Share this Article
Hong CC, Hey HW, Murphy D
Correspondence: Dr Hong Choon Chiet, choonchiet@gmail.com
ABSTRACT
INTRODUCTION New knowledge, and improved surgical hardware and fi xation techniques have changed surgical management. We review the evolving trends of surgically managed proximal humerus fractures.
METHODS Patients who underwent surgery for proximal humerus fractures from 1 January 2001 to 31 December 2010 were identified from the hospital’s electronic diagnosis and operative coding database. Data extracted from the database included patient demographics, comorbidities, clinical and radiological findings, operative techniques, and complications.
RESULTS In total, 95 patients with 97 surgically managed proximal humerus fractures were identified. The median age of the patients was 50 (range 12–85) years, and the male to female ratio was 1.2:1.0. Male patients tended to present at a younger age than female patients (peak age 30–39 years vs. 70–79 years, p < 0.001). Two-part surgical neck fracture was the most common type of fracture (n = 33, 34.0%). Plate osteosynthesis was predominantly used for two- and three-part surgical neck fractures involving the greater tuberosity (p = 0.03, p = 0.0002, respectively). Hemiarthroplasty was commonly performed for four-part fractures (p < 0.001). Wound infections, implant failure, avascular necrosis of the humeral head and nonunion were seen in 8 (8.3%) cases. Minimally invasive plate osteosynthesis (MIPO) had been in use since 2007 (p < 0.001).
CONCLUSION Surgically managed proximal humerus fractures predominantly involved young men following high velocity injury and elderly women following osteoporotic fractures. Open plating was most commonly used for two- and three-part fractures, and hemiarthroplasty for four-part fractures. MIPO techniques have been practised in our institution since 2007.
Keywords: complication, epidemiology, minimally invasive plate osteosynthesis, Neer’s classification, proximal humerus fracture
Singapore Med J 2014; 55(11): 574-578; http://dx.doi.org/10.11622/smedj.2014153
REFERENCES
| 1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37:691-7. http://dx.doi.org/10.1016/j.injury.2006.04.130 | ||||
| 2. Lind T, Krøner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 1989; 108:285-7. http://dx.doi.org/10.1007/BF00932316 | ||||
| 3. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72:365-71. http://dx.doi.org/10.1080/000164701753542023 | ||||
| 4. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52:1077-89. PMid:5455339 | ||||
| 5. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970; 52:1090-103. PMid:5455340 | ||||
| 6. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 2006; 442:87-92. http://dx.doi.org/10.1097/01.blo.0000194672.79634.78 | ||||
| 7. Chu SP, Kelsey JL, Keegan TH, et al. Risk factors for proximal humerus fracture. Am J Epidemiol 2004; 160:360-7. http://dx.doi.org/10.1093/aje/kwh224 | ||||
| 8. Lee SH, Dargent-Molina P, Bréart G; EPIDOS Group. Epidemiologie de l'Osteoporose Study. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 2002; 17:817-25. http://dx.doi.org/10.1359/jbmr.2002.17.5.817 | ||||
| 9. Seeley DG, Browner WS, Nevitt MC, et al. Which fractures are associated with low appendicular bone mass in elderly women- The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1991; 115:837-42. http://dx.doi.org/10.7326/0003-4819-115-11-837 | ||||
| 10. Lauritzen JB, Schwarz P, Lund B, McNair P, Transbøl I. Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int 1993; 3:127-32. http://dx.doi.org/10.1007/BF01623273 | ||||
| 11. Aggarwal S, Bali K, Dhillon MS, Kumar V, Mootha AK. Displaced proximal humeral fractures: an Indian experience with locking plates. J Orthop Surg Res 2010; 5:60. http://dx.doi.org/10.1186/1749-799X-5-60 | ||||
| 12. Key Demographic Trends. Census of Singapore Population 2010. Available at: www.singstat.gov.sg. Accessed November 8, 2012. | ||||
| 13. Szyszkowitz R, Seggl W, Schleifer P, Cundy PJ. Proximal humeral fractures. Management techniques and expected results. Clin Orthop Relat Res 1993; 13-25. PMid:8519100 | ||||
| 14. Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br 2000; 82:1107-12. http://dx.doi.org/10.1302/0301-620X.82B8.10330 | ||||
| 15. Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults--a systematic review of management. Injury 2001; 32:363-72. http://dx.doi.org/10.1016/S0020-1383(00)00242-4 | ||||
| 16. Resch H. Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 2011; 20:827-32. http://dx.doi.org/10.1016/j.jse.2011.01.009 | ||||
| 17. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible- A cadaveric study and preliminary report. Injury 2005; 36:530-8. http://dx.doi.org/10.1016/j.injury.2004.05.036 | ||||
| 18. Lau TW, Leung F, Chan CF, Chow SP. Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture. Int Orthop 2007; 31:657-64. http://dx.doi.org/10.1007/s00264-006-0242-4 | ||||
| 19. Rancan M, Dietrich M, Lamdark T, Can U, Platz A. Minimally invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury 2010; 41:1277-83. http://dx.doi.org/10.1016/j.injury.2010.07.235 | ||||
| 20. Brunner A, Thormann S, Babst R. Minimally invasive percutaneous plating of proximal humerus shaft fractures with the Proximal Humerus Internal Locking System (PHILOS). J Shoulder Elbow Surg 2012; 21:1056-63. http://dx.doi.org/10.1016/j.jse.2011.05.016 | ||||
| 21. Modi CS, Nnene CO, Godsiff SP, Esler CN. Axillary artery injury secondary to displaced proximal humeral fractures: a report of two cases. J Orthop Surg (Hong Kong) 2008; 16:243-6. | ||||
| 22. Mouzopoulos G, Lassanianos N, Mouzopoulos D, Tzurbakis M, Georgilas I. Axillary artery injury associated with proximal humerus fractures. Vasa 2008; 37:274-7. http://dx.doi.org/10.1024/0301-1526.37.3.274 | ||||
| 23. Visser CP, Coene LN, Brand R, Tavy DL. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg 2001; 10:421-7. http://dx.doi.org/10.1067/mse.2001.118002 | ||||
| 24. Nam D, Kepler CK, Neviaser AS, et al. Reverse total shoulder arthroplasty: current concepts, results, and component wear analysis. J Bone Joint Surg Am 2010; 92 Suppl 2:23-35. http://dx.doi.org/10.2106/JBJS.J.00769 | ||||
| 25. Garrigues GE, Johnston PS, Pepe MD, et al. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics 2012; 35:e703-8. http://dx.doi.org/10.3928/01477447-20120426-25 | ||||
| 26. Reitman RD, Kerzhner E. Reverse shoulder arthoplasty as treatment for comminuted proximal humeral fractures in elderly patients. Am J Orthop (Belle Mead NJ) 2011; 40:458-61. PMid:22022675 | ||||
| 27. Saltzman MD, Marecek GS, Edwards SL, Kalainov DM. Infection after shoulder surgery. J Am Acad Orthop Surg 2011; 19:208-18. PMid:21464214 | ||||