H Siekmann1,2, T S Bowen3, M Huschak1,2, F Radetzki4,5, C Bauer1,2, J Walther1,6. 1. Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther Universität, Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland. 2. Abteilung für Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität, Halle Wittenberg, Halle (Saale), Deutschland. 3. School of Biomedical Science, University of Leeds, Leeds, Großbritannien. 4. Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther Universität, Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland. florian.radetzki@klinikum-dessau.de. 5. Klinik für Orthopädie und Unfallchirurgie, Städtisches Klinikum Dessau, Dessau, Deutschland. florian.radetzki@klinikum-dessau.de. 6. Universitätszentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
Abstract
BACKGROUND: The exact incidence of postoperative periprosthetic humeral fractures (PPHF) months or years after fracture-related implantation of a hemiprosthesis is unknown. The currently available literature is predominantly concerned with operative treatment approaches. As a rule, these involved older patients and severe fracture conditions so that severe complications and unsatisfactory healing results were described. This article presents an alternative conservative treatment approach which is discussed based on the results of treatment. PATIENTS AND METHODS: Between 2011 and 2016 a conservative treatment of 5 female patients with PPHF could be carried out. Of the patients 4 were clinically and radiologically controlled at a mean follow-up time of 23 months. The fifth patient died 2 months after the trauma and only partial information of the treatment was available. RESULT: There were no intrahospital complications and just one posthospital complication. In the case of the patient who later died, repeated and unauthorized removal of the upper arm brace occurred in the nursing institution resulting in a lesion of the radial nerve. Of the four patients who completed treatment, three were very satisfied with the outcome of treatment. The mean DASH (Disabilities of Arm, Shoulder and Hand) and Oxford shoulder scores were on average 74 and 25 points, respectively. At the time of the follow-up examination all patients were free of pain, without the use of analgesics; however, there were still some limitations in the activities of daily life, which in three of the four patients was similar to the results following implantation of the fracture prosthesis. CONCLUSION: The conservative treatment of PPHF can be a safe treatment option in multimorbid and chronically ill patients. A close outpatient control and good patient compliance are important. In incompliant and dementia patients, the risk of failure of conservative treatment is increased.
BACKGROUND: The exact incidence of postoperative periprosthetic humeral fractures (PPHF) months or years after fracture-related implantation of a hemiprosthesis is unknown. The currently available literature is predominantly concerned with operative treatment approaches. As a rule, these involved older patients and severe fracture conditions so that severe complications and unsatisfactory healing results were described. This article presents an alternative conservative treatment approach which is discussed based on the results of treatment. PATIENTS AND METHODS: Between 2011 and 2016 a conservative treatment of 5 female patients with PPHF could be carried out. Of the patients 4 were clinically and radiologically controlled at a mean follow-up time of 23 months. The fifth patient died 2 months after the trauma and only partial information of the treatment was available. RESULT: There were no intrahospital complications and just one posthospital complication. In the case of the patient who later died, repeated and unauthorized removal of the upper arm brace occurred in the nursing institution resulting in a lesion of the radial nerve. Of the four patients who completed treatment, three were very satisfied with the outcome of treatment. The mean DASH (Disabilities of Arm, Shoulder and Hand) and Oxford shoulder scores were on average 74 and 25 points, respectively. At the time of the follow-up examination all patients were free of pain, without the use of analgesics; however, there were still some limitations in the activities of daily life, which in three of the four patients was similar to the results following implantation of the fracture prosthesis. CONCLUSION: The conservative treatment of PPHF can be a safe treatment option in multimorbid and chronically ill patients. A close outpatient control and good patient compliance are important. In incompliant and dementiapatients, the risk of failure of conservative treatment is increased.
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