MANAGEMENT OF PROXIMAL HUMERUS FRACTURES IN ADULTS
DOI:
https://doi.org/10.61841/s82kgz64Keywords:
Hemiarthroplasty, proximal humerus fracture, ORIF, Reverse Shoulder ArthroplastyAbstract
Introduction: Proximal humerus fractures, more common in women and increasingly prevalent with age due to falls, pose a challenge in orthopaedic care, often leading to persistent pain and reduced shoulder function. This systematic review aims to evaluate diverse management strategies for these fractures in adults, analysing their effectiveness, complications, and patient-reported outcomes to guide treatment decisions.
Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and MetaAnalysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research.
SS
Result Our search produced 13 results. After looking at the titles and summaries, we found several papers that fit our criteria. At first, we excluded few articles because they were written in review and case report style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included prospective, retrospective studies, and prospective randomized control trial study.
Conclusion: This comprehensive study compared ORIF, HA, and RSA in PHF patients, revealing that ORIF was preferred in younger patients with simpler fractures, while RSA was favoured in older patients with complex fractures. ORIF demonstrated better motion than HA, but higher reoperation rates were noted for ORIF and HA compared to RSA, essential information for patient discussions. Postoperative fractures were prevalent, highlighting a need for counselling to prevent future falls and fractures post-PHF treatment. Despite prior inconclusive studies, the need to reduce unnecessary surgeries, especially in the elderly, remains crucial to minimize complications and healthcare costs amidst the shifting treatment landscape.
References
Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6(6):CD000434. Published 2022 Jun 21. doi:10.1002/14651858.CD000434.pub5
Sears, B. W., Hatzidakis, A. M., & Johnston, P. S. (2019). Intramedullary Fixation for Proximal Humeral Fractures. Journal of the American Academy of Orthopaedic Surgeons, 1. doi:10.5435/jaaos-d-18-00360
Pencle F, Varacallo M. Proximal Humerus Fracture. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470346/
Brorson, S., Palm, H. (2021). Proximal Humeral Fractures: The Choice of Treatment. In: Falaschi, P., Marsh, D. (eds) Orthogeriatrics. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-481261_10
Tarlochan Bhambra, Panayiotis Souroullas, Andrew Philip Wright, Maulik Gandhi, Evidence-based management of proximal humerus fractures, Orthopaedics and Trauma, Volume 37, Issue 5, 2023, Pages 296302, ISSN 1877-1327, https://doi.org/10.1016/j.mporth.2023.07.011.
Baker, H.P.; Gutbrod, J.; Strelzow, J.A.; Maassen, N.H.; Shi, L. Management of Proximal Humerus Fractures in Adults. Encyclopedia. Available online: https://encyclopedia.pub/entry/32772 (accessed on 05 January 2024).
Yahuaca BI, Simon P, Christmas KN, et al. Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020;29(7S):S32-S40. doi:10.1016/j.jse.2019.10.012
Howard, L., Berdusco, R., Momoli, F. et al. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord 19, 299 (2018). https://doi.org/10.1186/s12891-018-2223-3
Miquel J, Martínez R, Santana F, Marimon P, Torrens C. Surgical treatment of proximal humeral fractures with the transosseous suture fixation. J Orthop Surg Res. 2021;16(1):405. Published 2021 Jun 23. doi:10.1186/s13018-021-02555-7
Liu N, Wang BG, Zhang LF. Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts: A retrospective, comparative cohort study. World J Clin Cases 2023; 11(27): 6363-6373
Klug, A., Gramlich, Y., Wincheringer, D., Schmidt-Horlohé, K., & Hoffmann, R. (2019). Trends in surgical
management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to
Archives of Orthopaedic and Trauma Surgery. doi:10.1007/s00402-019-03252-1
Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, et al. Surgical management of complex proximal humerus fracturesda systematic review of 92 studies including 4500 patients. J Orthop Trauma 2015;29:54-9. https://doi.org/10.1097/BOT. 0000000000000229
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg. 2011;20(5):747–55.
Fjalestad T, Hole MO. Displaced proximal humeral fractures: operative versus non-operative treatment-a 2-year extension of a randomized controlled trial. Eur J Orthop Surg Traumatol 2014.
Neuhaus V, Bot AG, Swellengrebel CH, Jain NB, Warner JJ, Ring DC. Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus. J Shoulder Elbow Surg. 2013.
Zirngibl B, Biber R, Bail HJ. Humeral head necrosis after proximal humeral nailing: what are the reasons for bad outcomes? Injury. 2016;47:S10–3 https://doi.org/10.1016/S0020-1383(16)30847-6.
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