Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017

McLean, Andrew; Price, Nathan; Graves, Stephen E.; Hatton, Alesha; Taylor, Frances

doi:10.1016/j.jse.2019.03.034

Cited by 74 publications

(61 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 1 With the elderly osteoporotic population continuing rising in this aging society, the megatrend of PHFs incidence remains increasing in the recent years. 2 - 4 Non-operative treatments might be beneficial to undisplaced or minimally displaced PHFs, showing good clinical outcomes. 5 However, there is still a controversy among the treatments between nonoperation and operation in the displaced PHFs.…”

Section: Introductionmentioning

confidence: 99%

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Sun

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Background Proximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. Methods A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. Results No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). Conclusions Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

show abstract

Section: Introductionmentioning

confidence: 99%

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Sun

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…The main theoretical advantage of rTSA is that shoulder function is thought to be less dependent on tuberosity healing as compared with HA. Since the publication of the first case series, 11,14 the use of rTSA for proximal humeral fractures has increased substantially, and rTSA is currently more commonly used than HA in some countries, 23,31,34,38 with some previous studies supporting the increasing use of rTSA 24,49 whereas others have not supported this. 37 We conducted a multicenter, generic randomized controlled trial (RCT) to test the hypothesis that rTSA provides better shoulder function than HA, with the Constant score as the primary outcome measure, for displaced 3-and 4-part proximal humeral fractures in elderly patients.…”

mentioning

confidence: 99%

Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial

Jonsson

Ekholm

Salomonsson

et al. 2021

Journal of Shoulder and Elbow Surgery

View full text Add to dashboard Cite

Background: The most appropriate treatment for displaced multiple-fragment proximal humeral fractures in elderly patients is currently unclear. Reverse total shoulder arthroplasty (rTSA) is a promising treatment option that is being used increasingly. The purpose of this study was to compare the outcome of rTSA vs. hemiarthroplasty (HA) for the treatment of displaced 3-and 4-part fractures in elderly patients. Methods: This was a multicenter randomized controlled trial. We included patients aged ! 70 years with displaced 3-or 4-part proximal humeral fractures between September 2013 and May 2016. The minimum follow-up period was 2 years, with outcome measures including the Constant score (primary outcome), Western Ontario Osteoarthritis of the Shoulder index, EQ-5D (EuroQol 5 Dimensions) index, and range of motion, as well as pain and shoulder satisfaction assessed on a visual analog scale. Results: We randomized 99 patients to rTSA (48 patients) or HA (51 patients). Fifteen patients were lost to follow-up, leaving 41 rTSA and 43 HA patients for analysis. The mean age was 79.5 years, and there were 76 women (90%). The rTSA group had a mean Constant score of 58.7 points compared with 47.7 points in the HA group, with a mean difference of 11.1 points (95% CI, 3.0-18.9 points; P ¼ .007). Compared with HA patients, rTSA patients had greater mean satisfaction with the shoulder (79 mm vs. 63 mm, P ¼ .011), flexion (125 vs. 90 , P < .001), and abduction (112 vs. 83 , P < .001), but there was no difference in Western Ontario Osteoarthritis of the Shoulder index, pain, or EQ-5D index scores. We identified 3 and 4 adverse events in the rTSA and HA groups, respectively. Among patients aged ! 80 years (n ¼ 38), there was no difference between rTSA treatment and HA treatment in pain (17 mm vs. 9 mm, P ¼ .17) or shoulder satisfaction (77 mm vs. 74 mm, P ¼ .73).This study was approved by the Swedish Ethical Review Authority (study no. 2013/1053-31/3).

show abstract

“…our results are comparable with the findings from all these studies. [4][5][6][7]17 in 2001, a cochrane database systematic review found the scientific evidence about the treatment of PHFs to be insufficient. 18 Subsequently, the subject has been studied intensively, and several rcTs have been published.…”

Section: Discussionmentioning

confidence: 99%

Proximal humeral fractures in Finland

Leino

Lehtimäki

Mäkelä

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims Proximal humeral fractures (PHFs) are common. There is increasing evidence that most of these fractures should be treated conservatively. However, recent studies have shown an increase in use of operative treatment. The aim of this study was to identify the trends in the incidence and methods of treatment of PHFs in Finland. Methods The study included all Finnish inhabitants aged ≥ 16 years between 1997 and 2019. All records, including diagnostic codes for PHFs and all surgical procedure codes for these fractures, were identified from two national registers. Data exclusion criteria were implemented in order to identify only acute PHFs, and the operations performed to treat them. Results During the 23-year study period, 79,676 PHFs were identified, and 14,941 operations were performed to treat them. The incidence of PHFs steadily increased. In 2019, the overall incidence was 105 per 100,000 person-years (105). The sex-adjusted incidence for females was 147.1 per 105, and the age-adjusted incidence for patients aged ≥ 80 years was 407.1 per 105. The incidence of operative treatment for PHFs rose during the first half of the study period and decreased during the second half. The use of plate osteosynthesis in particular decreased. In 2019, the incidence of operative treatment for PHFs was 13.2 per 105, with 604 operations. Conclusion Although the incidence of PHFs is steadily increasing, particularly in elderly females, the incidence of operative treatment is now decreasing, which is in line with current literature regarding their treatment. Cite this article: Bone Joint J 2022;104-B(1):150–156.

show abstract

Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017

Cited by 74 publications

References 33 publications

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial

Proximal humeral fractures in Finland

Contact Info

Product

Resources

About