The influence of biplanar reduction and surgeon experience on proximal humerus fractures treated with ORIF. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Liskutin, Tomas; Harkin, Elizabeth; Summers, Hobie; Cohen, Joseph; Bernstein, Mitchell; Lack, William
• Is Part Of: Injury. Volume 51:Issue 2(2020)
• Page Start: 322
• Page End: 328
• Publication Date: 2020-02
• Subjects: Proximal humerus fractures -- Trauma -- Open reduction internal fixation -- Locking plate; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.11.030
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Demonstrates sagittal plane reduction and medial calcar disruption were synergistically associated complications. Reveals that reduction quality significantly improved with surgeon experience. Proposes important factors to consider in future clinical studies of operative treatment for proximal humerus fractures. Abstract: Background: Treatment for proximal humerus fractures remains controversial. Studies of open reduction and internal fixation (ORIF) rarely account for reduction quality, while surgeon experience and sagittal plane reduction remain unstudied. In a retrospective case series analysis of AO/OTA C-type proximal humerus fractures treated with ORIF using a locking plate, we hypothesized that reduction quality would be associated with outcome, and reductions would improve with experience. Methods: We retrospectively identified 41 3- and 4-part proximal humerus fractures treated with ORIF by a single orthopaedic traumatologist. Two blinded traumatologists assessed injury and post-operative radiographs for medial calcar disruption and five measures of deformity. Major complications and functional outcome were assessed. Results: Outcome by ASES score was similar to previous reports (mean 73.6, std dev 22.5). Eleven of 35 patients (31.4%) with greater than six months follow-up experienced a complication. Post-reduction sagittal HSa<25° (RR = =9.44, p = =0.024) and medial calcar disruption (RR = =3.82, p = =0.009) were associated with complications. Post-reduction coronal and sagittal HSa improved with experience ( p < 0.001 and p = =0.032, respectively) as did the likelihood of overall anatomic reduction ( p = =0.006). ROC analysis found a threshold for superior reduction quality after 23 cases (AUC = =0.873, p < 0.001). Conclusion: Sagittal reduction quality and medial calcar disruption were associated with complications. Additionally, reduction quality improved with experience. Future studies of proximal humerus ORIF should include multiplanar assessments of reduction while accounting for surgeon experience.