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 Mortality After Complex Displaced Proximal Humerus Fractures in Elderly Patients: Conservative Versus Operative Treatment With Reverse Total Shoulder Arthroplasty

2018 ◽  
Vol 9 ◽  
pp. 215145931879524 ◽  
Author(s):  
Dani Rotman ◽  
Ornit Giladi ◽  
Adi Berliner Senderey ◽  
Alison Dallich ◽  
Oleg Dolkart ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Elderly Patients ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

Introduction: Proximal humerus fractures (PHFs) are a common fragility fracture and have been shown to increase mortality in elderly patients. In the last decade, reverse total shoulder arthroplasty (RTSA) was introduced as a reliable operative treatment option for this indication. In other fragility fractures, most notably hip fractures, urgent surgical treatment can reduce mortality. The purpose of this study is to evaluate whether treatment with RTSA can reduce 1-year mortality in elderly patients with complex displaced PHFs. Materials and Methods: A retrospective study was performed to compare 1-year mortality between 2 groups of elderly patients (>75 years old) who presented to a level 1 trauma center emergency department with complex displaced PHFs. The conservative treatment group (n = 83; mean age, 83.7 years) presented from 2008 to 2010 when RTSA was not yet available, and treatment was nonoperative. The surgical treatment group (n = 62; mean age, 82.2 years) presented from 2012 to 2015 and underwent RTSA. Results: One-year mortality was 8.1% (male 7.1%; female 8.3%) in the surgical treatment group and 10.8% (male 18.8%; female 9.0%) in the conservative treatment group. The reduction in mortality in the surgical treatment group was not significant (entire cohort P = .56; males P = .35; females P = .59). Discussion: Recent studies failed to show better functional results after surgical treatment with RTSA when compared to conservative treatment. This study suggests that a benefit of surgical treatment with RTSA that was not examined until now might exist—a reduction in the increased mortality risk associated with PHFs. Conclusions: There was no significant difference in 1-year mortality between the groups, although there was a trend showing lower mortality with RTSA, mostly in men. Further studies with larger populations and longer follow-up times are needed to determine whether this trend is of clinical significance.

Surgical treatment of displaced proximal humerus fractures with a short intramedullary nail

2011 ◽  
Vol 20 (8) ◽  
pp. 1241-1247 ◽  
Author(s):  
Betsy M. Nolan ◽  
Matthew A. Kippe ◽  
J. Michael Wiater ◽  
Gregory P. Nowinski
Keyword(s):  
Surgical Treatment ◽  
Intramedullary Nail ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Conservative Treatment for Proximal Humerus Fractures.

1999 ◽  
Vol 48 (2) ◽  
pp. 496-501
Author(s):  
Yasuhiro Shimizu ◽  
Tetsuo Nakano ◽  
Yasuyuki Abe ◽  
Ryuya Ochi ◽  
Ichirou Seike
Keyword(s):  
Conservative Treatment ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Prospective observational study evaluating the outcome of a fixed angle plate (proximal humerus internal locking system) in proximal humerus fractures

2019 ◽  
Vol 6 (1) ◽  
pp. 117
Author(s):  
Kiran Ramachandran ◽  
Jackson Mathew ◽  
Praveen Koraboina ◽  
Ponnezhathu Sebastian John
Keyword(s):  
Functional Outcomes ◽  
Proximal Humerus ◽  
Osteoporotic Fractures ◽  
Attrition Rate ◽  
Proximal Humerus Fractures ◽  
Fixed Angle ◽  
Significant Difference ◽  
Humerus Fractures ◽  
Study Participants ◽  
Type Of Fracture

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures are common among elderly. The present study assesses the functional outcomes of fixed angle plate (proximal humerus internal locking system (PHILOS)) in fractures of proximal humerus.</p><p class="abstract"><strong>Methods:</strong> 30 participants aged ≥18 years with proximal humerus fracture (2, 3 and 4 part) who underwent PHILOS fixation were enrolled. Undisplaced, open, severely comminuted, metastatic, and pathological fractures and with associated head injury and neurovascular injuries wew excluded. Clinical and radiological evaluation were done pre and post-operatively. Intraarticular extent of fracture geometry was assessed using 3-dimensional computed tomography. Participants were managed preoperatively with analgesics and shoulder immobilizer followed by preanesthetic check-up and routine investigations and surgery was done once participants were stable. Sample size was calculated assuming excellent or satisfactory results in 80% participants 6 months after surgery, relative precision of 20%, α of 5% and 10% attrition rate. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of study participants was 62.9 (14.9) years and were predominantly females (66.6%, n=20). No significant difference between type of fracture and duration of recovery was observed (p=0.4). 30% participants had post-operative complications, stiffness was the most common (13.3%, n=4) complication. 76.6% (n=23) participants had good functional outcomes. Significant correlation between type of fracture and NEER score was observed (p&lt;0.0001).</p><p><strong>Conclusions:</strong> PHILOS is a preferential implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures in younger patients, and osteoporotic fractures in elderly, thus allowing early mobilization and satisfactory final functional outcome. </p>

scholarly journals Inpatient surgical treatment of paediatric proximal humerus fractures between 2000 and 2012

2018 ◽  
Vol 12 (2) ◽  
pp. 111-116 ◽  
Author(s):  
A. I. Cruz Jr ◽  
J. E. Kleiner ◽  
J. A. Gil ◽  
A. D. Goodman ◽  
A. H. Daniels ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Proximal Humerus ◽  
National Database ◽  
Proximal Humerus Fractures ◽  
Children's Hospital ◽  
Severity Scores ◽  
Children’S Hospital ◽  
Humerus Fractures ◽  
Over Time

Purpose To estimate the rate of surgical treatment of paediatric proximal humerus fractures over time utilizing a large, publicly available national database. Methods The Healthcare Cost and Utilization Project Kids’ Inpatient Database was evaluated between the years 2000 and 2012. Proximal humerus fractures were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes. ICD-9 CM procedure codes were used to identify patients who received surgical treatment. Univariable and multivariable logistic regression were used to determine variables associated with greater proportions of surgical treatment. All statistical analyses were performed utilizing SAS statistical software v.9.4. Statistical significance was set at p < 0.05. Results A total of 7520 proximal humerus fracture admissions were identified; 3247 (43.2%) were treated surgically. The percentage of patients receiving surgery increased from 39.3% in 2000 to 46.4% in 2012 (p < 0.001). After adjustment for potential confounders, increased age, increased ICD-9 derived injury severity scores (ICISS) and more recent year were associated with an increased proportion of patients receiving surgical treatment (p < 0.001). Medicaid payer status (p < 0.001) and admission to a children’s hospital (p = 0.045) were associated with a lower proportion of surgical treatment. Conclusion The rate of operative treatment of paediatric proximal humerus fractures increased over time between 2000 and 2012. Increased surgical rates were independently associated with older age, increased ICISS, treatment at a non-children’s hospital and non-Medicaid insurance status. Further study is needed to provide evidence to support improved outcomes after operative treatment of paediatric proximal humerus fractures. Level of Evidence IV

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