Document Detail


Locked plating of proximal humeral fractures: is function affected by age, time, and fracture patterns?
MedLine Citation:
PMID:  21691910     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Locking plate fixation of proximal humeral fractures improves biomechanical stability. It has expanded the indications of traditional open reduction internal fixation and become increasingly common for treating unstable, displaced proximal humeral fractures. Despite improved stability it is unclear whether these improve function and if so for which patients.
QUESTIONS/PURPOSES: We therefore determined patient function after a locked plating technique for the treatment of unstable proximal humeral fractures based on age, time, fracture pattern, and associated injures.
PATIENTS AND METHODS: We retrospectively reviewed 66 patients with 69 proximal humeral fractures treated with a locked proximal humeral plating technique from 2002-2006 using prospectively gathered data. Function was measured using the Short Musculoskeletal Function Assessment (SMFA), Disability of the Arm, Shoulder, and Hand (DASH), and SF-36 at 6, 12, and 24 months. Fracture healing was determined radiographically and complication rates were determined from the medical records.
RESULTS: At 2 years, DASH scores were 26.5 and 37.4 for isolated and polytrauma patients, respectively. For age differences, DASH scores were 33.1 and 28.9 for ages younger than 60 and 60 years old or older, respectively. At 2 years, SMFA scores were higher (worse) in older compared with younger patients. Function, but not bother continues to improve in younger patients up to 2 years. More severe fracture patterns performed worse in all SMFA indices at 2 years. Polytrauma patients consistently experienced worse mobility than isolated injury patients at each time interval.
CONCLUSIONS: With locked plating of unstable proximal humeral fractures, older patients function as well as younger patients; improvement continues until 1 year postoperatively, the Neer fracture classification differentiates function, and polytrauma patients perform worse clinically. Long-term functional deficits persist.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Clifford B Jones; Debra L Sietsema; Daniel K Williams
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-08     Completed Date:  2012-08-17     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3307-16     Citation Subset:  AIM; IM    
Affiliation:
Orthopaedic Associates of Michigan, Michigan State University, 230 Michigan Street NE, Suite 300, Grand Rapids, MI 49503, USA. Clifford.Jones@oamichigan.com
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MeSH Terms
Descriptor/Qualifier:
Accidental Falls
Accidents, Traffic
Adult
Aged
Aged, 80 and over
Biomechanics
Bone Plates*
Female
Fracture Fixation, Internal / methods*
Health Status Indicators
Humans
Male
Middle Aged
Recovery of Function
Retrospective Studies
Shoulder Fractures / etiology,  physiopathology,  radiography,  surgery*
Treatment Outcome
Young Adult
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