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Buscariolo FF, Parron IAC, Costa EF, Santana MVF, Nishimura EM, Dobashi ET. CORRELATION OF OSTEONECROSIS RATES IN THE SURGICAL TREATMENT OF PROXIMAL HUMERAL FRACTURES ACCORDING TO THE NEER AND HERTEL CLASSIFICATIONS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268183. [PMID: 37469497 PMCID: PMC10353866 DOI: 10.1590/1413-785220233103e268183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 07/21/2023]
Abstract
Objective To predict the risk of osteonecrosis (ON) according to the Neer and Hertel et al. classification for surgically treated proximal humeral fractures after at least one year of follow-up. Methods This is a retrospective, cross-sectional, and observational cohort study. A total of 44 patients, 16 (36.36%) men and 28 (63.63%) women, with a mean age of 61.36 years, participated in this study. Lesions were categorized according to Neer and Hertel's classifications, considering the preoperative prognosis for ON. After at least a year of follow-up, patients were reassessed. Data were evaluated using IBM SPSS Statistics®. Results A total of three patients (6.8%) developed osteonecrosis. Comparisons showed no statistically significant difference, but we observed a superior association of osteonecrosis for the Hertel classification than that of Neer. Conclusion Both classifications showed a similar ability to identify patients at low risk of developing ON. New studies with a greater number of participants and sample homogeneity may intensify the value of the evaluation of clinical applicability and predictive capacity of the studied classifications with greater significance and correlation. Level of Evidence III, Case Control Study.
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Affiliation(s)
- Fabio Fabian Buscariolo
- Rede D'Or Sao Luiz, Hospital IFOR, Serviço de Ortopedia e Traumatologia, São Bernardo do Campo, SP, Brazil
| | - Igor Arthur Costa Parron
- Rede D'Or Sao Luiz, Hospital IFOR, Serviço de Ortopedia e Traumatologia, São Bernardo do Campo, SP, Brazil
| | - Elzir Finizola Costa
- Rede D'Or Sao Luiz, Hospital IFOR, Serviço de Ortopedia e Traumatologia, São Bernardo do Campo, SP, Brazil
| | | | | | - Eiffel Tsuyoshi Dobashi
- Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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Bue M, Bright E, Thillemann TM, Mosegaard SB, Hansen TB, Klebe T, Mechlenburg I, Stilling M. Osteoporosis does not affect bone mineral density change in the proximal humerus or the functional outcome after open reduction and internal fixation of unilateral displaced 3- or 4-part fractures at 12-month follow-up. J Shoulder Elbow Surg 2023; 32:292-301. [PMID: 35998782 DOI: 10.1016/j.jse.2022.07.008] [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: 02/20/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this prospective study was to investigate bone mineral density (BMD) changes in the proximal humerus of the shoulder during a healing period of 12 months after displaced 3- or 4-part proximal humerus fractures treated with open reduction and internal fixation (ORIF) with an anatomic angular stable locking plate and the influence on fracture healing and functional outcomes. METHODS In a prospective multicenter study, 36 patients (29F and 7M, age range: 38-83) with unilateral displaced 3- or 4-part proximal humerus fractures were included for ORIF. Dual-energy x-ray absorptiometry for osteoporosis status was employed. Postoperative and 6-week, 3-, 6-, and 12-month shoulder radiographs and dual-energy x-ray absorptiometry of the shoulder with BMD measures in 4 templated regions of interest (ROIs) were performed. Functional outcomes, Western Ontario Osteoarthritis of the Shoulder index, Constant score, visual analog scale pain (VAS), and 36-Item Short Form Survey, were collected. RESULTS A total of 17 of 36 patients had osteoporosis. We found no differences in BMD changes, functional outcomes, radiology, or need for revision surgery between the osteoporosis and nonosteoporosis groups. The BMD values gradually declined from baseline to 3-month follow-up in all 4 ROIs of the operated shoulders. All 4 ROIs in the operated shoulder presented with a reduction in BMD at 3, 6, and 12 months compared with baseline, whereas no significant BMD changes were seen in the healthy shoulder during the study period. The functional outcomes displayed an increase in Constant score from 3 to 12 months, but a decrease in domains of the 36-Item Short Form Survey from preinjury to 12 months (physical functioning, general health, and bodily pain). Preinjury and 12-month Western Ontario Osteoarthritis of the Shoulder index, VAS pain at rest, and VAS pain at activity were comparable. CONCLUSION BMD changes appeared swiftly in the proximal humerus, after the treatment of displaced 3- or 4-part fractures with ORIF, particularly affecting the proximal diaphysis of the humerus. Shoulder function was restored to preinjury levels for most of the patients. Osteoporosis may not be regarded as a contraindication for the treatment of displaced 3- or 4-part fractures with ORIF.
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Affiliation(s)
- Mats Bue
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Elisabeth Bright
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Theis Muncholm Thillemann
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Sebastian Breddam Mosegaard
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Torben Bæk Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Thomas Klebe
- Department of Orthopaedic Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark.
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