Changing trends in the management of proximal humerus fractures in New York State (original) (raw)
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Trials, 2023
Background Proximal humerus fractures (PHF) are common and painful injuries, with the majority resulting from falls from a standing height. As with other fragility fractures, its age-specific incidence is increasing. Surgical treatment with hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) have been increasingly used for displaced 3-and 4-part fractures despite a lack of good quality evidence as to whether one type of arthroplasty is superior to the other, and whether surgery is better than non-surgical management. The PROFHER-2 trial has been designed as a pragmatic, multicentre randomised trial to compare the clinical and cost-effectiveness of RSA vs HA vs Non-Surgical (NS) treatment in patients with 3-and 4-part PHF. Methods Adults over 65 years of age presenting with acute radiographically confirmed 3-or 4-part fractures, with or without associated glenohumeral joint dislocation, who consent for trial participation will be recruited from around 40 National Health Service (NHS) Hospitals in the UK. Patients with polytrauma, open fractures, presence of axillary nerve palsy, pathological (other than osteoporotic) fractures, and those who are unable to adhere to trial procedures will be excluded. We will aim to recruit 380 participants (152 RSA, 152 HA, 76 NS) using 2:2:1 (HA:RSA:NS) randomisation for 3-or 4-part fractures without joint dislocation, and 1:1 (HA:RSA) randomisation for 3-or 4-part fracture dislocations. The primary outcome is the Oxford Shoulder Score at 24 months. Secondary outcomes include quality of life (EQ-5D-5L), pain, range of shoulder motion, fracture healing and implant position on X-rays, further procedures, and
Reverse Total Shoulder Arthroplasty Versus Hemiarthroplasty for Proximal Humeral Fractures
Journal of Orthopaedic Trauma, 2015
To report and compare the clinical and radiographic outcomes of patients treated with reverse shoulder arthroplasty (RSA) or hemiarthroplasty for acute complex proximal humeral fractures. Data Sources: A systematic review of PubMed, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Cochrane Central Register of Controlled Trials was conducted. All published English language studies before January 2014 were reviewed for possible inclusion. Search terms included the following: proximal humerus, fracture, arthroplasty, hemiarthroplasty, RSA, and reverse total shoulder arthroplasty. Study Selection: Studies reporting outcomes in human subjects after either RSA or hemiarthroplasty for acute proximal humeral fractures were assessed for inclusion. Additional inclusion criteria included a minimum clinical follow-up of 1 year. Level V evidence, basic science/cadaveric studies, and those studies reporting outcomes after revision arthroplasty were excluded. Data Extraction: Patient demographics, clinical/radiographic outcomes, and complications were recorded. Posttreatment weighted means were calculated and reported. Homogenous outcome measures were analyzed, and a direct comparison of outcomes between treatment groups was performed. Conclusions: Patients treated with RSA possess improved forward flexion (RSA: 118 degrees, Hemi: 108 degrees) but decreased external rotation (RSA: 20 degrees, Hemi: 30 degrees) compared with patients undergoing hemiarthroplasty after acute proximal humeral fracture. No significant clinical difference in either American Shoulder and Elbow Surgeons Shoulder Score (RSA: 64.7, Hemi: 63.0) or Constant score (RSA: 54.6, Hemi: 58.0) was identified. RSA was associated with an increased rate of clinical complications (9.6%) and a lower revision rate (0.93%) at short-term to midterm follow-up compared with hemiarthroplasty. RSA offers an acceptable surgical option for patients after complex acute proximal humeral fractures.
Orthopedics, 2017
This study described surgical treatment patterns for proximal humerus fractures among elderly patients, focusing on reverse total shoulder arthroplasty (TSA), and evaluated how the type of fixation affects inpatient factors (cost, length of stay), transfusion rates, and patient disposition (home vs skilled nursing facility). With Nationwide Inpatient Sample data from 2011 to 2013, the authors identified patients 65 years and older who had proximal humerus fractures and divided them into 3 groups: (1) open reduction and internal fixation (ORIF); (2) hemiarthroplasty; and (3) reverse TSA. From 2011 to 2013, 38,729 surgically treated proximal humerus fractures were identified. The rate of reverse TSA increased 1.8-fold during this time, from 13% of operative cases in 2011 to 24% of operative cases in 2013 (P<.001). At the same time, the rates of hemiarthroplasty and ORIF decreased (hemiarthroplasty, from 28% to 21%; ORIF, from 59% to 55%). Although reverse TSA accounted for 32.2% of...
Singapore medical journal
New knowledge, and improved surgical hardware and fi xation techniques have changed surgical management. We review the evolving trends of surgically managed proximal humerus fractures. Patients who underwent surgery for proximal humerus fractures from 1 January 2001 to 31 December 2010 were identified from the hospital's electronic diagnosis and operative coding database. Data extracted from the database included patient demographics, comorbidities, clinical and radiological findings, operative techniques, and complications. In total, 95 patients with 97 surgically managed proximal humerus fractures were identified. The median age of the patients was 50 (range 12-85) years, and the male to female ratio was 1.2:1.0. Male patients tended to present at a younger age than female patients (peak age 30-39 years vs. 70-79 years, p < 0.001). Two-part surgical neck fracture was the most common type of fracture (n = 33, 34.0%). Plate osteosynthesis was predominantly used for two- and t...
Hemi- vs. reverse shoulder arthroplasty for acute proximal humeral fractures
Obere Extremität
Hemi-vs. reverse shoulder arthroplasty for acute proximal humeral fractures. A systematic review of level I and II studies Abstract Background. To date, there is no clear consensus on the superiority of shoulder hemiarthroplasty (HSA) or reverse shoulder arthroplasty (RSA) for the treatment of acute proximal humeral fractures (PHF). Objectives. The aim of this study was to review the relevant literature for level I and II studies reporting clinical outcomes and revision rates for HSA or RSA in the treatment of acute PHF. Methods. Two electronic databases (PubMed, and Embase) were systematically searched for level I and II studies published after 1998 reporting clinical and/or radiographic outcomes of primary HSA or primary RSA as treatments for acute PHF.
Open Journal of Orthopedics, 2019
Purpose: Shoulder replacement becomes more indicated in complex fractures of the humeral head. Indications depend on some factors especially age and fracture's pattern. The aim of our study is to compare the functional results of both reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in complex proximal humerus fractures. Materials and Methods: Fifty-two shoulder arthroplasties (20 reverse shoulder arthroplasties, 38 hemiarthroplasties), were reviewed retrospectively, between January 2010, and December, 2015. Preoperative, operative, and postoperative evaluations were achieved based on medical observations. At last follow-up, functional outcomes were established according Constant-Murley Score and American Shoulder and Elbow Surgeons (ASES) score. Complications rates were well-defined and compared between the study groups. Results: The mean of follow-up was 41.5 months. Comparing the study groups, reverse shoulder arthrosplasties were significantly older (mean age: 76.3 versus 66). These fractures occur more in women (70% versus 57%). At last follow-up, functional outcomes were better in reverse shoulder arthroplasty group (Constant-Murley Score 76 versus 59; ASES score 56 versus 41). The mean anterior elevation and external rotation were better in reverse shoulder arthroplasty respectively (110˚ versus 88˚; 28˚ versus 19˚). Revision was more required in hemiarthroplasty group than reverse shoulder arthroplasty group. Conclusion: Reverse shoulder arthroplasty seems to improve functional outcome at intermediate and long-term of follow-up of proximal complex humeral fractures on comparison to hemiarthroplasty.
Primary hemiarthroplasty for treatment of proximal humeral fractures
The Journal of bone and joint surgery. American volume, 2003
Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery. A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury. The overall rate of prosthetic survival was 96.9% at one year, 95...