Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery

Author:

Shahien Amir1,Likine Elive F.2,Soles Gillian3,Samborski Steven3,Mehta Siddhant K.4,Ryan Scott Patrick5,Leroy Taryn E.5,Mullis Brian2,Spitler Clay A.4,Tornetta Paul1

Affiliation:

1. Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA;

2. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN;

3. Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, MN;

4. Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and

5. Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, MA

Abstract

Objectives: To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively. Design: Retrospective multicenter analysis. Setting: Five level-one trauma centers. Patients/Participants: Two hundred ten patients (152 F; 58 M), average age 64, with 112 left- and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C). Intervention: All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with ≥80% anterior humeral translation were compared with those with <80% anterior translation, including those with no or posterior translation. Main Outcomes: The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion. Results: Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery (P = 0.012). In addition, of those with anterior translation, having ≥80% anterior translation compared with <80% was also associated with surgery (P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 (P = 0.0001). Conclusions: In a multicenter series of proximal humerus fractures, anterior translation of >80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Orthopedics and Sports Medicine,General Medicine,Surgery

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3