Risk factors for loss of reduction following locked plate fixation of proximal humerus fractures in older adults

被引：2

作者：

Haws, Brittany E. ^{[1
,3
]}

Samborski, Steven A. ^{[1
]}

Karnyski, Steven ^{[1
]}

Soles, Gillian ^{[2
]}

Gorczyca, John T. ^{[1
]}

Nicandri, Gregg T. ^{[1
]}

Voloshin, Ilya ^{[1
]}

Ketz, John P. ^{[1
]}

机构：

[1] Univ Rochester, Dept Orthopaed, Med Ctr, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA

[2] Univ Calif Davis, Dept Orthopaed Surg, Sacramento, CA USA

[3] Univ Rochester, Dept Orthopaed, Med Ctr, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA

来源：

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2023年 / 54卷 / 02期

关键词：

Proximal humerus fracture; ORIF; Loss of reduction; Comminution; Calcar screw; Radiographic parameters; Range of motion; Complications; CALCAR SCREW;

D O I：

10.1016/j.injury.2022.11.043

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: To identify characteristics associated with loss of reduction following open reduction and locked plate fixation (ORIF) of proximal humerus fractures in older adults and determine if loss of reduction affects patient reported outcomes (PROs), range of motion (ROM), and complication rates during the first postoperative year.Methods: Patients > 55 years old who underwent proximal humerus ORIF were reviewed. Patient and fracture characteristics were recorded. Fixation characteristics were measured on the initial postoperative AP radiograph including humeral head height (HHH) relative to the greater tuberosity (GT), head shaft angle (HSA), screw-calcar distance, and screw tip-joint surface distance. Loss of reduction was defined as GT displacement > 5 mm or HSA displacement > 10 degrees on final follow up radiographs. Patient, fracture, and fixation characteristics were tested for association with loss of reduction. Outcomes including ROM, visual analog scale pain and PROMIS scores, and complication/reoperation rates during the first postoperative year were compared between those with or without loss of reduction.Results: A total of 79 patients were identified, 23 (29.1%) of which had a loss of reduction. Calcar com-minution (relative risk [RR] = 2.5, 95% Confidence Interval [CI] = 1.3-5.0, p < 0.01), HHH < 5 mm above GT (RR = 2.0, CI = 1.0-3.9, p = 0.048), and screw-calcar distance >= 12 mm (RR = 2.1, CI = 1.1-4.1, p = 0.03) were risk factors for loss of reduction. Upon multivariate analysis, calcar comminution was determined to be an independent risk factor for loss of reduction (RR = 2.4, CI = 1.2-4.7, p = 0.01). Loss of reduction led to higher complication (44% vs 13%, p < 0.01) and reoperation rates (30% vs 7%, p < 0.01), and decreased achievement of satisfactory ROM ( > 90 degrees active forward flexion, 57% vs 82%, p = 0.02) compared to main-tained reduction, but similar PROs.Conclusions: Calcar comminution, decreased HHH, and increased screw-calcar distance are risk factors for loss of reduction following ORIF of proximal humerus fractures. These morphologic and technical factors are important considerations for prolonged reduction maintenance.(c) 2022 Published by Elsevier Ltd.

引用

页码：567 / 572

页数：6