The influence of biplanar reduction and surgeon experience on proximal humerus fractures treated with ORIF. Injury 2020 Feb;51(2):322-328
Date
12/10/2019Pubmed ID
31812323DOI
10.1016/j.injury.2019.11.030Scopus ID
2-s2.0-85076619428 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
BACKGROUND: Treatment for proximal humerus fractures remains controversial. Studies of open reduction and internal fixation (ORIF) rarely account for reduction quality, while surgeon experience and sagittal plane reduction remain unstudied. In a retrospective case series analysis of AO/OTA C-type proximal humerus fractures treated with ORIF using a locking plate, we hypothesized that reduction quality would be associated with outcome, and reductions would improve with experience.
METHODS: We retrospectively identified 41 3- and 4-part proximal humerus fractures treated with ORIF by a single orthopaedic traumatologist. Two blinded traumatologists assessed injury and post-operative radiographs for medial calcar disruption and five measures of deformity. Major complications and functional outcome were assessed.
RESULTS: Outcome by ASES score was similar to previous reports (mean 73.6, std dev 22.5). Eleven of 35 patients (31.4%) with greater than six months follow-up experienced a complication. Post-reduction sagittal HSa<25° (RR = =9.44, p = =0.024) and medial calcar disruption (RR = =3.82, p = =0.009) were associated with complications. Post-reduction coronal and sagittal HSa improved with experience (p < 0.001 and p = =0.032, respectively) as did the likelihood of overall anatomic reduction (p = =0.006). ROC analysis found a threshold for superior reduction quality after 23 cases (AUC = =0.873, p < 0.001).
CONCLUSION: Sagittal reduction quality and medial calcar disruption were associated with complications. Additionally, reduction quality improved with experience. Future studies of proximal humerus ORIF should include multiplanar assessments of reduction while accounting for surgeon experience.
Author List
Liskutin T, Harkin E, Summers H, Cohen J, Bernstein M, Lack WAuthor
Elizabeth A. Nolte MD Assistant Professor in the Orthopaedic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Bone Plates
Clinical Competence
Female
Fracture Fixation, Internal
Humans
Male
Middle Aged
Open Fracture Reduction
Postoperative Care
Radiography
Retrospective Studies
Shoulder Fractures
Surgeons
Treatment Outcome
