Corresponding author

Correspondence to Adam M. Gordon.

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The authors have no relevant financial or non-financial interests to disclose.

IRB approval

The study was exempt from our institution’s Institutional Review Board (IRB) approval process.

Ethical approval

This was an observational study of publicly available, deidentified data. The Maimonides Medical Center Research Ethics Committee has confirmed that no ethical approval is required.

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Sanchez, G., Vargas, M., Gordon, A.M. et al. Risk factors for nonunion following open reduction and internal fixation for proximal humerus fractures. Eur J Orthop Surg Traumatol 33, 883–888 (2023). https://doi.org/10.1007/s00590-022-03221-2

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  • DOI: https://doi.org/10.1007/s00590-022-03221-2

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