Authors: Fred Vilson, MS¹, Justin W. Griffin, MD², Stephen F. Brockmeir, MD², A. Rashard Dacus, MD², Eric W. Carson, MD², Bonnie S. Mason, MD³
A current mainstay operative intervention for proximal humerus fractures is an open reduction and internal fixation (ORIF) primarily addressing elderly patients with these fractures. Although there is literature addressing the outcome in non-elderly patients, there is limited data displaying outcomes in non-elderly patients that endure high energy trauma required to produce this type of fracture. The purpose of this study was to critically evaluate the outcomes of proximal humerus fracture using this operative construct in non-elderly patients.
A retrospective review performed of patients who had a proximal humerus fracture at a single institution between January 2008 and March 2011. Patients between the ages of 18 and 60 with a proximal humerus fracture and have received an open reduction and internal fixation with screws were identified using the International Classifications of Diseases, 9th revision, Clinical Modification (ICD-9 CM) diagnosis codes 812.0 and 812.1. A chart review was performed to identify any exclusionary criteria, comorbidities, radiographic imaging, demographic data points, and subsequent operations. Once eligibility has been declared, enrollment proceeded and patient follow up was performed via phone for functional outcome measurements. Function outcome assessed via Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeon (ASES), Single Assessment Numeric Evaluation (SANE), and satisfactory questionnaires. Complications and re-operation rates were also recorded.
The mean follow-up interval between the patients who did not require a subsequent operation was five years (sd=0.7 years). Of the 21 patients enrolled, six patients (29%) underwent a subsequent reoperation to the index shoulder. Functional outcome measurements were collected and analyzed: Mean DASH score: 17 (sd=17); Mean ASES Shoulder Score: 79 (sd=17); Mean SANE score: 86 (sd=14); Mean Satisfaction score: 8.3/10 (sd=2). 91% of patients who underwent ORIF returned to previous activities. The data depicts a significant different between the number of patients with four-part fracture undergoing subsequent operation compared to the patients who had a two and three-part fracture (p=0.0024)
Discussion and Conclusion:
The data presented suggest that ORIF with a locking plate and screw construct has favorable outcomes in the non-elderly patients with two and three-part fractures. In this study, three-part fractures had the best outcomes. Despite the excellent outcomes after five years in three-part fractures, in four-part fractures each patient that had an ORIF required a subsequent operation due to complications.
Complications were as followed: painful stiff shoulder, AVN, proximal head collapse, screw collapse, fracture malunion, and nonunion. Although our data is limited by small numbers, it indicates that in four-part fractures in non-elderly patients, ORIF with locking plates may not be ideal; thus, contributes to valuable information to the debate on the optimal treatment course in this condition.
- Liberty University College of Osteopathic Medicine, Lynchburg, VA
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
- Nth Dimensions, Chicago IL