Anterior fracture dislocation of the proximal humerus: Management and treatment results

Schirren, Mirjam; Siebenbuerger, Georg; Fleischhacker, Evi; Biermann, Niklas; Helfen, Tobias; Böcker, Wolfgang und Ockert, Ben (2019): Anterior fracture dislocation of the proximal humerus: Management and treatment results. In: Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand, Bd. 14, Nr. 2: S. 103-109

Abstract

BackgroundAnterior fracture dislocations are among the most severe forms of proximal humeral fractures. Because of potential devascularization of the humeral head, it is unclear whether open reduction and internal fixation (ORIF) offers superior results to primary hemiarthroplasty (HAS) or reverse shoulder arthroplasty (RSA).MethodsWe retrospectively compared functional outcomes, complications, and revision surgeries after ORIF, HSA, and RSA in 81patients with anterior fracture dislocations. Functional results were assessed with the age- and gender-normalized Constant Score (nCS).ResultsOf 81anterior fracture dislocations, 40 (49.4%) were treated by ORIF (mean age 61.513.9years, range 29-89), 19 (12.3%) by HSA (mean age 71.610.1years, range 53-85), and 22 (27.2%) by RSA (mean age 79.810.8years, range 58-91). Of 81patients (75.8% women, mean age: 67.412.5years, range 29-91years), the mean nCS after 3.42.9years of follow-up was 63.4 +/- 10.3 after ORIF, 52.4 +/- 12.9 after HSA, and 74.5 +/- 11.1 after RSA (ANOVA, p=0.001). The complication rate in ORIF procedures was 22.5% (secondary displacement n=2, avascular necrosis n=7), in HSA, 36.8% (tubercle dislocation n=4, tubercle resorption n=2, septic loosening n=1), and RSA, 13.6% (acromial fracture n=1, tubercle displacement n=1, tubercle resorption, n=1;p<0.001). Avascular necrosis was observed in 17.5% of cases following aprimary head-preserving treatment.ConclusionTreatment of anterior fracture dislocations is demanding. Open anatomic reduction and internal fixation can lead to good and excellent functional outcomes in young patients with good bone quality and should be performed in these patients as soon as possible. Elderly and frail patients may profit from RSA as aprimary treatment. HSA should be reserved for cases where anatomic reduction and stable fixation in patients <65years has failed;however, functional outcomes are poor.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1862-6599
• Sprache: Englisch