Difficulty in decision making in the treatment of displaced proximal humerus fractures: the effect of uncertainty on surgical outcomes

LaMartina, Joey; Christmas, Kaitlyn N.; Simon, Péter; Streit, Jonathan J.; Allert, Jesse; Clark, Jonathan; Otto, Randall J.; Abdelfattah, Adham; Mighell, Mark A.; Frankle, Mark A.

doi:10.1016/j.jse.2017.09.033

Cited by 47 publications

(29 citation statements)

References 14 publications

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“…Current trends show increases in surgical management of PHFs 6,11,12 and confirms a lack of consensus on choice of treatment among surgeons. 7,31 This is illustrated in a recent study 7 in which three experienced shoulder surgeons only unanimously agreed on treatment in 51% of 274 cases. In the cases in which unanimous agreement was achieved, the patients underwent the selected treatment 63.5% of the time.…”

Section: Managementmentioning

confidence: 99%

“…4,5 Many authors have suggested that up to 85% do not require surgery. 4,[6][7][8] Despite this, there appears to be a trend towards increased surgical intervention which has been attributed to newer designs of plating systems, as well as the promotion of the reverse shoulder replacement as a treatment option. 6,7,[9][10][11][12] The ideal outcome for a patient with a PHF is a pain-free shoulder with an acceptable range of motion according to the individual's specific functional requirements.…”

Section: Introductionmentioning

confidence: 99%

“…The decision about when to operate in order to achieve an acceptable outcome remains challenging, especially in older patients. 6,7,10,11 Olerud has published results in which surgical outcome was superior; 13 however, recent literature, 9,[14][15][16][17] including the well-publicised PROFHER trial, 9 continues to promote the conservative management of PHFs. This discrepancy continues to create more questions than answers.…”

Section: Introductionmentioning

confidence: 99%

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Proximal humerus fractures - Part 1: Conservative management

et al. 2019

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Fractures of the proximal humerus are common, especially in osteoporotic females. Despite this, there remains significant debate around their preferred treatment. The difficulties when considering treatment options is the wide array of fracture patterns and multiple patient factors which play an important role in the outcome of the management of these fractures. Fortunately, the vast majority of these fractures can be treated conservatively. The challenge, however, is the 15% of patients in which surgery may be required such as displaced three-and four-part fractures, and fractures in young and active patients. Although various recent studies and review papers show acceptable results with conservative treatment, especially in elderly patients, the decision on when to operate and when to consider conservative treatment remains challenging. The goal of this current concepts paper is to highlight important aspects of the conservative management of patients with proximal humerus fractures, from initial assessment through to treatment, including possible complications.

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Section: Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Proximal humerus fractures - Part 1: Conservative management

et al. 2019

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“…[5] [27]Intramedullary nails have the benefit of limited soft tissue dissection and blood loss for 2-par fracture, but there many complications like distraction, screw backout and nonunion. [3] Open reduction and locking plate fixation is generally chosen [16,24]. However, in elderly patients, the frequency of complications such as varus deformity and screw penetration due to osteoporosis is high.…”

Section: Introductionmentioning

confidence: 99%

“…Especially in combined medial comminuted fractures, loss of fracture reduction occurs more frequently [17,20]. Therefore, the number of reverse total shoulder arthroplasty cases is increasing in elderly patients [16]. Some authors said that the preference for RSA over HA was especially high among patients aged 80 years or older, because they have a higher prevalence rotator cuff disease.…”

Section: Introductionmentioning

confidence: 99%

Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

Shin

Kang

Son

et al. 2019

Preprint

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Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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