Giovanni Sanchez1,2, Marcos Vargas1,2, Adam M Gordon3, Ivan Golub1, Asad Ashraf1, Keith Diamond1, Kevin K Kang1, Afshin E Razi1. 1. Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA. 2. College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA. 3. Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA. Agordon55@gmail.com.
Abstract
PURPOSE: The incidence of proximal humerus fractures (PHF) is rising and surgical intervention carries risk for fracture nonunion. The purpose was (1) to compare patient demographics of those that developed nonunion and (2) identify patient risk factors that predispose to nonunion following open reduction and internal fixation (ORIF) for PHF. METHODS: A retrospective review of the Medicare Claims Database from 2005 to 2014 for patients who underwent primary ORIF for PHFs. Patients who developed nonunion were identified as the study group (n = 1020) and compared to a control group (n = 51,209). Primary endpoints were to compare demographics of the study group and the comparison cohorts and to identify patient-related risk factors associated with nonunion within 6-months following the index procedure. A logistic regression model was constructed to determine the association of comorbid conditions on developing a nonunion. A p value of 0.001 was the significance threshold. RESULTS: Patients who developed nonunion were younger, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (7 vs. 5; p < 0.0001) when compared with controls. Iron deficiency anemia (OR: 1.32; p = 0.0001), tobacco use (OR: 1.32; p = 0.0004), rheumatoid arthritis (OR: 1.29; p = 0.0001), depression (OR: 1.28; p = 0.0002), and BMI range from 30-39 kg/m2 (OR: 1.21; p = 0.001) were significant risk factors for nonunion. CONCLUSIONS: Certain patient risk factors including tobacco use, iron deficiency anemia, rheumatoid arthritis, depression, and a BMI in the range of 30-39 were associated with nonunion within 6 months of ORIF for PHF. This study may help in the risk stratification of these patients.
PURPOSE: The incidence of proximal humerus fractures (PHF) is rising and surgical intervention carries risk for fracture nonunion. The purpose was (1) to compare patient demographics of those that developed nonunion and (2) identify patient risk factors that predispose to nonunion following open reduction and internal fixation (ORIF) for PHF. METHODS: A retrospective review of the Medicare Claims Database from 2005 to 2014 for patients who underwent primary ORIF for PHFs. Patients who developed nonunion were identified as the study group (n = 1020) and compared to a control group (n = 51,209). Primary endpoints were to compare demographics of the study group and the comparison cohorts and to identify patient-related risk factors associated with nonunion within 6-months following the index procedure. A logistic regression model was constructed to determine the association of comorbid conditions on developing a nonunion. A p value of 0.001 was the significance threshold. RESULTS: Patients who developed nonunion were younger, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (7 vs. 5; p < 0.0001) when compared with controls. Iron deficiency anemia (OR: 1.32; p = 0.0001), tobacco use (OR: 1.32; p = 0.0004), rheumatoid arthritis (OR: 1.29; p = 0.0001), depression (OR: 1.28; p = 0.0002), and BMI range from 30-39 kg/m2 (OR: 1.21; p = 0.001) were significant risk factors for nonunion. CONCLUSIONS: Certain patient risk factors including tobacco use, iron deficiency anemia, rheumatoid arthritis, depression, and a BMI in the range of 30-39 were associated with nonunion within 6 months of ORIF for PHF. This study may help in the risk stratification of these patients.
Authors: Dietmar Krappinger; Nicola Bizzotto; Stephan Riedmann; Christian Kammerlander; Clemens Hengg; Franz Sebastian Kralinger Journal: Injury Date: 2011-02-09 Impact factor: 2.586
Authors: Sandra Boesmueller; Margit Wech; Markus Gregori; Florian Domaszewski; Adam Bukaty; Christian Fialka; Christian Albrecht Journal: Injury Date: 2015-10-22 Impact factor: 2.586