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Chua N, Onggo JR, Nambiar M, Onggo JD, Wang KK, Pennington R, Hau R. Functional outcomes of reverse total shoulder arthroplasty in Boileau class 1 and class 2 proximal humeral fracture sequelae: A meta-analysis and systematic review. Shoulder Elbow 2023; 15:43-53. [PMID: 37974647 PMCID: PMC10649513 DOI: 10.1177/17585732221088496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2023]
Abstract
Background Reverse total shoulder arthroplasty (RTSA) is an increasingly popular salvage treatment option for proximal humeral fracture (PHF) sequelae. This meta-analysis aimed to conduct a pooled analysis of functional outcomes of RTSA in PHF sequelae, with subgroup analysis comparing between intracapsular (Class 1) and extracapsular (Class 2) PHF sequelae. Methods A multi-database search (PubMed, OVID, EMBASE) was performed according to PRISMA guidelines on 27th July 2020. Data from all published literature meeting inclusion criteria were extracted and analysed. Findings Eleven studies were included, comprising 359 shoulders (167 Class 1 and 192 Class 2). The mean age was 68.2 years, and the mean time between injury and surgery was 49 months, (1-516 months). Constant score and forward flexion improved by 31.8 (95%CI: 30.5-33.1, p < 0.001) and 60o (95%CI: 58o-62o, p < 0.001) respectively between pre-operative and post-operative values for both groups. Constant scores were better in Class 1 patients (MD = 3.60, 95%CI: 1.0-6.2, p < 0.001) pre-operatively and post-operatively (MD = 7.4, 95%CI: 5.8-9.0, p < 0.001). Forward flexion was significantly better in Class 1 patients (MD = 13o, 95%CI: 7o-17o, p < 0.001) pre-operatively, but was slightly better in Class 2 patients post-operatively (MD = 7o, 95%CI: 4o-10o, p < 0.001). Overall complication rate was 16.8%. Conclusion Salvage RTSA is effective for PHF sequelae, with multiple factors contributing to the high complication rate.
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Affiliation(s)
- Nina Chua
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Orthopaedic Surgery, Royal Children’s Hospital, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Richard Pennington
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
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2
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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3
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Cosic F, Kirzner N, Edwards E, Page R, Kimmel L, Gabbe B. The Translated Proximal Humerus Fracture: A Comparison of Operative and Nonoperative Management. J Orthop Trauma 2023; 37:e341-e348. [PMID: 37053113 DOI: 10.1097/bot.0000000000002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To report on the long-term outcomes of the management of translated proximal humerus fractures. DESIGN A prospective cohort study was conducted from January 2010 to December 2018. SETTING Academic Level 1 trauma center. PARTICIPANTS/PATIENTS A total of 108 patients with a proximal humerus fracture with ≥100% translation, defined as no cortical bony contact between the shaft and humeral head fragments, were included. INTERVENTION Patients were managed nonoperatively with sling immobilization or with operative management as determined by the treating surgeon. MAIN OUTCOME MEASURES Outcome measures were the Oxford Shoulder Score, EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, nonunion/malunion, and avascular necrosis. RESULTS Of the 108 patients, 76 underwent operative intervention and 32 were managed nonoperatively. The mean (SD) age in the operative group was 54.3 (±20.2) years and in the nonoperative group was 73.3 (±15.3) years ( P < 0.001). There was no association between Oxford Shoulder Score and management options (mean 38.5 [±9.5] operative versus mean 41.3 [±8.5] nonoperative, P = 0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference was 0.16 (95% CI, 0.04-0.27; P = 0.008); EQ-5D VAS adjusted mean difference was 19.2 (95% CI, 5.2-33.2; P = 0.008). Operative management was associated with a lower odds of nonunion (adjusted OR 0.30; 95% CI, 0.09-0.97; P = 0.04), malunion (adjusted OR 0.14; 95% CI, 0.04-0.51; P = 0.003), and complications (adjusted OR 0.07; 95% CI, 0.02-0.32; P = 0.001). CONCLUSION Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes after surgical fixation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Filip Cosic
- Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia
| | - Nathan Kirzner
- Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia
| | - Elton Edwards
- Department of Orthopaedic Surgery, The Alfred, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Page
- Department of Orthopaedic Surgery, University Hospital Geelong, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Deakin University, Geelong, Australia
| | - Lara Kimmel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, The Alfred, Melbourne, Australia; and
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, United Kingdom
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Marshall WG, Filliquist B, Tzimtzimis E, Fracka A, Miquel J, Garcia J, Fontana MD. Delayed union, non-union and mal-union in 442 dogs. Vet Surg 2022; 51:1087-1095. [PMID: 36053918 PMCID: PMC9804201 DOI: 10.1111/vsu.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES (1) To estimate the prevalence of delayed union, non-union and mal-union in canine fractures; (2) to describe fracture, demographic, and treatment characteristics for these outcomes; (3) to identify risk factors for delayed or non-union. STUDY DESIGN Retrospective study. SAMPLE POPULATION Four hundred and forty two dogs (461 fractures). METHODS A review was conducted of clinical records and radiographs from 2 teaching hospitals. "Union," "delayed union," "non-union" and "mal-union" were defined, and fracture, demographic, treatment, and outcome variables described. Differences in proportions or medians between "union," "delayed union" and "non-union" were tested using χ2 and Mann-Whitney U-tests for categorical and continuous variables respectively. Potential explanatory variables for "delayed or non-union" were tested using logistic regression to identify risk factors. RESULTS Median radiographic follow up was 53 days (14-282). Delayed union occurred in 13.9% of fractures (64/461), non-union in 4.6% (21/461), and mal-union in 0.7% (3/461). Risk factors for delayed or non-union were age (OR 1.21, 95% CI 1.12-1.31); comminuted fracture (OR 4.24, 95% CI 2.4-7.5); treatment with bone graft (all types) (OR 3.32, 95% CI 1.3-8.5); surgical site infection (OR 3.24, 95% CI 1.17-8.97), and major implant failure (OR 12.94, 95% CI 5.06-33.1). CONCLUSION Older dogs, dogs with comminuted fractures, surgical site infection, or major implant failure were at increased odds of delayed or non-union. Radius and ulna fractures in toy breed dogs were not at increased odds of delayed or non-union. CLINICAL SIGNIFICANCE The identified risk factors should inform fracture planning and prognosticating. The prognosis for radial fractures in toy breeds appears better than historically believed.
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Affiliation(s)
| | - Barbro Filliquist
- Department of Surgical and Radiological Sciences, School of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Emmanouil Tzimtzimis
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Agnieszka Fracka
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Jose Miquel
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Javier Garcia
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Maria Dalla Fontana
- Small Animal Hospital, School of Veterinary MedicineUniversity of GlasgowGlasgowUK
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5
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Dahm F, Feichtinger X, Vallant SM, Haffner N, Schaden W, Fialka C, Mittermayr R. High-energy extracorporeal shockwave therapy in humeral delayed and non-unions. Eur J Trauma Emerg Surg 2021; 48:3043-3049. [PMID: 34515810 DOI: 10.1007/s00068-021-01782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. MATERIALS AND METHODS A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. RESULTS A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002). CONCLUSION The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.
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Affiliation(s)
- Falko Dahm
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria. .,Women's College Hospital, University of Toronto Orthopaedics Sports Medicine, Toronto, Canada.
| | - Xaver Feichtinger
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | - Nicolas Haffner
- Department for Orthopedics and Trauma Surgery, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Wolfgang Schaden
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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6
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Alkhoury D, Atchison J, Trujillo AJ, Oslin K, Frey KP, O'Toole RV, Castillo RC, O'Hara NN. Can financial payments incentivize short-term smoking cessation in orthopaedic trauma patients? Evidence from a discrete choice experiment. HEALTH ECONOMICS REVIEW 2021; 11:15. [PMID: 33903947 PMCID: PMC8077692 DOI: 10.1186/s13561-021-00313-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Smoking increases the risk of complications and related costs after an orthopaedic fracture. Research in other populations suggests that a one-time payment may incentivize smoking cessation. However, little is known on fracture patients' willingness to accept financial incentives to stop smoking; and the level of incentive required to motivate smoking cessation in this population. This study aimed to estimate the financial threshold required to motivate fracture patients to stop smoking after injury. METHODS This cross-sectional study utilized a discrete choice experiment (DCE) to elicit patient preferences towards financial incentives and reduced complications associated with smoking cessation. We presented participants with 12 hypothetical options with several attributes with varying levels. The respondents' data was used to determine the utility of each attribute level and the relative importance associated with each attribute. RESULTS Of the 130 enrolled patients, 79% reported an interest in quitting smoking. We estimated the financial incentive to be of greater relative importance (ri) (45%) than any of the included clinical benefits of smoking cessations (deep infection (ri: 24%), bone healing complications (ri: 19%), and superficial infections (ri: 12%)). A one-time payment of $800 provided the greatest utility to the respondents (0.64, 95% CI: 0.36 to 0.93), surpassing the utility associated with a single $1000 financial incentive (0.36, 95% CI: 0.18 to 0.55). CONCLUSIONS Financial incentives may be an effective tool to promote smoking cessation in the orthopaedic trauma population. The findings of this study define optimal payment thresholds for smoking cessation programs.
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Affiliation(s)
- Dana Alkhoury
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared Atchison
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Suite 300, Baltimore, MD, USA
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kimberly Oslin
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Suite 300, Baltimore, MD, USA
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert V O'Toole
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Suite 300, Baltimore, MD, USA
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Suite 300, Baltimore, MD, USA.
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7
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Short-term reoperation risk after surgical and nonsurgical management of isolated greater tuberosity fractures. JSES Int 2021; 5:532-539. [PMID: 34136866 PMCID: PMC8178603 DOI: 10.1016/j.jseint.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The outcomes and complication rates of patients with isolated greater tuberosity fractures are not well documented. The present study aimed to evaluate the reoperation rates, types of reoperations, and complications for patients undergoing open reduction internal fixation and those undergoing initial nonoperative treatment of isolated greater tuberosity fractures. Methods An administrative claims database was queried from 2010 to 2018 for adult patients treated with open reduction internal fixation or initial nonoperative treatment within 6 weeks of sustaining a closed isolated greater tuberosity fracture. Reoperation rates, types of reoperations, local/surgical complications, and systemic complications for two cohorts were collected, and statistical analysis was performed using R statistical software for patients initially treated operatively and nonoperatively. Complication rates were compared using multivariate logistic regression, while demographic data were compared using chi-square analysis. Results Of the 8509 patients who were documented to have sustained a closed isolated greater tuberosity fracture, 333 patients underwent operative treatment and 8176 patients received initial nonoperative treatment within the first 6 weeks of diagnosis. The operative cohort had a reoperation rate of 2.7% at 90 days, 5.7% at 6 months, and 7.8% at 1 year, with the majority of reoperations being rotator cuff repair (40.6%). Within the initial nonoperative cohort, 7.3% had an operation within a year, with the majority of operations being open reduction internal fixation (41.3%). The subsequent reoperation rate for those patients was 3.5% at 2 years with the majority of reoperations being rotator cuff repair (32.4%). In the operative cohort, the 90-day infection rate was 3.0%. Nonunion was demonstrated in the operative cohort at a rate of 1.8% at 6 months and 2.7% at 1 year. Conclusion When surgical care was provided to patients sustaining isolated greater tuberosity fractures in the first 6 weeks, there was a 7.8% rate of reoperation within the first year. Patients initially treated nonoperatively had a future operation rate of 7.3% within the first year and a 3.5% reoperation rate within the second year. The most common reoperation regardless of initial treatment was rotator cuff repair. With an elevated rate of subsequent operations, education is paramount to provide patients with expectations for the sequelae of this injury especially when presenting with concomitant injuries.
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Gorter E, Gerretsen B, Krijnen P, Appelman-Dijkstra N, Schipper I. Does osteoporosis affect the healing of subcapital humerus and distal radius fractures? J Orthop 2020; 22:237-241. [PMID: 32425424 PMCID: PMC7226641 DOI: 10.1016/j.jor.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 05/02/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Animal models indicate that osteoporosis may negatively influence the fracture healing process, but clinical studies on this topic are scarce. In this study we investigated the effect of osteoporosis on fracture healing in patients with an upper extremity fracture. Methods This retrospective cohort study included all patients aged 50 years or older, with a fracture of the proximal humerus or the distal radius treated in the period June 2012 to July 2015 and a DEXA scan within a year after fracture. The incidence of delayed-union and non-union were compared between patients with or without osteoporosis (BMD T score ≤ -2.5SD). A secondary analysis was performed with a more pragmatically definition; BMD T score ≤ -2.5SD or a proximal humerus fracture with a T-score between -2.5SD and -1.0SD. Results Osteoporosis was diagnosed in 133/455 patients (29.2%). A total of 461 fractures (distal radius n = 311 and proximal humerus n = 150) were treated. Radiological delayed- or non-union was described in 11/461 cases (2.4%); all proximal humerus fractures of which 6 cases (1.3%) were clinically manifest. The incidence of delayed- or non-union in fracture treatment did not differ between patients with osteoporosis (5/137 fractures) and the patients without osteoporosis (6/324 fractures) (p = 0.27). In the second analysis a significantly higher incidence was found in patients with osteoporosis (10/214 fractures vs 1/247 fractures p = 0.003). Conclusions The results of this study suggest that osteoporosis does not significantly influence the progress of fracture healing in distal radius and proximal humerus fractures, although there seems to be a tendency towards a negative effect.
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Affiliation(s)
- E.A. Gorter
- Leiden University Medical Center, Departments of Trauma Surgery, Center for Bone Quality, Leiden, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
- Corresponding author. Leiden University Medical Center, Department of Trauma Surgery, postzone K6-R, P.O. Box 9600, 2300, RC, Leiden, the Netherlands.
| | - B.M. Gerretsen
- Leiden University Medical Center, Departments of Trauma Surgery, Center for Bone Quality, Leiden, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
| | - P. Krijnen
- Leiden University Medical Center, Departments of Trauma Surgery, Center for Bone Quality, Leiden, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
| | - N.M. Appelman-Dijkstra
- Leiden University Medical Center, Departments of Internal Medicine, Center for Bone Quality, Leiden, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
| | - I.B. Schipper
- Leiden University Medical Center, Departments of Trauma Surgery, Center for Bone Quality, Leiden, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
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9
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Brorson S, Alispahic N, Bahrs C, Joeris A, Steinitz A, Audigé L. Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions. BMC Musculoskelet Disord 2019; 20:91. [PMID: 30797232 PMCID: PMC6387518 DOI: 10.1186/s12891-019-2459-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background A majority of proximal humeral fractures can be managed without surgery. Recent randomized clinical trials and meta-analyses even question the benefit of surgical treatment for displaced 3-, and 4-part fractures. However, evidence-based treatment recommendations, balancing benefits and harms, presuppose a common reporting of complications and adverse events, which at the moment is largely missing. Therefore we systematically reviewed the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Methods We searched PubMed, EMBASE, Cochrane Library, Scopus and WorldCat (2010–2017) and included articles and book chapters containing complication terms or definitions. Two reviewers independently extracted and grouped terms and definitions according to a predefined scheme. Terms and definitions concerning non-surgical management were tabulated, grouped and analyzed qualitatively. Results The initial search identified 1376 references from which 470 articles were selected for full-text retrieval. Data-extraction included first articles published in 2017, was then performed iteratively in batches of 20 articles, and terminated after retrieval of 91 articles when no additional definitions or terms was found. In addition, 12 book chapters were reviewed from an initial list of 100. No general definition of a complication was found. A total of 69 terms for complications after non-surgical management were identified from 19 articles. Sixty-seven terms regarded local events. The most commonly reported event terms regarded osteonecrosis, malunion, secondary displacement and rotator cuff problems. Seven individual terms were accompanied by some kind of definition. Most terms and definitions were based on radiographical assessments. Conclusions We found no consensus in the use of terms and definitions of complications after nonsurgical management of proximal humeral fractures. Multiple terms, some synonymous, some partly synonymous, some distinct, were used. Few complication terms were explicitly defined. Development and validation of an internationally consensus-based core event set for complications after proximal humeral fractures managed non-surgically is needed. Electronic supplementary material The online version of this article (10.1186/s12891-019-2459-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Nikola Alispahic
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - Christian Bahrs
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
| | | | - Laurent Audigé
- Research and Development Department, Upper Extremities, Schulthess Clinic, Zurich, Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
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10
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Abstract
Interfragmental ischaemia is a prerequisite for the initiation of the inflammatory and immunological response to fracturing of bone.Intrafragmental ischaemia is inevitable: the extent of the initial ischaemic insult does not, however, directly relate to the outcome for healing of the fracture zones and avascular necrosis of the humeral head. The survival of distal regions of fragments with critical perfusion may be the result of a type of inosculation (blood vessel contact), which establishes reperfusion before either revascularization or neo-angiogenesis has occurred.Periosteum has a poorly defined role in fracture healing in the proximal humerus. The metaphyseal periosteal perfusion may have a profound effect, as yet undefined, on the healing of most metaphyseal fractures of the proximal humerus, and may be disturbed further by inadvertent surgical manipulation.The metaphysis can be considered as a 'torus' or ring of bone, its surface covered by periosteum antero- and posterolaterally, through which the tuberosity segments gain perfusion and capsular reflections antero- and posteromedially, through which the humeral head (articular) fragment gains perfusion.The torus is broken in relatively simple primary patterns: a fracture line at the upper surface of the torus is an anatomical 'neck' fracture; a fracture line at the lower surface of the torus is the surgical 'neck' fracture. Secondary fragmentation (through compression and/or distraction) of the torus itself creates complexity for analysis (classification), alters the capacity and outcome for healing (by variable interruption of the fragmental blood supply) and influences interfragmental stability. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180005.
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