Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures

Siebenbürger, Georg; Delden, Dustin Van; Helfen, Tobias; Haasters, Florian; Böcker, Wolfgang; Ockert, Ben

doi:10.1016/s0020-1383(15)30019-x

Cited by 42 publications

(31 citation statements)

References 30 publications

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“…However, the timing of surgery for acute fractures remains unclear. Recently, proximal humerus fracture fixation within five days of the fracture event was recommended, since a delayed intervention (six or more days after the injury) is related to a significant increase in complications [21], which is similar to the results of this study. A delayed surgical intervention is thought to complicate the anatomical fracture reduction and increase soft tissue dissection, which may result in a longer fracture union time [24].…”

Section: Discussionsupporting

confidence: 87%

“…Patients who met these criteria were further divided into two groups; an early treatment group (early group), which included patients for whom the time from injury to surgery was within six days, and a delayed treatment group (delayed group), which included patients for whom time to surgery was seven days or more. This cut-off was set based on a previous report on acute proximal humeral fracture for which delayed surgical intervention (six or more days after the injury) was related to a significant increase in postoperative complications [21] because there was no reference describing the timing of surgery for acute distal clavicular fractures.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Furuhata

Takahashi

Hayashi

et al. 2020

Preprint

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Background Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after seven days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. Results Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P=0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures . In addition, this study suggested that performing surgery within six days after injury is recommended to reduce postoperative complications .

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Furuhata

Takahashi

Hayashi

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…These results suggest that delaying the surgical intervention for seven or more days after injury may be associated with an increase in prostoperative complications. Regarding the timing of distal clavicle fracture surgery, postoperative complications have been reported to increase in subjects that undergo surgery more than four weeks after injury [1,21]; however, the timing of surgery for acute fractures remains unclear. Recently, proximal humerus fracture fixation within five days of the fracture event was recommended, since a delayed intervention (six or more days after the injury) is related to a significant increase in complications [21], which is similar to the results of this study.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who met these criteria were further divided into two groups based on a previous report on the treatment of acute proximal humeral fractures; an early treatment group (early group), which included patients for whom the time from injury to surgery was within six days, and a delayed treatment group (delayed group), which included patients for whom time to surgery was seven days or more, according to a previous report on the treatment of acute proximal humeral fractures [21].…”

Section: Patient Selectionmentioning

confidence: 99%

Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Furuhata

Takahashi

Hayashi

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Plate fixation is the established method of treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after seven days). The outcomes were postoperative complications (delayed union, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes.Results Among the 105 patients, delayed union, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one (1.0%) patient, respectively. The delayed union rate was significantly higher in the delayed treatment group than that in the early treatment group (P=0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures . In addition, this study suggested that performing surgery within six days after injury is recommended to reduce postoperative complications .

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“…If surgery was performed more than 5 days after the accident, an increased risk of complications could be observed [41]. In our population, 57.5% of interventions were conducted during this critical time period.…”

Section: Discussionmentioning

confidence: 99%

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

Saul¹,

Himmelmann²,

Dresing³

2017

TOORTHJ

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Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS® plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.

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Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures

Cited by 42 publications

References 30 publications

Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Treatment of Distal Clavicle Fractures using a Scorpion Plate and Influence of Timing on Surgical Outcomes: A Retrospective Cohort Study of 105 Cases

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

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