Influence of Radiographic Bone Quality on the Type of Proximal Humerus Fracture

BACKGROUND

The risk of proximal humerus fractures increases with age and deterioration of bone quality over time, and the treatment of these injuries may be clinically challenging.The aim of this study was to analyse the relationship between local bone quality and the morphology of proximal humerus fractures.

MATERIAL AND METHODS

We conducted a retrospective study of 187 patients diagnosed with proximal humerus fractures. X-ray images of all patients were analysed, and on this basis, bone quality was assessed, using the Deltoid Tuberosity Index (DTI), average cortical bone thickness (CBTavg) and the Tingart measurement. The type of fracture was classified according to Neer's and Association for Osteosynthesis (AO) classifications. Moreover, the caput-collum-diaphyseal (CCD) angle was measured and the relationships between valgus or varus fractures and the DTI, CBTAVG and Tingart parameters were investigated in all patients.

RESULTS

Using the Neer classification, the most common fracture type was type 3, found in 90 patients (48.1%). A total of 51 patients (27.3%) sustained an AO B1 fracture. Significantly lower mean DTI values were noted in patients with a Neer 4 fracture compared to those with Neer 3 (p = 0.02) and Neer 2 fractures (p = 0.03). Moreover, significantly higher mean DTI (p <0.00) and CBTAVG (p <0.025) values were noted in the group of patients with valgus fractures (CCD> 140º).

CONCLUSIONS

1. In the group of patients diagnosed with a four-part fracture according to Neer, bone quality assessed using the Deltoid Tuberosity Index was significantly worse than in two- and three-part fractures. 2. Significantly higher bone quality, assessed on the basis of the DTI and CBTAVG indices, was observed among patients with valgus fractures compared to those with varus fractures.

THE INFLUENCE OF HIP ARTHROPLASTY ON HEALTH RELATED QUALITY OF LIFE IN MALE POPULATION WITH OSTEOARTHRITIS HIP DISEASE

OBJECTIVE

Introduction: Hip osteoarthritis is a disabling disease which become substantial health-related, social, and economic issue. The aim: To assess short term quality of life in male population with hip ostheoarthritis, after total hip arthroplasty.

PATIENTS AND METHODS

Material and methods: 118 male patients were included in the study, age range from 31 to 79 year-old, who underwent total hip arthroplasty. Patients quality of life was assessed using questioners: abbreviated version of WHOQoL-BREF, as well as EQ-5D-5L, and SF-36 scale. Patients condition was investigated before surgery, 6 weeks and 6 months after the surgery.

RESULTS

Results: The results from WHOQoL-BREF questionnaire demonstrated a statistically significant improvement of quality of life after the surgery - 6 weeks after the procedure by 4% and 21% (p<0.001), after 6 months by 13% and 42% (p<0.001), respectively. The most significant improvement was found in the somatic domain - by 5% after 6 weeks, and by 6% after 6 months (p<0.001). The quality of life according to the EQ-5D-5L questionnaire revealed statistically significant improvement after 6 weeks, by 18-24% (p<0.001), after 6 months by 41-48% (p<0.001). Substantial improvement was achieved in reducing pain and improving mobility. SF-36 questionnaire showed statistically significant improvement after 6 months from the surgery in both physical (by 44%), and mental condition (by 54%) (p<0.001).

CONCLUSION

Conclusions: Improvement of the quality of life - mainly less severe pain and better mobility after total hip arthroplasty in the investigated group of men was proven in 6 weeks after the procedure, while the further progress was more noticeable 6 months after the procedure.