Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder
					Surgery

Rony-Orijit Dey Hazra; Robert Maximilian Blach; Alexander Ellwein; Jan Christoph Katthagen; Helmut Lill; Gunnar Jensen

doi:10.1055/a-1333-3951

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2022; 160(03): 287-298
DOI: 10.1055/a-1333-3951

Original Article/Originalarbeit

Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

Article in several languages: English | deutsch

Rony-Orijit Dey Hazra

¹Orthopaedic and Trauma Clinic, DIAKOVERE Friederikenstift, Hanover, Germany

,

Robert Maximilian Blach

¹Orthopaedic and Trauma Clinic, DIAKOVERE Friederikenstift, Hanover, Germany

,

Alexander Ellwein

²Orthopaedic Clinic, Medical School Hanover (MHH), DIAKOVERE Annastift, Hanover, Germany

,

Jan Christoph Katthagen

³Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelmʼs University of Munster, Medical Faculty, Munster, Germany

,

Helmut Lill

¹Orthopaedic and Trauma Clinic, DIAKOVERE Friederikenstift, Hanover, Germany

,

Gunnar Jensen

¹Orthopaedic and Trauma Clinic, DIAKOVERE Friederikenstift, Hanover, Germany

› Author Affiliations

Abstract

Background The management of proximal humeral fracture (PHF) is not only complex but ever changing. Published epidemiological data are often dated and do not factor in demographic changes or the latest developments in implant material and surgical techniques.

Aims The primary aim of this study was to evaluate changes in the epidemiology and actual treatment of PHF at a level-1 trauma centre, with a special focus on shoulder surgery.

Hypotheses 1. Between 2009 to 2012 and 2014 to 2017, an increase in complex PHF entities can be observed. 2. In correlation with fracture complexity, an increasing number of comorbidities, especially osteoporosis, can be observed.

Methods Between 2014 and 2017, a total of 589 patients (73% female; mean age: 68.96 ± 14.9 years) with 593 PHFs were treated. Patient records and imaging (XRs and CTs) of all patients were analysed. Fractures with ad latus displacement of a maximum of 0,5 cm and/or humeral head angulation of less than 20° were classified as non-displaced. Patients with displaced fractures were included in the analysis of the therapeutic algorithm. These results were compared to those of a cohort 2009 to 2012 (566 patients, 569 PHFs), which used the same inclusion criteria.

Results The two cohorts showed comparable patient numbers, as well as gender and age distributions. Between 2009 to 2012 and 2014 to 2017, a decrease in 2-part fractures (13.9 to 8.6%) and a simultaneous increase in 4-part fractures (20.4 to 30%), and thus fracture complexity was observed. Further decreases were observed in conservative therapy (27.8 to 20.6%), nail osteosynthesis (10.7 to 2.7%) and anatomic shoulder arthroplasty (5,4 to 1%). Furthermore, there was an increase in the use of locking plate osteosynthesis (43.2 to 56.7%) and reverse shoulder arthroplasty (9 to 18.4%). The general trend shows an increase in surgical therapy between the years (72.2 to 79.4%), as well as an increase in osteoporosis incidence (13 to 20.6%). The greatest numbers of comorbidities were found in 3- and 4-part fractures.

Conclusion There is an increase in both the complexity of fractures and the number of surgically treated fractures between 2009 and 2012. Furthermore, an increase in osteoporosis numbers can be observed. New implants (PEEK, fenestrated screws for cement augmentation) and new surgical techniques (double plating osteosynthesis) were used as a result of increasing fracture complexity. Moreover, reverse total shoulder arthroplasty was used more commonly.

Key words

proximal humerus fracture - reverse shoulder arthroplasty - osteoporosis - CFR-PEEK plate osteosynthesis - dual plate fixation

Full Text

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