Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures

Abstract Background Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. Methods The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005–2011), Florida (2005–2014), and New York (2008–2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. Results At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p < 0.0001). All-cause in-hospital mortality was 9.8% for patients managed non-operatively, 8.8% for ORIF, and 10.0% for arthroplasty (p = 0.003). Conclusions A majority of patients with proximal humeral fractures underwent non-operative treatment. There was a relatively high all-cause in-hospital mortality irrespective of treatment. Given the recent debate on operative versus non-operative treatment for proximal humeral fractures, our study provides valuable information on the need for revision surgery after initial treatment. The differences in rates of revision surgery between patients treated non-operatively, with ORIF, and with arthroplasty were small in magnitude. At nine years of follow-up, ORIF had the lowest probability of needing follow-up surgery, and arthroplasty had the highest.

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In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01890-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hideaki Ishii ◽

Takanori Shintaku ◽

Shu Yoshizawa ◽

Misato Sakamoto ◽

Takao Kaneko ◽

...

Keyword(s):

Cyclic Loading ◽

Proximal Humerus Fracture ◽

Tension Band ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Suture Materials ◽

Loading Test ◽

Cyclic Loading Test ◽

Mechanical Durability

Abstract Background Proximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view. Methods The mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test. Results The most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly. Conclusions From a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.

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Displaced proximal humeral fractures: operative versus non-operative treatment—a 2-year extension of a randomized controlled trial

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-013-1403-y ◽

2014 ◽

Vol 24 (7) ◽

pp. 1067-1073 ◽

Cited By ~ 30

Author(s):

Tore Fjalestad ◽

Margrethe Øye Hole

Keyword(s):

Randomized Controlled Trial ◽

Operative Treatment ◽

Controlled Trial ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Randomized Controlled

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Proximal humeral fractures in Finland

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0987.r1 ◽

2022 ◽

Vol 104-B (1) ◽

pp. 150-156

Author(s):

Oskari K. Leino ◽

Kaisa K. Lehtimäki ◽

Keijo Mäkelä ◽

Ville Äärimaa ◽

Elina Ekman

Keyword(s):

Operative Treatment ◽

Surgical Procedure ◽

Plate Osteosynthesis ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Exclusion Criteria ◽

Diagnostic Codes ◽

Procedure Codes ◽

Adjusted Incidence ◽

Methods Of Treatment

Aims Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland. Methods The study included all Finnish inhabitants aged ≥ 16 years between 1997 and 2019. All records, including diagnostic codes for PHFs and all surgical procedure codes for these fractures, were identified from two national registers. Data exclusion criteria were implemented in order to identify only acute PHFs, and the operations performed to treat them. Results During the 23-year study period, 79,676 PHFs were identified, and 14,941 operations were performed to treat them. The incidence of PHFs steadily increased. In 2019, the overall incidence was 105 per 100,000 person-years (105). The sex-adjusted incidence for females was 147.1 per 105, and the age-adjusted incidence for patients aged ≥ 80 years was 407.1 per 105. The incidence of operative treatment for PHFs rose during the first half of the study period and decreased during the second half. The use of plate osteosynthesis in particular decreased. In 2019, the incidence of operative treatment for PHFs was 13.2 per 105, with 604 operations. Conclusion Although the incidence of PHFs is steadily increasing, particularly in elderly females, the incidence of operative treatment is now decreasing, which is in line with current literature regarding their treatment. Cite this article: Bone Joint J 2022;104-B(1):150–156.

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