Reinier W A Spek1,2,3, Lotje A Hoogervorst4, Michaëla E C Elias5, Ruurd L Jaarsma6, DirkJan H E J Veeger7, Job N Doornberg8, Paul C Jutte8, Michel P J van den Bekerom9. 1. Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia. reinierspek@gmail.com. 2. Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands. reinierspek@gmail.com. 3. Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands. reinierspek@gmail.com. 4. Department of Orthopaedic Surgery, Department of Biomedical Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands. 5. Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands. 6. Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia. 7. Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands. 8. Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands. 9. Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Abstract
INTRODUCTION: It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus. Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). MATERIALS AND METHODS: A consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016-2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. Linear mixed modelling was performed to evaluate if these measurements would improve over time. RESULTS: Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. The mean age (range) was 68 years (24-93), and the mean number (range) of follow-up radiographs per patient was 1 (1-4). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up (p-value = 0.004). CONCLUSIONS: Apart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. LEVEL OF CLINICAL EVIDENCE: Level IV, retrospective case series.
INTRODUCTION: It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus. Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). MATERIALS AND METHODS: A consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016-2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. Linear mixed modelling was performed to evaluate if these measurements would improve over time. RESULTS: Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. The mean age (range) was 68 years (24-93), and the mean number (range) of follow-up radiographs per patient was 1 (1-4). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up (p-value = 0.004). CONCLUSIONS: Apart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. LEVEL OF CLINICAL EVIDENCE: Level IV, retrospective case series.
Authors: C Meyer; V Alt; H Hassanin; C Heiss; J-P Stahl; G Giebel; J Koebke; R Schnettler Journal: Surg Radiol Anat Date: 2005-07-06 Impact factor: 1.246
Authors: Marieke F van Wier; Ihsane Amajjar; Noortje C Hagemeijer; Femke M A P Claessen; Michel P J van den Bekerom; Derek F P van Deurzen Journal: Orthop Traumatol Surg Res Date: 2020-03-12 Impact factor: 2.256
Authors: Antti P Launonen; Bakir O Sumrein; Aleksi Reito; Vesa Lepola; Juha Paloneva; Kenneth B Jonsson; Olof Wolf; Peter Ström; Hans E Berg; Li Felländer-Tsai; Karl-Åke Jansson; Daniel Fell; Inger Mechlenburg; Kaj Døssing; Helle Østergaard; Aare Märtson; Minna K Laitinen; Ville M Mattila Journal: PLoS Med Date: 2019-07-18 Impact factor: 11.069