scholarly journals Proximal Humerus Fractures in the Elderly: Concomitant Fractures and Management

2020 ◽  
Vol 13 (1) ◽  
pp. 101-105
Author(s):  
Kelly Zachariasen ◽  
Bradley Dart ◽  
Elizabeth Ablah ◽  
Kelly Lightwine ◽  
James Haan
Keyword(s):  
Injury Severity ◽  
Proximal Humerus ◽  
Motor Vehicle ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Provider Type ◽  
Concomitant Injuries ◽  
Discharge Disposition ◽  
Vehicle Collision ◽  
Humerus Fractures

Introduction. The purpose of this study was to identify additional injuries commonly seen with proximal humerus fractures experienced by patients 65 years or older and to evaluate discrepancies in the management of these patients with regard to provider type. Methods. A retrospective review was conducted of all patients 65 years or older who sustained a proximal humerus fracture. Patient data collected included demographics, injury details, hospital course, and discharge destination. Results. Patients with a concomitant fracture (45.5%, n = 65) had a slightly higher Injury Severity Score (ISS; 8.3 ± 3.0 vs. 6.4 ± 3.0, p < 0.001) and experienced one additional death than those with an isolated fracture (54.5%, n = 78). Slightly more patients were managed by a trauma provider (51.7%, n = 74) than by a non-trauma provider (48.3%, n = 69). Those managed by a trauma provider sustained the most pelvic fractures (12.2% vs. 2.9%, p = 0.038), were more likely to be injured in a motor vehicle collision (8.1% vs. 0%, p = 0.005), had a higher ISS (8.0 ± 3.3 vs. 6.4 ± 2.8, p = 0.003), and had more imaging performed than those treated by a non-trauma provider. There was, however, no difference in operative rates, concomitant injuries, length of stay or discharge disposition regarding provider type.  Conclusions. It is important to recognize proximal humerus fractures as a sign of fragility and to optimize hospital management of these patients.

scholarly journals Treatment of proximal humerus fractures in the elderly

2015 ◽  
Vol 86 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Antti P Launonen ◽  
Vesa Lepola ◽  
Tapio Flinkkilä ◽  
Minna Laitinen ◽  
Mika Paavola ◽  
...  
Keyword(s):  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Trends in Surgical Management and Costs for Operative Treatment of Proximal Humerus Fractures in the Elderly

Orthopedics ◽  
2017 ◽  
Vol 40 (4) ◽  
pp. e641-e647 ◽  
Author(s):  
Eddie K. Hasty ◽  
Edward W. Jernigan ◽  
Adrianne Soo ◽  
Dax T. Varkey ◽  
Ganesh V. Kamath
Keyword(s):  
Surgical Management ◽  
Operative Treatment ◽  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

2020 ◽  
Vol 4 ◽  
pp. 247154922094973
Author(s):  
Patrick A Nelson ◽  
Changyow C Kwan ◽  
Vehniah K Tjong ◽  
Michael A Terry ◽  
Ujash Sheth
Keyword(s):  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Salvage Procedure ◽  
Proximal Humerus Fractures ◽  
Patient Reported ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

Background There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. Methods A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. Results Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. Conclusions Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.

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.

Arthroplasty for the surgical management of complex proximal humerus fractures in the elderly: a cost-utility analysis

2016 ◽  
Vol 25 (5) ◽  
pp. 704-713 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
William W. Schairer ◽  
Frank McCormick ◽  
David M. Dines ◽  
Edward V. Craig ◽  
...  
Keyword(s):  
Surgical Management ◽  
Proximal Humerus ◽  
The Elderly ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Proximal Humerus Fractures ◽  
Utility Analysis ◽  
Humerus Fractures

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.

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