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Anazor FC, Relwani J, Dhinsa BS. Postoperative outcomes of third-generation shoulder hemiarthroplasties for three-and four-part proximal humeral fractures: A systematic review of published studies from 2012 to 2022. J Clin Orthop Trauma 2024; 53:102435. [PMID: 38983585 PMCID: PMC11228791 DOI: 10.1016/j.jcot.2024.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/19/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024] Open
Abstract
Background The aim of this study was to provide up-to-date evidence on the outcomes for hemiarthroplasties (HAs) that were performed using modern third-generation prostheses (post-2004) for isolated (excluding head-splits and fracture-dislocations) three-and four-part proximal humerus fractures (PHFs). Methods PubMed, Medline, Embase and the Cochrane register were searched from January 1, 2012, to November 15, 2022, conforming to the PRISMA guidelines. The outcome measures were the complication rates, revision rates, surgery-related postoperative mortality, post-operative clinical outcome scores and radiological outcomes. Results 432 hemiarthroplasties in 432 patients were performed across the 11 eligible studies (two prospective and 9 retrospective). Three studies compared HA versus reverse shoulder replacement (RSR); one study compared HA with locking plate fixation (LPF) and RSR; one study compared HA with LPF. 61.1 % and 19.4 % of hemiarthroplasties were performed using cemented and uncemented techniques respectively, while cementing data was ill-defined in 19.4 % of shoulders. The results for the outcome measures have been derived directly from the included studies and no statistical pooling was performed, due to heterogeneity in the different study designs and outcomes. Descriptive data synthesis from the included studies showed that third generation HAs have higher overall postoperative complication rates, with similar revision and mortality rates when compared to RSR and LPF for three-and four-part PHFs. RSR and LPF showed better statistically significant improvements than HA for the Constant-Murley score, Quick DASH, forward flexion and abduction. Mixed results were observed for the DASH score, ASES score and internal rotation ROM between RSR/LPF versus HA. Conclusion Low to moderate quality evidence from this review showed that even third-generation HA prostheses provided worse overall outcomes than RSR and LPF for three-and four-part PHFs.
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Affiliation(s)
- Fitzgerald Chukwuemeka Anazor
- Specialty Trainee Registrar (ST3), Trauma and Orthopaedic Surgery, East Midlands North (Nottingham) Orthopaedic Rotation, United Kingdom
| | - Jaikumar Relwani
- Consultant Orthopaedic and Trauma Surgeon, Department of Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, TN 24 0LZ, United Kingdom
| | - Baljinder Singh Dhinsa
- Consultant Orthopaedic and Trauma Surgeon, Department of Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, TN 24 0LZ, United Kingdom
- Professor of Regenerative Orthopaedics, Canterbury Christchurch University, United Kingdom
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Hasler A, Ker A, Grubhofer F, El Nashar R, Ernstbrunner L, Gerber C, Wieser K. Clinical and radiographic long-term outcomes of hemiarthroplasty for complex proximal humeral fractures. J Shoulder Elbow Surg 2024; 33:698-706. [PMID: 37611843 DOI: 10.1016/j.jse.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Hemiarthroplasty (HA) is a treatment option for complex proximal humeral fractures not suitable for conservative treatment or open reduction-internal fixation. Long-term outcomes using a large-metaphyseal volume prosthesis in the management of proximal humeral fractures have not been reported thus far. METHODS Between 2006 and 2010, 41 patients with proximal humeral fractures were treated with HA at our institution (average age, 62 years; age range, 38-85 years). Nine patients underwent revision surgery, 3 were lost to follow-up, and 7 died unrelated to the index surgical procedure. Twenty-two patients were reviewed clinically and radiographically after a mean period of 10.4 years (range, 9-13 years). RESULTS Of the 9 HA failures, 7 occurred within the first 2 postoperative years: 2 patients had infections and 5 had greater tuberosity nonunions or malunions. The other 2 patients underwent revision for rotator cuff deficiency >5 years after initial surgery. Among the patients available for final follow-up, the implant survival rate was 71% (22 of 31 patients). At final follow-up, these patients showed a mean relative Constant score of 76% (range, 49%-96%), mean active elevation of 116° (range, 60°-170°), and mean external rotation of 28° (range, 0°-55°). The majority had good or excellent internal rotation, with internal rotation to the 12th thoracic vertebra in 13 patients (59%) and to the eighth thoracic vertebra in 7 (31%). The mean Subjective Shoulder Value was 76% (range, 40%-100%). Clinical outcomes did not significantly deteriorate over a period of 10 years, except for flexion (P < .001) and internal rotation (P = .002). On analysis of greater tuberosity healing, 1 patient had a nonunion and 10 patients (45%) had a malunion, whereas the greater tuberosity had healed in an anatomic position in 12 patients (55%). Patients with a displaced malunion of the greater tuberosity did not have inferior clinical results at last follow-up. Only 2 patients showed glenoid erosion, and in no patients could stem loosening be identified at final follow-up. CONCLUSION The revision rate following large-metaphyseal volume HA to treat a proximal humeral fracture was 29% after 10 years postoperatively, with failure within 2 years largely related to greater tuberosity nonunion or malunion and failure later related to rotator cuff insufficiency. Patients with a retained implant showed good clinical and radiographic long-term results, without relevant deterioration over time even when the greater tuberosity healed in a nonanatomic position.
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Affiliation(s)
- Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrew Ker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rany El Nashar
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Zhao Y, Zhu Y, Lu Y, Li F, Jiang C. Does age affect patient outcomes after humeral head replacement in the treatment of acute proximal humeral fractures? A comparative cohort study with a minimum 10 years long-term follow-up. J Shoulder Elbow Surg 2024; 33:46-54. [PMID: 37331501 DOI: 10.1016/j.jse.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Humeral head replacement (HHR) is now rarely recommended for complex proximal humeral fractures (PHFs) in older patients. However, in relatively young and active patients with unreconstructable complex PHFs, controversy still exists regarding the treatment options of reverse shoulder arthroplasty and HHR. The goal of this study was to compare the survival, functional, and radiographic outcomes of HHR in patients aged <70 years and those aged ≥70 years after a minimum 10 years follow-up. METHODS Eighty-seven out of 135 patients undergoing primary HHR were enrolled and then divided into 2 groups based on age: <70 years and ≥70 years. Clinical and radiographic evaluations were performed with a minimum follow-up of 10 years. RESULTS There were 64 patients (mean, 54.9 years) in the younger group and 23 patients (mean, 73.5 years) in the older group. The younger and older groups had comparable 10-year implant survivorship (98.4% vs. 91.3%). Patients aged ≥70 years had worse American Shoulder and Elbow Surgeons scores (74.2 vs. 81.0, P = .042) and lower satisfaction rates (12% vs. 64%, P < .001) than younger patients. At the final follow-up, older patients had worse forward flexion (117° vs. 129°, P = .047) and internal rotation (17 vs. 15, P = .036). More greater tuberosity complications (39% vs. 16%, P = .019), glenoid erosion (100% vs. 59%, P = .077), and humeral head superior migration (80% vs. 31%, P = .037) were also identified in patients aged ≥70 years. CONCLUSIONS Unlike the increased risk for revision and functional deterioration over time after reverse shoulder arthroplasty for PHFs in younger patients, a high implant survival rate with lasting pain relief and stable functional outcomes could be observed in younger patients after HHR during long-term follow-up. Patients aged ≥70 years had worse clinical outcomes, lower patient satisfaction, more greater tuberosity complications, and more glenoid erosion and humeral head superior migration than those aged <70 years. HHR should not be recommended for the treatment of unreconstructable complex acute PHFs in older patient populations.
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Affiliation(s)
- Yang Zhao
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yiming Zhu
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Lu
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Fenglong Li
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Jiang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.
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Zhao Y, Zhu Y, Lu Y, Li F, Jiang C. Long-term outcomes of shoulder hemiarthroplasty for acute proximal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1517-1526. [DOI: 10.1007/s00264-023-05746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
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Chelli M, Gasbarro G, Lavoué V, Gauci MO, Raynier JL, Trojani C, Boileau P. The reliability of the Neer classification for proximal humerus fractures: A survey of orthopedic shoulder surgeons. JSES Int 2022; 6:331-337. [PMID: 35572425 PMCID: PMC9091924 DOI: 10.1016/j.jseint.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The Neer classification is among the most widely used systems to describe proximal humerus fractures (PHF) despite the poor interobserver agreement. The purpose of this study was to verify whether or not blinded shoulder surgeons and trainees agree with the authors of articles published in the highest impact-factor orthopedic journals. Methods All articles regarding PHF published between 2017 and 2019 in the top 10 orthopedic journals as rated by impact factor were searched. Articles were included if the authors used the Neer classification to describe at least 1 PHF in the figures. Figures were extracted without the legend, and X-rays ± computed tomography scan images were included when available. An international survey was conducted among 138 shoulder surgeons who were asked to record the Neer classification for each de-identified radiograph in the publications. The type of fracture mentioned in the legend of the published figure was considered as the gold standard. Results Survey participants agreed with the published article authors in 55% of cases overall (range 6%-96%, n = 35). The most common response disagreed with the article authors in 13 cases (37%), underestimating the number of parts in 11 of 13 cases. The interobserver agreement between the 138 responders was fair (k = 0.296). There was an association between the percentage of concordant answers and greater experience (number of years of shoulder surgery practice) of the responders (P = .0023). The number of parts, the number or type of available imaging modalities, and the geographic origin of participants did not influence the agreement between responders and authors. Discussion In more than one-third of cases, specialized shoulder surgeons disagree with article authors when interpreting the Neer classification of de-identified images of PHF in published manuscripts. Morphologic classification of PHF as the sole basis for treatment algorithms and surgical success should be scrutinized.
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Affiliation(s)
- Mikaël Chelli
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
- Université Côte d'Azur, Inria, Epione Research Team, Nice, Provence-Alpes-Côte d'Azur, France
- Corresponding author: Mikaël Chelli, MD, MSc, ICR - 7 avenue Durante, 06000 Nice, Provence-Alpes-Côte d'Azur, France.
| | - Gregory Gasbarro
- Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
| | - Vincent Lavoué
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Marc-Olivier Gauci
- University Institute for Locomotion and Sports (iULS), University Côte d'Azur, Nice, Provence-Alpes-Côte d'Azur, France
| | - Jean-Luc Raynier
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Christophe Trojani
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
| | - Pascal Boileau
- ICR Nice - Institute for Reconstructive Bone and Joint Surgery and Sport Surgery, Groupe Kantys, Nice, Provence-Alpes-Côte d'Azur, France
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Shu Y, Chen M, Yu W, Ge Z, Hu H, Zhang X, Zeng X, Liu X. PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study. Geriatr Orthop Surg Rehabil 2021; 12:2151459321992666. [PMID: 33747609 PMCID: PMC7940727 DOI: 10.1177/2151459321992666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction: The aim of this retrospective study was to evaluate the outcomes of older patients with 2-part proximal humerus fractures (PHFs) with medial column disruption stabilized using a proximal humeral internal locking system (PHILOS) plate plus oblique insertion of autologous fibula as a primary procedure. Materials and Methods: Data involving 112 patients (112 shoulders) sustaining 2-part PHFs with medial column disruption treated with PHILOS plate plus oblique insertion of autologous fibula as a primary procedure during 2012-2019 were identified. The median follow-up was 36 months (range: 11.2-43.5 months). The primary endpoint was the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores. The secondary endpoint was the main orthopedic complication rate. Results: The median Constant and ASES scores were 78 (range, 52-95) and 77 (range, 62-96) at the final follow-up, respectively. The main orthopedic complication rate was 10.7% (12/112). Twelve orthopedic complications in 8 patients were detected, and they involved loss of reduction, varus collapse, aseptic loosening, mal-union, revision, and intolerable shoulder pain. Of these complications, 3 (2.6%) involved loss of reduction, 2 (1.7%) involved varus collapse, 3 (2.6%) involved aseptic loosening, 1 (0.8%) involved mal-union, 2 (1.7%) required revision surgery, and 1 (0.8%) presented intolerable shoulder pain. Conclusion: PHILOS plate plus oblique insertion of autologous fibula as a primary procedure may yield good functional outcomes and a low rate of the main orthopedic complications.
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Affiliation(s)
- Ying Shu
- Department of Anesthesiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, Wuhan, China., Ying Shu and Meiji Chen contributed equally to this work
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China., Ying Shu and Meiji Chen contributed equally to this work
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Zhe Ge
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai, China
| | - Hao Hu
- Department of Anesthesiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, Wuhan, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Jinshan District, Shanghai, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
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Sun Q, Wu X, Wang L, Cai M. The plate fixation strategy of complex proximal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1785-1795. [PMID: 32535700 DOI: 10.1007/s00264-020-04544-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate fixation is still a preference and the proper selection of its strategy for each individual seems to be essential. METHOD The available classification system of the fracture, determination of surgical intervention, the common complications and related causes, and the latest critical surgical strategies with locking plate fixation were discussed in this review. RESULTS The frequent complications with complex proximal humeral fractures after operative treatment present a great challenge to orthopedic surgeons. In order to maintain the stability of locking plate fixation, several options including calcar screw, bone graft, bone cement augmentation, dual plate fixation, and fracture impaction were available for restoration of medial support. CONCLUSION Restoration of medial support seems of importance to provide solid stability and reduced complication for the complex fractures with fixation of locking plates.
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Affiliation(s)
- Qi Sun
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Xiaoming Wu
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Lei Wang
- Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Ming Cai
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China.
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Mencia MM, Goalan R, Skeete R. Atraumatic dissociation of a modular shoulder hemiarthroplasty: a case report and literature review. JSES Int 2020; 4:400-403. [PMID: 32490434 PMCID: PMC7256893 DOI: 10.1016/j.jseint.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad
| | - Raakesh Goalan
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Trinidad
| | - Rondell Skeete
- Department of Surgery, Port of Spain General Hospital, Trinidad
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Sayegh MJ, Nixon RA, Perfetti DC, Rokito SE, Sgaglione NA. Changing trends in the management of proximal humerus fractures in New York State. J Orthop 2020; 21:127-130. [PMID: 32255993 DOI: 10.1016/j.jor.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022] Open
Abstract
Purpose Reverse shoulder arthroplasty (RSA) as an alternative to hemiarthroplasty (HA) as treatment for proximal humerus fractures has prompted a re-evaluation of utilization trends. Methods Operative treatment for proximal humeral fractures were analyzed using a New York State database. Results After introduction as an ICD-9 code, RSA increased to 39.3% (m = +5.2%/year, r = 0.984). When stratifying by age ≥65, HA decreased to 7.7% (m = -2.8%/year, r = 0.962) while RSA increased to 50.6% (m = +6.4%/year, r = 0.985). Conclusion RSA overtook HA as the arthroplasty procedure of choice for proximal humerus fractures. In patients ≥65, RSA passed ORIF as the most prevalent procedure in 2017. Level of evidence III, Descriptive Epidemiology Study, Large Database Analysis.
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Affiliation(s)
- Michael J Sayegh
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Ryan A Nixon
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Dean C Perfetti
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Steven E Rokito
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nicholas A Sgaglione
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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Erdle B, Izadpanah K, Eberbach H, Zwingmann J, Jaeger M, Südkamp N, Maier D. [Primary fracture protheses and reverse shoulder arthroplasty in complex humeral head fractures : An alternative to joint-preserving osteosynthesis?]. DER ORTHOPADE 2019; 47:410-419. [PMID: 29632973 DOI: 10.1007/s00132-018-3570-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The surgical management of complex humeral head fractures has adapted dynamically over the course of the last decade. The primary use of reverse shoulder arthroplasty in elderly patients has gained in relevance due to promising short and middle-term results. Long-term results, however, are still pending. The appliance of anatomical hemiarthroplasty, on the other hand, has lost in significance in favour of osteosynthesis and reverse shoulder arthroplasty. INDICATIONS This review article follows the question as to under which circumstances primary fracture arthroplasty reflects an alternative or even a preference to joint-preserving osteosynthesis in the treatment of complex proximal humeral fractures. It also specifies spectrums of indications for anatomical hemiarthroplasty and reverse shoulder arthroplasty.
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Affiliation(s)
- B Erdle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - K Izadpanah
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - H Eberbach
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - J Zwingmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - M Jaeger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - N Südkamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - D Maier
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
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Brorson S, Alispahic N, Bahrs C, Joeris A, Steinitz A, Audigé L. Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions. BMC Musculoskelet Disord 2019; 20:91. [PMID: 30797232 PMCID: PMC6387518 DOI: 10.1186/s12891-019-2459-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background A majority of proximal humeral fractures can be managed without surgery. Recent randomized clinical trials and meta-analyses even question the benefit of surgical treatment for displaced 3-, and 4-part fractures. However, evidence-based treatment recommendations, balancing benefits and harms, presuppose a common reporting of complications and adverse events, which at the moment is largely missing. Therefore we systematically reviewed the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Methods We searched PubMed, EMBASE, Cochrane Library, Scopus and WorldCat (2010–2017) and included articles and book chapters containing complication terms or definitions. Two reviewers independently extracted and grouped terms and definitions according to a predefined scheme. Terms and definitions concerning non-surgical management were tabulated, grouped and analyzed qualitatively. Results The initial search identified 1376 references from which 470 articles were selected for full-text retrieval. Data-extraction included first articles published in 2017, was then performed iteratively in batches of 20 articles, and terminated after retrieval of 91 articles when no additional definitions or terms was found. In addition, 12 book chapters were reviewed from an initial list of 100. No general definition of a complication was found. A total of 69 terms for complications after non-surgical management were identified from 19 articles. Sixty-seven terms regarded local events. The most commonly reported event terms regarded osteonecrosis, malunion, secondary displacement and rotator cuff problems. Seven individual terms were accompanied by some kind of definition. Most terms and definitions were based on radiographical assessments. Conclusions We found no consensus in the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Multiple terms, some synonymous, some partly synonymous, some distinct, were used. Few complication terms were explicitly defined. Development and validation of an internationally consensus-based core event set for complications after proximal humeral fractures managed non-surgically is needed. Electronic supplementary material The online version of this article (10.1186/s12891-019-2459-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Nikola Alispahic
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Christian Bahrs
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
| | | | - Laurent Audigé
- Research and Development Department, Upper Extremities, Schulthess Clinic, Zurich, Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
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Reverse Shoulder Arthroplasty in Acute Fractures of the Proximal Humerus: Does Tuberosity Healing Improve Clinical Outcomes? J Orthop Trauma 2019; 33:e46-e51. [PMID: 30277991 DOI: 10.1097/bot.0000000000001338] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical outcomes of reverse shoulder arthroplasty (RSA) in elderly patients with proximal humeral fractures and assess the role of tuberosity healing on the outcome. DESIGN Case series. SETTING Multicenter clinical study of Level-2 trauma centers. PATIENTS/PARTICIPANTS We included 81 patients with a mean age of 78.5 ± 6.5 years (range, 58.5-90.9 years) and a nonreconstructable proximal humeral fracture. INTERVENTION Modular reverse fracture shoulder arthroplasty. MAIN OUTCOME MEASUREMENTS We determined range of motion, constant score, and the American Shoulder and Elbow Surgeons Shoulder Score as clinical outcomes and evaluated tuberosity healing at 6 weeks, 6 months, 1 year, and 2 years. RESULTS Tuberosities healed in most patients; 37 patients had completely healed tuberosities, and 33 patients had partially healed tuberosities, whereas 11 patients had unhealed tuberosities. However, no significant differences were found in the functional outcomes among the 3 groups (P > 0.05). CONCLUSIONS Our results with a modular reverse prosthesis confirmed similar constant scores, American Shoulder and Elbow Surgeons Shoulder Scores, and tuberosity healing rates as reported in the current clinical evidence for RSA. We could not confirm that tuberosity healing improved functional outcomes; however, it should be noted that tuberosity healing was assessed using standard radiographs. Nevertheless, our study strengthens the consensus that RSA can be recommended for well-selected elderly patients with complex displaced proximal humeral fractures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis. J Orthop Trauma 2019; 33:49-57. [PMID: 30211792 DOI: 10.1097/bot.0000000000001321] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought to compare range of motion, clinical outcome scores, and complications after reverse total shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in geriatric patients with acute proximal humerus fractures. DATA SOURCES We searched MEDLINE (1946-2017), EMBASE (1947-2017), the Cochrane Central Register of Controlled Trials (1898-2017) and ClinicalTrials.gov in October 2017. No limits were used in the database search. We also manually reviewed reference lists of included studies. We did not restrict studies based on language. STUDY SELECTION We included all randomized controlled trials and cohort studies in which the study population had a mean age of 65 years or older, received RSA or HA to treat an acute proximal humerus fracture, and had a minimum follow-up of 6 months. DATA EXTRACTION Two independent reviewers used a standardized data collection form to extract relevant information from included studies. Discrepancies were resolved by a consensus or a third party if consensus could not be reached. Study authors were contacted for missing or incomplete data. DATA SYNTHESIS Using a random effects model, we calculated mean differences (MD) and standardized mean differences (SMD) for continuous outcomes; we calculated relative risk for dichotomous outcomes. RESULTS Fifteen studies were included in the meta-analysis, including 421 patients treated with RSA and 492 treated with HA for a total of 913 patients. Compared with HA, the RSA group had significantly improved pain scores (SMD = 0.74, P < 0.001), outcome scores (SMD = 0.63, P < 0.001), and forward flexion (MD = 24.3 degrees, P < 0.001). Compared with RSA, the HA group had a significantly increased risk of reoperation (relative risk = 2.8, P = 0.02). There were no differences between the groups with regard to external rotation (P = 0.31) or deep infection (P = 0.90). CONCLUSIONS Aggregating available research suggests that RSA results in improved range of motion, clinical outcome scores, and rates of all-cause reoperation with no difference in infection rates. Using RSA for the treatment of acute proximal humerus fractures in the elderly population may result in improved short- and medium-term outcomes compared with HA. Future work should evaluate long-term outcomes to see if the benefits of RSA persist. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Holschen M, Siemes MK, Witt KA, Steinbeck J. Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty. Bone Joint J 2018; 100-B:761-766. [PMID: 29855243 DOI: 10.1302/0301-620x.100b6.bjj-2017-1280.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761-6.
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Affiliation(s)
- M Holschen
- Orthopedic Practice Clinic (OPPK) and Raphaelsklinik Münster, Münster, Germany
| | - M-K Siemes
- Orthopedic Practice Clinic (OPPK), Münster, Germany
| | - K-A Witt
- Orthopedic Practice Clinic (OPPK), Münster, Germany
| | - J Steinbeck
- Orthopedic Practice Clinic (OPPK), Münster, Germany
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van der Merwe M, Boyle MJ, Frampton CMA, Ball CM. Reverse shoulder arthroplasty compared with hemiarthroplasty in the treatment of acute proximal humeral fractures. J Shoulder Elbow Surg 2017; 26:1539-1545. [PMID: 28412103 DOI: 10.1016/j.jse.2017.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Complex proximal humeral fractures may require prosthetic replacement of the humeral head. Surgical options include reverse shoulder arthroplasty (RSA) and shoulder hemiarthroplasty; however, the optimal technique remains controversial. The goal of this study was to compare functional outcomes and revision rates of RSA with hemiarthroplasty in patients with acute proximal humeral fractures. MATERIALS AND METHODS Between January 1, 1999, and December 31, 2014, there were 218 patients who underwent RSA and 427 who underwent hemiarthroplasty for acute proximal humeral fractures identified through New Zealand Joint Registry records. Study groups were compared with regard to baseline characteristics, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS], revision rate, mortality rate) at 6 months and 5 years after surgery. RESULTS RSA patients were significantly older (mean age, 78.2 vs. 71.6 years; P < .001), with a higher proportion of female patients (90% vs. 77%; P < .001) than in the hemiarthroplasty group. No statistically significant difference existed in revision rate per 100 component-years (0.58 [RSA] vs. 1.16 [hemiarthroplasty]; P = .137) or 1-year mortality (3.8% vs. 3.4%; P = .805) between both groups. There was no significant difference in 6-month OSS (29.6 vs. 28.4; P = .305). The RSA group demonstrated a superior mean 5-year OSS (37.6 vs. 32.7; P = .078); however, the difference did not achieve statistical significance. CONCLUSIONS Although our results suggest that RSA patients may experience superior 5-year functional scores, we have identified no significant difference in functional outcomes and revision rates between RSA and hemiarthroplasty in the treatment of acute proximal humeral fractures.
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Affiliation(s)
- Michael van der Merwe
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand; Auckland Bone and Joint Surgery, Auckland, New Zealand.
| | - Matthew J Boyle
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand; Auckland Bone and Joint Surgery, Auckland, New Zealand
| | | | - Craig M Ball
- Auckland Bone and Joint Surgery, Auckland, New Zealand
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