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Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort
Background In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment. Methods Radiographs and computed...
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| Published in: | European journal of orthopaedic surgery & traumatology 2021-04, Vol.31 (3), p.517-524 |
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| container_issue | 3 |
| container_start_page | 517 |
| container_title | European journal of orthopaedic surgery & traumatology |
| container_volume | 31 |
| creator | Schmalzl, Jonas Jessen, Malik Gilbert, Fabian Gerhardt, Christian Lehmann, Lars-Johannes |
| description | Background
In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.
Methods
Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum–collum–diaphyseal (CCD) angle were analyzed.
Results
A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6–1.9;
p
|
| doi_str_mv | 10.1007/s00590-020-02801-4 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2449180219</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2503197776</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ada5e539b8994dd46d31286813b52d3880078206be0dc3f575af8c694cc956ba3</originalsourceid><addsrcrecordid>eNp9kc-O1SAUhxujccbRF3BhSNy4qR6gUHBnJv5LJtGFrgkFettJW64HGL3P4EvLnTtq4sIFORC-8xHOr2meUnhJAfpXCUBoaIEdlwLadveac9px1lKQ6n7dS85bBVKcNY9SugagQlPxsDnjHJioh_Pm52eMP-bVLmQqa8BaR7QuFwxkjbif4hJ3BzJvZG_zHLacyPc5T8T6G7u54Ikr40hysEgs5gljxabDa2I3EocU8KZ2xa1aUy7-1mNJKribnV2WA8kYbD5a4hQxP24ejHZJ4cldvWi-vnv75fJDe_Xp_cfLN1et473IrfVWBMH1oLTuvO-k55QpqSgfBPNcqTobxUAOAbzjo-iFHZWTunNOCzlYftG8OHn3GL-VkLJZ5-TCstgtxJIM6zpNFTCqK_r8H_Q6FqwfqpQATnXf97JS7EQ5jClhGM0e60zxYCiYY1TmFJWpUZnbqExXm57dqcuwBv-n5Xc2FeAnINWrbRfw79v_0f4CLhag8A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2503197776</pqid></control><display><type>article</type><title>Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort</title><source>Springer Link</source><creator>Schmalzl, Jonas ; Jessen, Malik ; Gilbert, Fabian ; Gerhardt, Christian ; Lehmann, Lars-Johannes</creator><creatorcontrib>Schmalzl, Jonas ; Jessen, Malik ; Gilbert, Fabian ; Gerhardt, Christian ; Lehmann, Lars-Johannes</creatorcontrib><description>Background
In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.
Methods
Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum–collum–diaphyseal (CCD) angle were analyzed.
Results
A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6–1.9;
p
< 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17–2.40;
p
= 0.0046) compared to those with advanced CTA.
Conclusion
In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.</description><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-020-02801-4</identifier><identifier>PMID: 33025159</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Classification ; Confidence intervals ; Fractures ; Kinematics ; Medical imaging ; Medicine ; Medicine & Public Health ; Morphology ; Observational studies ; Original Article ; Rotator cuff ; Statistical analysis ; Surgery ; Surgical Orthopedics ; Trauma ; Traumatic Surgery</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2021-04, Vol.31 (3), p.517-524</ispartof><rights>Springer-Verlag France SAS, part of Springer Nature 2020</rights><rights>Springer-Verlag France SAS, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ada5e539b8994dd46d31286813b52d3880078206be0dc3f575af8c694cc956ba3</citedby><cites>FETCH-LOGICAL-c375t-ada5e539b8994dd46d31286813b52d3880078206be0dc3f575af8c694cc956ba3</cites><orcidid>0000-0002-8995-522X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33025159$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schmalzl, Jonas</creatorcontrib><creatorcontrib>Jessen, Malik</creatorcontrib><creatorcontrib>Gilbert, Fabian</creatorcontrib><creatorcontrib>Gerhardt, Christian</creatorcontrib><creatorcontrib>Lehmann, Lars-Johannes</creatorcontrib><title>Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Background
In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.
Methods
Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum–collum–diaphyseal (CCD) angle were analyzed.
Results
A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6–1.9;
p
< 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17–2.40;
p
= 0.0046) compared to those with advanced CTA.
Conclusion
In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.</description><subject>Classification</subject><subject>Confidence intervals</subject><subject>Fractures</subject><subject>Kinematics</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morphology</subject><subject>Observational studies</subject><subject>Original Article</subject><subject>Rotator cuff</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Trauma</subject><subject>Traumatic Surgery</subject><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc-O1SAUhxujccbRF3BhSNy4qR6gUHBnJv5LJtGFrgkFettJW64HGL3P4EvLnTtq4sIFORC-8xHOr2meUnhJAfpXCUBoaIEdlwLadveac9px1lKQ6n7dS85bBVKcNY9SugagQlPxsDnjHJioh_Pm52eMP-bVLmQqa8BaR7QuFwxkjbif4hJ3BzJvZG_zHLacyPc5T8T6G7u54Ikr40hysEgs5gljxabDa2I3EocU8KZ2xa1aUy7-1mNJKribnV2WA8kYbD5a4hQxP24ejHZJ4cldvWi-vnv75fJDe_Xp_cfLN1et473IrfVWBMH1oLTuvO-k55QpqSgfBPNcqTobxUAOAbzjo-iFHZWTunNOCzlYftG8OHn3GL-VkLJZ5-TCstgtxJIM6zpNFTCqK_r8H_Q6FqwfqpQATnXf97JS7EQ5jClhGM0e60zxYCiYY1TmFJWpUZnbqExXm57dqcuwBv-n5Xc2FeAnINWrbRfw79v_0f4CLhag8A</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Schmalzl, Jonas</creator><creator>Jessen, Malik</creator><creator>Gilbert, Fabian</creator><creator>Gerhardt, Christian</creator><creator>Lehmann, Lars-Johannes</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8995-522X</orcidid></search><sort><creationdate>20210401</creationdate><title>Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort</title><author>Schmalzl, Jonas ; Jessen, Malik ; Gilbert, Fabian ; Gerhardt, Christian ; Lehmann, Lars-Johannes</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ada5e539b8994dd46d31286813b52d3880078206be0dc3f575af8c694cc956ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Classification</topic><topic>Confidence intervals</topic><topic>Fractures</topic><topic>Kinematics</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morphology</topic><topic>Observational studies</topic><topic>Original Article</topic><topic>Rotator cuff</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Trauma</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schmalzl, Jonas</creatorcontrib><creatorcontrib>Jessen, Malik</creatorcontrib><creatorcontrib>Gilbert, Fabian</creatorcontrib><creatorcontrib>Gerhardt, Christian</creatorcontrib><creatorcontrib>Lehmann, Lars-Johannes</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schmalzl, Jonas</au><au>Jessen, Malik</au><au>Gilbert, Fabian</au><au>Gerhardt, Christian</au><au>Lehmann, Lars-Johannes</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>31</volume><issue>3</issue><spage>517</spage><epage>524</epage><pages>517-524</pages><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Background
In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.
Methods
Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum–collum–diaphyseal (CCD) angle were analyzed.
Results
A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6–1.9;
p
< 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17–2.40;
p
= 0.0046) compared to those with advanced CTA.
Conclusion
In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>33025159</pmid><doi>10.1007/s00590-020-02801-4</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8995-522X</orcidid></addata></record> |
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| subjects | Classification Confidence intervals Fractures Kinematics Medical imaging Medicine Medicine & Public Health Morphology Observational studies Original Article Rotator cuff Statistical analysis Surgery Surgical Orthopedics Trauma Traumatic Surgery |
| title | Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort |
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