scholarly journals Comorbidities, substance abuse, weight and age are independent risk factors for postoperative complications following operation for proximal humerus fractures: a retrospective analysis of 1109 patients

2021 ◽  
Author(s):  
Ralf Henkelmann ◽  
Jan Theopold ◽  
Jonas Kitsche ◽  
Paul-Vincent Link ◽  
Meinhard Mende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Abuse ◽  
Body Weight ◽  
Postoperative Complications ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Level Of Evidence ◽  
Operative Revision ◽  
Independent Risk Factors ◽  
Humerus Fractures

Abstract Introduction This study aimed to investigate the influence of epidemiologic parameters on complications that needed operative revision of operatively treated proximal humerus fractures. Methods We performed a retrospective single-center study in a level 1 trauma center. We included all patients with operatively treated proximal humerus fractures from January 1 2005 to December 31 2015. We characterized our cohort and subgroup using descriptive statistics. The primary outcome was postoperative complications. For this purpose, postoperative complications were defined in advance, an operative revision was necessary on a general rule. The secondary outcome was a model of the risk factors for complications created with multiple logistic regression. Results We included 1109 patients. The average age was 67.2 years (± 16.4), and 71.4% of the fractures occurred in women. A total of 644 patients (58.1%) had between one to three comorbidities, and 27.8% had four or more. The fracture morphology was as follows: 3 part 41.8%, 4 part 26.9%, 2 part 24.3%, and dislocation fracture 6.7%. Complications occurred in 150 patients (13.5%). The number of comorbidities [odds ratio (OR) 2.85, p < 0.01], body weight (OR 1.15, p = 0.02), and substance abuse (OR 1.82, p = 0.04) significantly correlated with the risk of complications. We achieved a sensitivity of 48% and a specificity of 74% for the variables body weight, substance abuse, age, and comorbidities Conclusion The epidemiologic parameters, comorbidities, substance abuse, weight, and age are independent risk factors for complications. If these factors are present, one can predict a postoperative complication requiring surgical revision with low sensitivity and moderate specificity. Therefore, concerning the high number of multi-morbid patients with proximal humerus fractures, an increased postoperative complication rate can be expected. Level of evidence Level of evidence IV

scholarly journals Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alejandro Garcia-Reza ◽  
Diego Matias Dominguez-Prado ◽  
Constantino Iglesias-Nuñez ◽  
Lucia Alvarez-Alvarez ◽  
Beatriz Hernandez-Gonzalez ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Proximal Humerus ◽  
Cox Regression ◽  
Survival Rates ◽  
Osteoporotic Fractures ◽  
Fundamental Parameter ◽  
Proximal Humerus Fractures ◽  
Level Of Evidence ◽  
Humerus Fractures

Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR  = 3.83; p  < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR  = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR  = 3.64; p  < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.

scholarly journals Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures

2018 ◽  
Vol 11 (6) ◽  
pp. 430-439
Author(s):  
Azeem T Malik ◽  
Jonathan D Barlow ◽  
Nikhil Jain ◽  
Safdar N Khan
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Open Reduction Internal Fixation ◽  
Clinical Impact ◽  
Proximal Humerus Fractures ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Humerus Fractures

Introduction There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. Methods The 2012–2016 American College of Surgeons—National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. Results Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. Conclusion The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.

scholarly journals Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

2018 ◽  
Vol 9 ◽  
pp. 215145851775051 ◽  
Author(s):  
Adam Schumaier ◽  
Brian Grawe
Keyword(s):  
Risk Factors ◽  
Proximal Humerus ◽  
The Elderly ◽  
Controlled Trials ◽  
Proximal Humerus Fractures ◽  
Locking Plates ◽  
Intramedullary Nails ◽  
Surgical Risk ◽  
Randomized Controlled ◽  
Humerus Fractures

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

Epidemiology and Risk Factors of Humerus Fractures among Skiers and Snowboarders

2008 ◽  
Vol 36 (10) ◽  
pp. 1880-1888 ◽  
Author(s):  
Benjamin T. Bissell ◽  
Robert J. Johnson ◽  
Adam B. Shafritz ◽  
Derek C. Chase ◽  
Carl F. Ettlinger
Keyword(s):  
Risk Factors ◽  
Proximal Humerus ◽  
Similar Rate ◽  
Level Of Evidence ◽  
Helmet Use ◽  
Increased Risk ◽  
Humerus Fractures ◽  
And Gender ◽  
Left Humerus ◽  
Control Study

Background The incidence of humerus fractures while participating in snowboarding and skiing is undefined. Very little is known about the risk factors associated with these fractures. Hypothesis Snowboarders are at increased risk for sustaining humerus fractures when compared with skiers. In addition, the types of fractures, laterality, and risk factors differ between the 2 groups. Study Design Case-control study; Level of evidence, 3. Methods At a major ski area clinic, 318 humerus fractures were evaluated over 34 seasons. Radiographs were classified according to the AO and Neer systems. Patient data were analyzed and compared with that of a control population of uninjured skiers and snowboarders to determine incidence and risk factors. Results The incidence of humerus fractures among snowboarders (0.062 per 1000 snowboarder days) was significantly higher than that of skiers (0.041 per 1000, P < .05). Skiers were more likely to sustain proximal fractures, and snowboarders were relatively more likely to sustain diaphyseal and distal fractures ( P < .05). Of glenohumeral dislocations, 6.56% were associated with proximal humerus fractures among skiers (1.7% among snowboarders). Snowboarders who lead with their left foot were more likely to fracture their left humerus ( P = .023). Helmet use and gender were not risk factors for humerus fractures among either skiers or snowboarders. Jumping was involved in 28.3% of humerus fractures among snowboarders and in 5.4% among skiers. Skiers with humerus fractures were more skilled, older, and fell less frequently than controls. Snowboarders were less skilled, younger, and fell at a similar rate compared with controls. Conclusion Snowboarders are at significantly higher risk of sustaining humerus fractures than skiers. In skiers, humerus fractures show no laterality and most often involve the proximal humerus. In contrast, snowboarders more often fracture the left humerus at the diaphysis.

Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures

2015 ◽  
Vol 24 (4) ◽  
pp. 593-600 ◽  
Author(s):  
Brian C. Werner ◽  
Justin W. Griffin ◽  
Scott Yang ◽  
Stephen F. Brockmeier ◽  
F. Winston Gwathmey
Keyword(s):  
Postoperative Complications ◽  
Proximal Humerus ◽  
Operative Management ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Can patient and fracture factors predict opioid dependence following upper extremity fractures?: a retrospective review

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Vani Janaki Sabesan ◽  
Kiran Chatha ◽  
Lucas Goss ◽  
Claudia Ghisa ◽  
Gregory Gilot
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Review ◽  
Opioid Dependence ◽  
Proximal Humerus ◽  
Significant Risk ◽  
Proximal Humerus Fractures ◽  
Fracture Type ◽  
Increased Risk ◽  
Humerus Fractures

Abstract Background Since the early 1990s, opioids have been used as a mainstay for pain management surrounding fracture injuries. As opioid dependence has become a major public health issue, it is important to understand what factors can leave patients vulnerable. The purpose of this study was to examine what risk factors, patient or injury severity, contribute most to postoperative opioid dependence following surgical treatment of proximal humerus fractures (PHFs). Methods A retrospective review of all patients who underwent an open reduction and internal fixation of PHF was performed within a large multisite hospital system. Recorded variables included age, gender, ASA class, BMI, fracture type, time to surgery, pre- and postoperative opioid prescriptions, physical and psychological comorbidities, smoking status, and complications. Pre- and postoperative opioid dependence was defined as prescription opioid use in the 3 months leading up to or following surgery. Odds ratio calculations were performed for each variable, and a multivariate logistic regression was used to compare all predictors. Results A total of 198 surgically treated PHFs were included in the cohort with an average age of 59.9 years. Thirty-nine cases were determined to be preoperatively opioid dependent while 159 cases were preoperatively opioid naïve. Preoperative opioid dependence was found to be a significant risk factor for postoperative narcotic dependence, carrying a 2.42 times increased risk. (CI 1.07–5.48, p = 0.034). Fracture type was also found to be a risk factor for postoperative dependence, with complex 3- and 4-part fracture patients being 1.93 times more likely to be opioid dependent postoperatively compared to 2 part fractures (CI 1.010–3.764, p = 0.049). All other factors were not found to have any significant influence on postoperative opioid dependence. Conclusions Our results demonstrate that the most important risk factors of postoperative opioid dependence following proximal humerus fractures are preoperative dependence and fracture complexity. It is important for orthopedic surgeons to ensure that patients who have more complex fractures or are preoperatively opioid dependent receive adequate education on their increased risk and support to wean off of opioids following surgery. Level of evidence III

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