- Shoulder Trauma Abstracts (1)
- Abstracts on shoulder fractures and dislocations from proceedings of orthopaedic meetings & societies
Archive Copy: - 1999 Annual Meeting Scientific Program. Proximal Humerus Fractures: An Unsolved Fracture?
The proximal humerus section of the AO Surgery Reference. The whole surgical management described, including decision-making support, approaches, and surgical procedures.
OTA 2002 - Session 10 Session X - Upper Extremity Sun., 10/13/02 Upper Extremity, Paper #63, 10:10 AM The Impacted Varus Proximal Humeral Fracture. Which Factors Affect
Outcome? Charles M. Court-Brown, MD, FRCS; Margaret M. McQueen,
MD, FRCS; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom Purpose: A prospective analysis of 99 impacted varus (OTA, A2.2)
proximal humeral fractures was undertaken to study the outcome of nonoperative
management and to assess whether age, increasing varus deformity during
treatment, and physical therapy altered the prognosis. Methods: In a 4-year period, 135 consecutive patients with impacted
varus (OTA, A2.2) proximal humeral fractures were treated and prospectively
documented in one trauma unit. Two patients were treated operatively and
34 either died or were lost to follow-up. The remaining 99 patients were
followed at a research clinic at 6, 13, 26, and 52 weeks after the injury.
The Neer score was used to monitor their progress, with patient examinations
performed by an independent research physical therapist. Radiological assessment
was performed by one surgeon to prevent inter-observer error. Varus displacement
was estimated by measuring the angle between the humeral diaphysis and a
line drawn between the greater tuberosity and the inferior articular surface
on the initial and final radiographs. The effect of age, increasing varus
displacement during nonoperative treatment and physical therapy was assessed.
Tests for association were undertaken using multiple regression or logistic
regression. Results: The average age of all 135 patients, 106 women and 39
men, was 68 years. The mean Neer score of the 99 patients followed throughout
the study was 59.7 at 6 weeks, 73.9 at 13 weeks, 81.7 at 26 weeks, and 86.7
at 52 weeks. Application of the Neer outcome criteria showed that 78.5%
of patients had a good or excellent result 1 year after injury. Analysis
of the effect of age on outcome showed a positive correlation, with a decreasing
Neer score at 1 year recorded among older patients. The mean Neer score
in patients less than 40 years of age was 94.5 and 82.1 in the over-80-year
age group. There was no correlation between increasing varus malalignment
during treatment and function or pain at 1 year. Radiological analysis showed
a mean increase in varus displacement of the humeral head of 12 o (range, 0° to 41 o ) during treatment. The average Neer score
for patients with less than 5 o of varus displacement during treatment
was 89.7 compared with 91.1 for patients with 25° to 29 o of varus displacement. The possibility of increasing pain due to greater
tuberosity impingement associated with varus displacement was studied by
assessing pain, using Neer's criteria, at each examination between 6 and
52 weeks. There was no correlation between pain and varus displacement.
Univariate analysis of the use of physical therapy suggested that there
might be a correlation with function, but multivariate analysis indicated
that the older, less fit patients tended not to receive physical therapy.
Our results do not suggest that physical therapy is useful. Discussion: In a recent epidemiological study of proximal humeral
fractures, the A2.2 impacted varus fracture was shown to be the third most
common proximal humeral fracture. Despite this finding, there has been no
previous study of the outcome of this fracture. There is, however, a common
assumption that the increasing varus deformity that commonly follows nonoperative
treatment of this fracture leads to subacromial impingement, restricted
shoulder function, and pain. However, analysis of our data shows that this
is not the case. Although progressive varus deformity is common in the A2.2
fracture, it does not cause deterioration in function or increase in pain.
The results of nonoperative treatment are good, particularly in younger
patients. Older patients have poorer results, but it is unlikely that surgery
will improve function in this group of patients. Physical therapy does not
appear to help patients. Conclusions: Nonoperative management of the OTA A2.2 proximal
humeral fracture gives good results, regardless of the degree of varus displacement
during treatment and whether physical therapy is used. The results indicate
that the parameter that affects outcome is age.
Archive Copy: 2000 AAOS On-Line Service - 1999 Annual Meeting Scientific Program. Proximal Humerus Fractures: An Unsolved Fracture?
A proximal humerus fracture is very common and accounts for 1 in 20 of all fractures. OTA Residents Fracture Course. The majority are nondisplaced fractures . The typical patient is an elderly woman with osteoporosis who falls and sustains a fracture of the proximal humerus
OTA Residents Fracture course. Neer divided the proximal humerus into 4 parts. Understnading the classification aids in decding if fractures need ORIF
OTA Residents Fracture Course. Only a small population of patients (approximately 20% ) have unstable, displaced fractures which require more extensive treatment.