Antonio M Foruria1, Milagros Martí, Joaquin Sanchez-Sotelo. 1. *Department of Orthopedic Surgery, Fundación Jiménez Díaz, Madrid, Spain; †Department of Radiology, La Paz University Hospital, Madrid, Spain; and ‡Department of Orthopedic Surgery, The Mayo Clinic, Rochester MN.
Abstract
OBJECTIVES: Determine the relative position of the main fractured fragments of proximal humerus fractures treated conservatively to compare displacement at 2 time points: injury (0), and 1 year later (1). DESIGN: Prospective, comparative cohort study. SETTING: Level I trauma center. PATIENTS: Eighty-nine prospectively enrolled adults. INTERVENTION: Six weeks of sling immobilization and a home-based program rehabilitation protocol started 2 weeks after injury. MAIN OUTCOME MEASUREMENTS: Standardized radiographs of injured shoulders were obtained in all patients at times 0 and 1. Computed tomography scans were also obtained at these times in 73 cases. Forty-two computer-assisted measurements of displacement were performed at times 0 and 1 and then compared. Factors related to progression of displacement were analyzed. RESULTS: Ninety percent of fractures were classified into 1 of 4 patterns: posteromedial (varus) impaction (46), lateral (valgus) impaction (13), isolated greater tuberosity (15), and anteromedial impaction (6). Head-shaft displacement increased over time. In posteromedial impaction fractures, average fracture settling included 9 degrees in varus, 7 degrees in retroversion, and 3.2 mm in posterior shortening. In valgus-impacted fractures, a decrease in valgus tilt and a tendency toward a more anterior orientation of the articular surface was observed. Greater tuberosity displacement increased more than 5 mm in less than 20% of cases. Age and initial displacement were related to progression of displacement. CONCLUSIONS: Proximal humerus fractures treated conservatively settle at the head-shaft junction during healing. Substantial additional displacement of tuberosities was seldom observed. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: Determine the relative position of the main fractured fragments of proximal humerus fractures treated conservatively to compare displacement at 2 time points: injury (0), and 1 year later (1). DESIGN: Prospective, comparative cohort study. SETTING: Level I trauma center. PATIENTS: Eighty-nine prospectively enrolled adults. INTERVENTION: Six weeks of sling immobilization and a home-based program rehabilitation protocol started 2 weeks after injury. MAIN OUTCOME MEASUREMENTS: Standardized radiographs of injured shoulders were obtained in all patients at times 0 and 1. Computed tomography scans were also obtained at these times in 73 cases. Forty-two computer-assisted measurements of displacement were performed at times 0 and 1 and then compared. Factors related to progression of displacement were analyzed. RESULTS: Ninety percent of fractures were classified into 1 of 4 patterns: posteromedial (varus) impaction (46), lateral (valgus) impaction (13), isolated greater tuberosity (15), and anteromedial impaction (6). Head-shaft displacement increased over time. In posteromedial impaction fractures, average fracture settling included 9 degrees in varus, 7 degrees in retroversion, and 3.2 mm in posterior shortening. In valgus-impacted fractures, a decrease in valgus tilt and a tendency toward a more anterior orientation of the articular surface was observed. Greater tuberosity displacement increased more than 5 mm in less than 20% of cases. Age and initial displacement were related to progression of displacement. CONCLUSIONS: Proximal humerus fractures treated conservatively settle at the head-shaft junction during healing. Substantial additional displacement of tuberosities was seldom observed. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Ingrid Bønes; Anna Cecilie Karlberg; Maria Liljeholm; Alexander Nilsskog Fraser; Jan Erik Madsen; Tore Fjalestad Journal: J Orthop Surg Res Date: 2022-02-02 Impact factor: 2.359