Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients
Purpose The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients. Methods Between 2007 and 2011, 92 consecutive patients with diagnosis of...
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| Veröffentlicht in: | Musculoskeletal surgery 2017-08, Vol.101 (2), p.153-158 |
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| creator | Repetto, I. Alessio-Mazzola, M. Cerruti, P. Sanguineti, F. Formica, M. Felli, L. |
| description | Purpose
The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients.
Methods
Between 2007 and 2011, 92 consecutive patients with diagnosis of three–four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant–Murley score, disability of arm, shoulder and hand score and simple shoulder test.
Results
All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (
p
0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (
p
|
| doi_str_mv | 10.1007/s12306-017-0451-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1861859979</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1861859979</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2396-119b09562d2a87ab9c18b82949a92b1ba742100bebf2b2b5b62cc14bf76c1cb23</originalsourceid><addsrcrecordid>eNp1kEtLxDAQgIMovn-AFwl48WA1M23TxpuIL1jwoJ5Dkk13u7ZpTVpY_71ZdhURPE3CfPP6CDkBdgmMFVcBMGU8YVAkLMsh4VtkH1maJzlAtv3zZnyPHISwYIxnZS52yR6WgAzLdJ-ol9HPaqMa2iqnZra1bqBdRU3X9o1d0t53y7qN6fnYWh9j5ZUZRm_DNe1r52o3u6BNZ97tlPaNGixVbkqVH-a-i_8wfB6RnUo1wR5v4iF5u797vX1MJs8PT7c3k8RgKngCIDQTOccpqrJQWhgodYkiE0qgBq2KDOPR2uoKNepcczQGMl0V3IDRmB6S83XfuPLHaMMg2zoY2zTK2W4MEkoO8XpRiIie_UEX3ehd3E6CwCyFHFkWKVhTxncheFvJ3kcV_lMCkyv_cu1fRv9y5V_yWHO66Tzq1k5_Kr6FRwDXQIgpN7P-1-h_u34BRBqQRg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1924315204</pqid></control><display><type>article</type><title>Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Repetto, I. ; Alessio-Mazzola, M. ; Cerruti, P. ; Sanguineti, F. ; Formica, M. ; Felli, L.</creator><creatorcontrib>Repetto, I. ; Alessio-Mazzola, M. ; Cerruti, P. ; Sanguineti, F. ; Formica, M. ; Felli, L.</creatorcontrib><description>Purpose
The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients.
Methods
Between 2007 and 2011, 92 consecutive patients with diagnosis of three–four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant–Murley score, disability of arm, shoulder and hand score and simple shoulder test.
Results
All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (
p
< 0.05) for: locked plating versus HA, locked plating versus RSA and RSA versus HA. No differences between postoperative range of motion, complication rate and overall revision rate of the treatment groups were found at the end of follow-up (
p
> 0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (
p
< 0.05).
Conclusions
The treatment of complex PHF is nowadays a challenge even for skilled shoulder surgeons. The several viable operative options give good results whenever used for the correct indication. The range of reported complications from 18.2 to 37.5% remains concerning, but most of them did not affect clinical outcome in this series. Accurate preoperative characterization of the fracture pattern is necessary, and high surgical skills of the different operative techniques, including arthroplasty, are recommended to meet the increased functional expectations of patients.
Level of evidence
Therapeutic series, Level IV.</description><identifier>ISSN: 2035-5106</identifier><identifier>EISSN: 2035-5114</identifier><identifier>DOI: 10.1007/s12306-017-0451-6</identifier><identifier>PMID: 28120283</identifier><language>eng</language><publisher>Milan: Springer Milan</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Shoulder - methods ; Bone Nails ; Bone Plates ; Female ; Fracture Fixation, Internal ; Humans ; Joint surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Orthopedics ; Postoperative Complications - epidemiology ; Retrospective Studies ; Shoulder Fractures - complications ; Shoulder Fractures - surgery ; Surgical Orthopedics ; Treatment Outcome</subject><ispartof>Musculoskeletal surgery, 2017-08, Vol.101 (2), p.153-158</ispartof><rights>Istituto Ortopedico Rizzoli 2017</rights><rights>MUSCULOSKELETAL SURGERY is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2396-119b09562d2a87ab9c18b82949a92b1ba742100bebf2b2b5b62cc14bf76c1cb23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12306-017-0451-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12306-017-0451-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28120283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Repetto, I.</creatorcontrib><creatorcontrib>Alessio-Mazzola, M.</creatorcontrib><creatorcontrib>Cerruti, P.</creatorcontrib><creatorcontrib>Sanguineti, F.</creatorcontrib><creatorcontrib>Formica, M.</creatorcontrib><creatorcontrib>Felli, L.</creatorcontrib><title>Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients</title><title>Musculoskeletal surgery</title><addtitle>Musculoskelet Surg</addtitle><addtitle>Musculoskelet Surg</addtitle><description>Purpose
The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients.
Methods
Between 2007 and 2011, 92 consecutive patients with diagnosis of three–four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant–Murley score, disability of arm, shoulder and hand score and simple shoulder test.
Results
All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (
p
< 0.05) for: locked plating versus HA, locked plating versus RSA and RSA versus HA. No differences between postoperative range of motion, complication rate and overall revision rate of the treatment groups were found at the end of follow-up (
p
> 0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (
p
< 0.05).
Conclusions
The treatment of complex PHF is nowadays a challenge even for skilled shoulder surgeons. The several viable operative options give good results whenever used for the correct indication. The range of reported complications from 18.2 to 37.5% remains concerning, but most of them did not affect clinical outcome in this series. Accurate preoperative characterization of the fracture pattern is necessary, and high surgical skills of the different operative techniques, including arthroplasty, are recommended to meet the increased functional expectations of patients.
Level of evidence
Therapeutic series, Level IV.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty, Replacement, Shoulder - methods</subject><subject>Bone Nails</subject><subject>Bone Plates</subject><subject>Female</subject><subject>Fracture Fixation, Internal</subject><subject>Humans</subject><subject>Joint surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Shoulder Fractures - complications</subject><subject>Shoulder Fractures - surgery</subject><subject>Surgical Orthopedics</subject><subject>Treatment Outcome</subject><issn>2035-5106</issn><issn>2035-5114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kEtLxDAQgIMovn-AFwl48WA1M23TxpuIL1jwoJ5Dkk13u7ZpTVpY_71ZdhURPE3CfPP6CDkBdgmMFVcBMGU8YVAkLMsh4VtkH1maJzlAtv3zZnyPHISwYIxnZS52yR6WgAzLdJ-ol9HPaqMa2iqnZra1bqBdRU3X9o1d0t53y7qN6fnYWh9j5ZUZRm_DNe1r52o3u6BNZ97tlPaNGixVbkqVH-a-i_8wfB6RnUo1wR5v4iF5u797vX1MJs8PT7c3k8RgKngCIDQTOccpqrJQWhgodYkiE0qgBq2KDOPR2uoKNepcczQGMl0V3IDRmB6S83XfuPLHaMMg2zoY2zTK2W4MEkoO8XpRiIie_UEX3ehd3E6CwCyFHFkWKVhTxncheFvJ3kcV_lMCkyv_cu1fRv9y5V_yWHO66Tzq1k5_Kr6FRwDXQIgpN7P-1-h_u34BRBqQRg</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Repetto, I.</creator><creator>Alessio-Mazzola, M.</creator><creator>Cerruti, P.</creator><creator>Sanguineti, F.</creator><creator>Formica, M.</creator><creator>Felli, L.</creator><general>Springer Milan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty</title><author>Repetto, I. ; Alessio-Mazzola, M. ; Cerruti, P. ; Sanguineti, F. ; Formica, M. ; Felli, L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2396-119b09562d2a87ab9c18b82949a92b1ba742100bebf2b2b5b62cc14bf76c1cb23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroplasty, Replacement, Shoulder - methods</topic><topic>Bone Nails</topic><topic>Bone Plates</topic><topic>Female</topic><topic>Fracture Fixation, Internal</topic><topic>Humans</topic><topic>Joint surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Shoulder Fractures - complications</topic><topic>Shoulder Fractures - surgery</topic><topic>Surgical Orthopedics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Repetto, I.</creatorcontrib><creatorcontrib>Alessio-Mazzola, M.</creatorcontrib><creatorcontrib>Cerruti, P.</creatorcontrib><creatorcontrib>Sanguineti, F.</creatorcontrib><creatorcontrib>Formica, M.</creatorcontrib><creatorcontrib>Felli, L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Musculoskeletal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Repetto, I.</au><au>Alessio-Mazzola, M.</au><au>Cerruti, P.</au><au>Sanguineti, F.</au><au>Formica, M.</au><au>Felli, L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients</atitle><jtitle>Musculoskeletal surgery</jtitle><stitle>Musculoskelet Surg</stitle><addtitle>Musculoskelet Surg</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>101</volume><issue>2</issue><spage>153</spage><epage>158</epage><pages>153-158</pages><issn>2035-5106</issn><eissn>2035-5114</eissn><abstract>Purpose
The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients.
Methods
Between 2007 and 2011, 92 consecutive patients with diagnosis of three–four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant–Murley score, disability of arm, shoulder and hand score and simple shoulder test.
Results
All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (
p
< 0.05) for: locked plating versus HA, locked plating versus RSA and RSA versus HA. No differences between postoperative range of motion, complication rate and overall revision rate of the treatment groups were found at the end of follow-up (
p
> 0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (
p
< 0.05).
Conclusions
The treatment of complex PHF is nowadays a challenge even for skilled shoulder surgeons. The several viable operative options give good results whenever used for the correct indication. The range of reported complications from 18.2 to 37.5% remains concerning, but most of them did not affect clinical outcome in this series. Accurate preoperative characterization of the fracture pattern is necessary, and high surgical skills of the different operative techniques, including arthroplasty, are recommended to meet the increased functional expectations of patients.
Level of evidence
Therapeutic series, Level IV.</abstract><cop>Milan</cop><pub>Springer Milan</pub><pmid>28120283</pmid><doi>10.1007/s12306-017-0451-6</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2035-5106 |
| ispartof | Musculoskeletal surgery, 2017-08, Vol.101 (2), p.153-158 |
| issn | 2035-5106 2035-5114 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Aged, 80 and over Arthroplasty, Replacement, Shoulder - methods Bone Nails Bone Plates Female Fracture Fixation, Internal Humans Joint surgery Male Medicine Medicine & Public Health Middle Aged Original Article Orthopedics Postoperative Complications - epidemiology Retrospective Studies Shoulder Fractures - complications Shoulder Fractures - surgery Surgical Orthopedics Treatment Outcome |
| title | Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty: Clinical results and functional outcome on retrospective series of patients |
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