Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol

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.

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Outcomes for reverse total shoulder arthroplasty after failed open reduction internal fixation versus primary reverse total shoulder arthroplasty for proximal humerus fractures

Seminars in Arthroplasty ◽

10.1053/j.sart.2020.06.005 ◽

2020 ◽

Vol 30 (2) ◽

pp. 111-116

Author(s):

Nickolas Linkous ◽

Jon O Wright ◽

Denise M Koueiter ◽

David Marcantonio ◽

J.Michael Wiater ◽

...

Keyword(s):

Internal Fixation ◽

Shoulder Arthroplasty ◽

Open Reduction ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Open Reduction Internal Fixation ◽

Reverse Total Shoulder Arthroplasty ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Reverse Total Shoulder

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Surgical management of proximal humerus fracture treated with locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174707 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1165

Author(s):

Sivakumar Arumugam ◽

Venkateshwara Arumugam ◽

V. Raviraman

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Early Mobilization ◽

Open Reduction Internal Fixation ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Comminuted Fractures ◽

Humerus Fractures

Background: Proximal humerus fractures accounts for about 4 to 5% of all fractures. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remain challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Various operative procedures are carried out, the recent trend in internal fixation has moved on to locking plates. The present study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by locking compression plate.Methods: This is a prospective study comprising of 30 patients with fractures of proximal humerus were treated by open reduction and internal fixation with locking compression plate were evaluated at Velammal Institute Of Medical Sciences, Madurai from the period of April 2015 to December 2016. Clinical and radiological evaluation was done. Patients will undergo open reduction internal fixation with locking compression plate for the sustained fracture under general anesthesia.Results: In our series, the majority of the patients were males, elderly aged, with RTA being the commonest mode of injury, involving 2 part, 3 part and 4 part fractures of the proximal humerus. Excellent and satisfactory results were found in 76.7% of patients with unsatisfactory results in 23.3 % according to Neer’s criteria. There were 100 % union rates and no failures.Conclusions: In conclusion locking Compression, the plate is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in Osteoporotic bones in elderly patients, thus allowing early mobilization.

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Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517750516 ◽

2018 ◽

Vol 9 ◽

pp. 215145851775051 ◽

Cited By ~ 30

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.

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Proximal Humerus Fractures in Children: Experience from a Central London Paediatric Orthopaedic Service

The Open Orthopaedics Journal ◽

10.2174/1874325001913010202 ◽

2019 ◽

Vol 13 (1) ◽

pp. 202-207

Author(s):

Woojin Chae ◽

Akib Khan ◽

Sarah Abbott ◽

Angelos Assiotis

Keyword(s):

Proximal Humerus ◽

Limb Length Discrepancy ◽

Operative Management ◽

Proximal Humerus Fractures ◽

Tertiary Referral Centre ◽

Correct Treatment ◽

Treatment Methods ◽

Fractures In Children ◽

Humerus Fractures ◽

The Mean

Objective: Proximal humeral fractures are commonly observed in children who sustain falls whilst running, or from heights. Appropriate and correct treatment is key in order to avoid limb length discrepancy and functional deficiencies. Current treatment methods include non-operative management such as collar and cuff immobilisation, and operative methods such as elastic stable intramedullary nails or Kirschner wires. This paper aims to present the demographics of this patient population and our experience in managing patients with proximal humerus fractures in an urban tertiary referral centre. Method: We assessed 41 cases across two sites in central London, identified via hospital electronic notes and our radiology digital system. We analysed patient demographics, mechanism of injury, time to discharge from orthopaedic services taking into account radiological and clinical union, and the treatment methods utilised. Results: The mean age of the cohort was 8.6 years old. 70% of the injuries were due to falls and 85% of cases were treated without an operation. The mean time to discharge from our service following radiological and clinical union was 46 days (9 – 161 days). Mean radiological and clinical union were 21.8 and 36.2 days respectively. Conclusion: These results support a non-operative approach, especially in cases with patients under 10 years of age. Surgery should only be undertaken in patients who have severe displacement and who have failed attempts at closed reduction. We would advocate a similar approach in institutions dealing with a comparable population of patients, as long as there are provisions for referral of more complex cases that require surgical stabilisation.

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