No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures

Bergdahl, Carl; Wennergren, David; Swensson-Backelin, Eleonora; Ekelund, Jan; Möller, Michael

doi:10.1080/17453674.2021.1941629

Cited by 6 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A Swedish single-center study of 4,070 PHF reported an average proportion of surgically treated fractures (2011–2017) of 23%. Among the operated cases, the proportion of locking plates decreased from 47% to 25% while the proportion of RSA increased from 2% to 19% ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology and trends in management of acute proximal humeral fractures in adults: an observational study of 137,436 cases from the Danish National Patient Register, 1996–2018

Brorson

Viberg

Gundtoft

et al. 2022

ActaO

View full text Add to dashboard Cite

Background and purpose: Proximal humeral fractures (PHF) can be managed surgically or non-surgically. Locking plates have been the preferred head-preserving surgical technique while hemiarthroplasty (HA) or reverse shoulder arthroplasty (RSA) have been used in joint replacement surgery. We describe the epidemiology and trends in management of acute PHF in Denmark with a focus on (i) changes in the incidence of PHF; (ii) changes in the proportion of surgical cases; and (iii) changes in preferred surgical techniques.Patients and methods: Data on diagnoses and interventions was retrieved from the Danish National Patient Register. Patients aged 18 years and above were included. Surgical treatment was defined as the diagnosis of PHF combined with a predefined surgical procedure code within 3 weeks of injury. Data on plate osteosynthesis, HA, RSA, and “other techniques” was retrieved. Non-surgical treatment was defined as no relevant surgical procedure code within 3 weeks.Results: We identified 137,436 PHF (72% women) in the Danish National Patient Register. The overall mean incidence was 138/100,000/year (500 for women 60 years or above). Non-surgical treatment accounted for 119,966 (87%). The 17,470 surgical procedures included 42% locking plates, 34% arthroplasties, and 25% other techniques. The rate of surgery declined from 17% in 2013 to 11% in 2018.Interpretation: The overall incidence of PHF remained stable between 1996 and 2018 but the absolute number increased. The approach to PHF remains predominantly non-surgical. The number of surgeries in Denmark have decreased since 2013, especially for locking plates and HA, while RSA is increasingly used.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Bergdahl et al ( 35 ) demonstrated problems with coding in the Swedish National Patient Registry. However, the DNPR differs from the Swedish National Patient Registry in several aspects.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and trends in management of acute proximal humeral fractures in adults: an observational study of 137,436 cases from the Danish National Patient Register, 1996–2018

Brorson

Viberg

Gundtoft

et al. 2022

ActaO

View full text Add to dashboard Cite

show abstract

“…Due to thinning trabeculae and cortical bones, severely displaced and comminuted PHFs with medial calcar impaction are common injuries and are normally treated using a locking plate or intramedullary nail internal fixation ( Mease et al, 2021 ). Unfortunately, complications, such as a loss of reduction and internal fixation failure, and functional limitations occurred in approximately 40% of patients who underwent surgery, and the reoperation rate was 19.7% ( Barlow et al, 2020 ; Bergdahl et al, 2021 ). Increasing the mechanical stability of the medial column and counteracting varus displacement force may be useful to avoid those complications ( Euler et al, 2017 ; Dasari et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of novel intra- and extramedullary assembly fixation for proximal humerus fractures in the elderly

Zhu,

Chang,

Zhang

et al. 2023

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

Purpose: A novel intra- and extramedullary assembly fixation method was introduced, which achieved good clinical results in complex proximal humeral fractures; however, evidence of its comparability with traditional fixation is lacking. This biomechanical study aimed to compare it with traditional fixation devices in osteoporotic proximal humeral fractures.Methods: Three-part proximal humeral fractures with osteopenia were created on 12 pairs of fresh frozen humerus specimens and allocated to three groups: 1) lateral locking plate, 2) intramedullary nail, and 3) intra- and extramedullary assembly fixation. The specimens were loaded to simulate the force at 25° abduction. Thereafter, an axial stiffness test and a compound cyclic load to failure test were applied. Structural stiffness, number of cycles loaded to failure, and relative displacement values at predetermined measurement points were recorded using a testing machine and a synchronized 3D video tracking system.Results: In terms of initial stiffness and the number of cycles loaded to failure, the intra- and extramedullary assembly fixation group showed notable improvements compared to the other groups (p <0.017). The mean relative displacement value of measurement points in the intra- and extramedullary assembly fixation group was smaller than that in the other two groups. However, there was no significant difference until 10,000 cycles. The mean relative displacement of the intramedullary nail group (3.136 mm) exceeded 3 mm at 7,500 cycles of loading.Conclusion: In this test model, axial fixation can provide better mechanical stability than non-axial fixation. The intra- and extramedullary assembly fixation is better able to prevent the varus collapse for elderly proximal humeral fractures with posteromedial comminution.

show abstract

“…Importantly, with the increasing performance of shoulder arthroplasty procedures, also the risk of complications such as periprosthetic joint infection is heightened. A few studies reported revision rates based on large registry data such as the Nordic Arthroplasty Register Association [14][15][16], the Swedish Fracture Register [17] and the Australian Orthopaedic Association National Joint Replacement Registry [18]. However, substantial heterogeneity among studies reporting reoperation rates was noted [19].…”

Section: Introductionmentioning

confidence: 99%

Revision Rates and Associated Risk Factors after Shoulder Arthroplasty

Walter

Lowenberg

Kurtz

et al. 2022

JCM

View full text Add to dashboard Cite

This study aims at answering the following questions (1) How high is the revision rate after osteoarthritis-, and rotator cuff-related compared to proximal humerus fracture (PHF)-related shoulder arthroplasty? (2) What are the associated risk factors for a revision after shoulder arthroplasty? Shoulder arthroplasty procedures occurring between 1 January 2009 and 31 December 2019 were identified from the Medicare database. First, revision rates for PHF patients and age- and sex-matched non-fracture patients, grouped into osteoarthritis-related and rotator cuff-related arthroplasty, were compared. Second, revision rates between total shoulder arthroplasty and hemiarthroplasty after PHF were compared. Semiparametric Cox regression was applied, incorporating 23 demographic, clinical, and socioeconomic covariates, to investigate risk factors for revision surgery. Between the considered time period from 2009 through 2019, a total number of 47,979 PHFs was identified. A shoulder arthroplasty procedure was performed in n = 2639 (5.5%, 95%CI: 4.8–6.1) of the cases. The five-year survivorship of the implant was 96.3 (95%CI: 93.8–97.9) after hemiarthroplasty and 96.1% (05%CI: 94.2–97.3) after total shoulder arthroplasty. To compare the revision rates, n = 14,775 patients with osteoarthritis and n = 4268 patients with rotator cuff arthropathy, who received a shoulder arthroplasty, served as a non-fracture control group. Patients receiving a rotator cuff-related arthroplasty were more likely to require a revision compared to patients treated for osteoarthritis (HR: 1.27, 95%CI: 1.04–1.44, p = 0.018). Identified significant risk factors for revision surgery after shoulder arthroplasty included age ≤ 75 years, male sex, and osteoporosis. High implant survival was found for hemiarthroplasty and total shoulder arthroplasty for the treatment of PHF in elderly patients. The risk of revision surgery was elevated in patients receiving a rotator cuff-related arthroplasty as well as in patients with osteoporosis, male patients and patients older than 75 years.

show abstract

No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures

Abstract: 2021): No change in reoperation rates despite shifting treatment trends: a population-based study of 4,070 proximal humeral fractures, Acta Orthopaedica,

Cited by 6 publications

References 30 publications

Epidemiology and trends in management of acute proximal humeral fractures in adults: an observational study of 137,436 cases from the Danish National Patient Register, 1996–2018

Epidemiology and trends in management of acute proximal humeral fractures in adults: an observational study of 137,436 cases from the Danish National Patient Register, 1996–2018

Biomechanical evaluation of novel intra- and extramedullary assembly fixation for proximal humerus fractures in the elderly

Revision Rates and Associated Risk Factors after Shoulder Arthroplasty

Contact Info

Product

Resources

About