Samuel Haupt1,2, Sabrina Weber3, Herman Frima4, René Hutter3, Holger Grehn3, Christoph Sommer5. 1. Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland. samuelhaupt@gmail.com. 2. Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland. samuelhaupt@gmail.com. 3. Department of Orthopedics, Kantonsspital Graubünden, Loëstrasse 99, 7000, Chur, Switzerland. 4. Department of Trauma Surgery, Northwest Hospitalgroup, Wilhelminalaan 12, 1815 JD, Alkmaar, Netherlands. 5. Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Abstract
PURPOSE: Proximal humeral fracture-dislocations (PHFD) are challenging to treat. In older patients, usually arthroplasty is performed. In younger patients, osteosynthesis is chosen. This study presents functional outcomes of these different treatment modalities. METHODS: All patients operated for PHFD from 2010 until 2017 were included. Osteosynthesis was performed in younger patients and if reconstruction was possible. Either an open deltopectoral approach or a minimal invasive plate osteosynthesis (MIPO) was performed. Hemiarthroplasty (HA) was done if reconstruction of the tubercles was possible, age was below 63 years and no signs of osteoarthritis were present. In all other cases, a reverse total shoulder arthroplasty (rTSA) was done. The primary endpoint was functional outcome assessed with the QuickDASH Score (QDS). Secondary outcomes were subjective shoulder value (SSV), complications, revisions, and conversion into arthroplasty. RESULTS: The mean follow-up of 40 patients was 56 ± 24 months. The mean QDS was 4.5 (0.6-9.1) and the mean SSV was 90 (80-98.6). Of these, 33 patients (mean age: 50) had an osteosynthesis, 25 were treated with MIPO. Only 18% were converted into an arthroplasty after a mean of 22 months. Among them, 7 patients received a primary arthroplasty (mean age: 68), no revisions were recorded. Subgroup analysis showed functional outcome deficits in avascular necrosis (AVN) compared to no AVN (p = 0.021), revision surgery compared to no revision (p = 0.040) and in HA compared to rTSA (p = 0.007). CONCLUSION: Both osteosynthesis and primary arthroplasty after PHFD can lead to good or even excellent functional outcome. Revision rates in osteosynthesis are high. Revision procedures or secondary conversion into arthroplasty after failed osteosynthesis decrease outcome scores significantly.
PURPOSE: Proximal humeral fracture-dislocations (PHFD) are challenging to treat. In older patients, usually arthroplasty is performed. In younger patients, osteosynthesis is chosen. This study presents functional outcomes of these different treatment modalities. METHODS: All patients operated for PHFD from 2010 until 2017 were included. Osteosynthesis was performed in younger patients and if reconstruction was possible. Either an open deltopectoral approach or a minimal invasive plate osteosynthesis (MIPO) was performed. Hemiarthroplasty (HA) was done if reconstruction of the tubercles was possible, age was below 63 years and no signs of osteoarthritis were present. In all other cases, a reverse total shoulder arthroplasty (rTSA) was done. The primary endpoint was functional outcome assessed with the QuickDASH Score (QDS). Secondary outcomes were subjective shoulder value (SSV), complications, revisions, and conversion into arthroplasty. RESULTS: The mean follow-up of 40 patients was 56 ± 24 months. The mean QDS was 4.5 (0.6-9.1) and the mean SSV was 90 (80-98.6). Of these, 33 patients (mean age: 50) had an osteosynthesis, 25 were treated with MIPO. Only 18% were converted into an arthroplasty after a mean of 22 months. Among them, 7 patients received a primary arthroplasty (mean age: 68), no revisions were recorded. Subgroup analysis showed functional outcome deficits in avascular necrosis (AVN) compared to no AVN (p = 0.021), revision surgery compared to no revision (p = 0.040) and in HA compared to rTSA (p = 0.007). CONCLUSION: Both osteosynthesis and primary arthroplasty after PHFD can lead to good or even excellent functional outcome. Revision rates in osteosynthesis are high. Revision procedures or secondary conversion into arthroplasty after failed osteosynthesis decrease outcome scores significantly.
Authors: C Michael Robinson; Paul H C Stirling; Ewan B Goudie; Deborah J MacDonald; Jason A Strelzow Journal: J Bone Joint Surg Am Date: 2019-12-04 Impact factor: 5.284
Authors: Christian Spross; Jan Meester; Ruben A Mazzucchelli; Gábor J Puskás; Vilijam Zdravkovic; Bernhard Jost Journal: J Shoulder Elbow Surg Date: 2019-04-16 Impact factor: 3.019
Authors: Christian Spross; Nicola Kaestle; Emanuel Benninger; Jürgen Fornaro; Johannes Erhardt; Vilijam Zdravkovic; Bernhard Jost Journal: Clin Orthop Relat Res Date: 2015-04-25 Impact factor: 4.176