Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level-1 trauma center

• Published in: Journal of orthopaedics and traumatology 2017-09, Vol.18 (3), p.265-274
• Main Authors: Katthagen, Jan Christoph, Huber, Meret, Grabowski, Svenja, Ellwein, Alexander, Jensen, Gunnar, Lill, Helmut
• Format: Article
• Language: English
• Subjects: Abuse; Adult; Aged; Aged, 80 and over; Alcohol; Alcohol abuse; Alcohols; Algorithms; Arthroplasty, Replacement; Cigarette smoking; Conservative Orthopedics; Failure; Female; Females; Fracture Fixation; Humans; Humerus; Male; Males; Medical materials; Medical records; Medicine; Medicine & Public Health; Middle Aged; Non-operative; Original; Original Article; Orthopedics; Patients; Prostheses; Prosthetics; Proximal humeral fracture; Reoperation; Retrospective Studies; Revision; Rheumatology; Shoulder Fractures - classification; Shoulder Fractures - surgery; Shoulder Fractures - therapy; Smoking; Sports Medicine; Surgery; Surgical Orthopedics; Surveys and Questionnaires; Trauma; Trauma Centers; Traumatic Surgery; Treatment algorithm; Treatment Failure
• ISSN: 1590-9921; 1590-9999
• DOI: 10.1007/s10195-017-0457-8

Background The aims of this study were to evaluate treatment failure and revision rates of proximal humeral fracture (PHF) treatment with a standardized treatment algorithm within the reality of a level-1 trauma center and to identify predictors of subsequent surgery. Materials and methods The medical database of a level-1 trauma center was screened for all primary treatments of PHFs between January 2009 and June 2012. Medical records and imaging were analyzed to identify the fracture morphology, pre-existing diseases, revision surgeries and treatment failures (conversion to another treatment). The patients were asked about subsequent surgeries by phone. A functional outcome questionnaire was mailed to participating patients. Results Follow-up data were available for 423 of 521 patients (312 females, 111 males). The mean age at the time of primary treatment was 68.3 years; mean follow-up was 24.6 ± 12.3 months. The overall rate of mandatory re-operations was 15.6%, including a failure rate of 8.3%; another 7.6% of patients had additional arthroscopic surgeries. Treatment with anatomic hemi-prostheses was associated with the highest re-operation rates, and lowest outcomes. Involvement of the medial calcar region, complex fracture morphologies, cigarette smoking and alcohol-abuse were predictors for subsequent surgery. Patients without subsequent surgery had significantly higher functional outcome scores than patients with additional surgery. Conclusions With the use of a standardized treatment algorithm no treatment modality was at significantly higher risk for having additional surgery. Complex fracture types, involvement of the medial calcar, cigarette-smoking and alcohol-abuse were associated with subsequent surgeries. Level of evidence Level IV case series.