Correction to: Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

Abstract Introduction Surgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA). Materials and Methods All patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Results A cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 3 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal. Conclusions Reversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.

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Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan

Cancers ◽

10.3390/cancers13133320 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3320

Author(s):

Satoshi Takenaka ◽

Hironari Tamiya ◽

Toru Wakamatsu ◽

Sho Nakai ◽

Yoshinori Imura ◽

...

Keyword(s):

Surgical Treatment ◽

Propensity Score ◽

Surgical Resection ◽

Bone Tumor ◽

Poor Prognosis ◽

Propensity Score Analysis ◽

The Elderly ◽

Tumor Stage ◽

Tumor Registry ◽

Score Analysis

Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.

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Surgical treatment of ankle and foot fractures in the elderly

Osteoporosis International ◽

10.1007/s00198-004-1737-8 ◽

2004 ◽

Vol 16 (S02) ◽

pp. S103-S106 ◽

Cited By ~ 16

Author(s):

J. Kettunen ◽

H. Kröger

Keyword(s):

Surgical Treatment ◽

The Elderly ◽

Foot Fractures ◽

Ankle And Foot

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Surgical treatment of acute complicated diverticulitis in the elderly

Minerva Chirurgica ◽

10.23736/s0026-4733.18.07744-1 ◽

2020 ◽

Vol 74 (6) ◽

Cited By ~ 1

Author(s):

Roberto Cirocchi ◽

Riccardo Nascimbeni ◽

Gian A. Binda ◽

Nereo Vettoretto ◽

Rosario Cuomo ◽

...

Keyword(s):

Surgical Treatment ◽

The Elderly ◽

Complicated Diverticulitis

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Surgical Treatment Modalities for Cervical Stenosis: Central Cord Syndrome and Other Spinal Cord Injuries in the Elderly

The Comprehensive Treatment of the Aging Spine ◽

10.1016/b978-1-4377-0373-3.10027-2 ◽

2011 ◽

pp. 160-163 ◽

Cited By ~ 1

Author(s):

Michael Fehlings ◽

Randolph Gray

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Injuries ◽

The Elderly ◽

Treatment Modalities ◽

Cervical Stenosis ◽

Central Cord Syndrome

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Surgical Treatment of Thoracic Aortic Disease in the Elderly

Cardiothoracic Surgery in the Elderly ◽

10.1007/978-1-4419-0892-6_33 ◽

2011 ◽

pp. 427-436 ◽

Cited By ~ 1

Author(s):

Arnar Geirsson

Keyword(s):

Surgical Treatment ◽

The Elderly ◽

Aortic Disease ◽

Thoracic Aortic Disease

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STABILITY IN RELATION TO HUMERAL HEAD RETROVERSION AFTER SURGICAL TREATMENT OF RECURRENT ANTERIOR SHOULDER DISLOCATIONS

Orthopedics ◽

10.3928/0147-7447-19930301-05 ◽

1993 ◽

Vol 16 (3) ◽

pp. 281-285

Author(s):

Margareta Kronberg ◽

Lars-Åke Broström ◽

Elisabeth Posch

Keyword(s):

Surgical Treatment ◽

Humeral Head

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Surgical Treatment of Humeral Head Defect in Shoulder Posterior Instability

360° Around Shoulder Instability ◽

10.1007/978-3-662-61074-9_36 ◽

2020 ◽

pp. 305-312

Author(s):

Riccardo Compagnoni ◽

Matteo Lo Duca ◽

Pietro S. Randelli

Keyword(s):

Surgical Treatment ◽

Humeral Head ◽

Posterior Instability

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Surgical Treatment of Midclavicular Fractures in the Elderly: A Comparison of Locking and Nonlocking Plates

Orthopedics ◽

10.3928/01477447-20090401-17 ◽

2009 ◽

Vol 32 (4) ◽

pp. 257-262 ◽

Cited By ~ 6

Author(s):

Hsin-Te Pai ◽

Yih-Shiunn Lee ◽

Chyi-Yin Cheng

Keyword(s):

Surgical Treatment ◽

The Elderly

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Differences in 30- and 90-Day Readmission Rates After Surgical Treatment for Lumbar Degenerative Disc Disease in Elderly Patients (³ð65 Years): A National Readmission Database Study

Neurosurgery ◽

10.1093/neuros/nyz310_629 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Aladine A Elsamadicy ◽

Andrew B Koo ◽

Megan Lee ◽

Adam Kundishora ◽

Joaquin Q Camara-Quintana ◽

...

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Degenerative Disc Disease ◽

Postoperative Infection ◽

Lumbar Fusion ◽

The Elderly ◽

Disc Disease ◽

Readmission Rates ◽

Posterior Lumbar Fusion ◽

Degenerative Disc

Abstract INTRODUCTION For spine surgery performed for degenerative disc disease (DDD), a paucity of nationwide studies exists describing common complications and readmission rates. The aim of this study was to investigate the differences and complications associated with 30- and 90-d readmissions following surgical treatment for lumbar DDD in the elderly. METHODS The Nationwide Readmission Database years 2013 to 2015 was queried. Elderly patients (>65 yr old) undergoing anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLIF)/posterolateral lumbar fusion (PLF), or anterior and posterior lumbar fusion (APLF) for lumbar DDD were identified. Unique patient linkage numbers were used to follow patients and identify 30- and 31 to 90-d readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 d (30-R), and readmission within 31 to 90 d (90-R). RESULTS We identified 11 651 elderly patients undergoing ALIF, PLIF/PLF, or APLF for lumbar DDD, with 1213 (10.4%) patients encountering a readmission (30-R: n = 812[7.0%]; 90-R: n = 401[3.4%]; Non-R: n = 10 438). The greatest proportion of each cohort had 2 to 3 vertebral levels fused (30-R: 63.7%, 90-R: 69.2%, Non-R: 70.2%). Iliac crest bone graft was the most common fusion agent used (30-R: 59.9%, 90-R: 51.4%, Non-R: 53.5%), followed by bone morphogenetic protein (30-R: 24.6%, 90-R: 22.9%, Non-R: 21.2%). The most common inpatient complications observed were acute posthemorrhagic anemia (30-R: 26.6%, 90-R: 22.3%, Non-R: 18.2%), postoperative infection (30-R: 6.2%, 90-R: 9.7%, Non-R: 3.5%), and genitourinary complication (30-R: 7.7%, 90-R: 2.7%, Non-R: 3.5%). The most prevalent 30- and 90-d complications seen among the readmitted cohort were postoperative infection (30-R: 18.7%, 90-R: 8.9%), device complications (30-R: 5.2%, 90-R: 9.1%), and sepsis (30-R: 6.9%, 90-R: 4.9%). On multivariate regression analysis, obesity, chronic pulmonary disease, smoking, and any complication during index admission were independently associated with 30-d readmission; private insurance and coagulopathy were independently associated with 90-d readmission. CONCLUSION Our study suggests that 30- and 90-d readmissions for treatment of lumbar DDD in the elderly are common, and that multiple patient-level factors independently predict hospital readmission.

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