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Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort

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Abstract

Background

In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.

Methods

Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum–collum–diaphyseal (CCD) angle were analyzed.

Results

A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6–1.9; p < 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17–2.40; p = 0.0046) compared to those with advanced CTA.

Conclusion

In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.

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Data are available on reasonable demand.

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Funding

This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany

    Jonas Schmalzl, Malik Jessen, Christian Gerhardt & Lars-Johannes Lehmann

  2. Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany

    Malik Jessen & Lars-Johannes Lehmann

  3. Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany

    Jonas Schmalzl & Fabian Gilbert

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  1. Jonas Schmalzl
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  4. Christian Gerhardt
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  5. Lars-Johannes Lehmann
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Contributions

All authors contributed to the study conception and design. Evaluation of the radiological date, data collection and analysis were performed by J S, M J and F G. The first draft of the manuscript was written by Jonas Schmalzl, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jonas Schmalzl.

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The authors declare that they have no conflict of interest.

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Ethical approval was obtained prior to the study from the University of Mannheim/Heidelberg (Study number 2019-833R).

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Schmalzl, J., Jessen, M., Gilbert, F. et al. Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort. Eur J Orthop Surg Traumatol 31, 517–524 (2021). https://doi.org/10.1007/s00590-020-02801-4

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  • DOI: https://doi.org/10.1007/s00590-020-02801-4

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