American Shoulder and Elbow Surgeons Annual Meeting

American Shoulder and Elbow Surgeons Annual Meeting

Perspective from Michael McKee, MD, FRCSC
October 29, 2019
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Patient, fracture characteristics may affect treatment of proximal humerus fractures

Perspective from Michael McKee, MD, FRCSC
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B. Israel Yahuaca

NEW YORK — A retrospective review presented at the American Shoulder and Elbow Surgeons Annual Meeting showed younger patients with less complex proximal humerus fractures were more commonly treated with open reduction and internal fixation, while older patients with more complex fractures were more commonly treated with reverse shoulder arthroplasty.

B. Israel Yahuaca, MD, and colleagues analyzed patient and fracture characteristics, postoperative falls, reoperation and range of motion for 425 patients with proximal humerus fractures treated with open reduction and internal fixation (ORIF), hemiarthroplasty or reverse shoulder arthroplasty.

Yahuaca said in his presentation here, “Our questions were: What factors influence the choice of device? Does that treatment affect the range of motion? Do the healing and reoperation rates vary by treatment type and do the patient characteristics influence any risk of recurrent fall or injury?”

Yahuaca noted patients who were older and had a higher American Society of Anesthesiologists (ASA) grade and fracture class were more likely to be treated with arthroplasty compared with younger patients with a lower ASA grade and fracture class who were more likely to be treated with ORIF.

“We can see the average age for reverse was higher and this was significant, as well as the majority of two-part [fractures] were treated with operative fixation, while a higher percentage of more complex [fractures] were treated with reverse [shoulder arthroplasty],” Yahuaca said.
significant differences were only found between ORIF and hemiarthroplasty, according to Yahuaca. He added younger patients and ORIF showed higher fracture union rates, while ORIF and hemiarthroplasty had significantly higher reoperation rates vs. reverse shoulder arthroplasty.

“We had almost a quarter of our patients, 97 of the 425, who had a recurrent fall and 73% of those had at least one more fracture,” Yahuaca said. – by Casey Tingle

 

Reference:

Yahuaca BI, et al. Paper 32. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.

 

Disclosure: Yahuaca reports no relevant financial disclosures.