Outcomes for type C proximal humerus fractures in the adult population: comparison of nonoperative treatment, locked plate fixation, and reverse shoulder arthroplasty

S. Andrew Samborski, MD; Brittany E. Haws, MD; Steven Karnyski, MD; Gillian Soles, MD; John T. Gorczyca, MD; Gregg Nicandri, MD; Ilya Voloshin, MD; John P. Ketz, MD

JSES International (Sep 2022)

Outcomes for type C proximal humerus fractures in the adult population: comparison of nonoperative treatment, locked plate fixation, and reverse shoulder arthroplasty

S. Andrew Samborski, MD,
Brittany E. Haws, MD,
Steven Karnyski, MD,
Gillian Soles, MD,
John T. Gorczyca, MD,
Gregg Nicandri, MD,
Ilya Voloshin, MD,
John P. Ketz, MD

Affiliations

S. Andrew Samborski, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA; Corresponding author: S. Andrew Samborski, MD, Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
Brittany E. Haws, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
Steven Karnyski, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
Gillian Soles, MD: Department of Orthopaedics, University of California Davis, Sacramento, CA, USA
John T. Gorczyca, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
Gregg Nicandri, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
Ilya Voloshin, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
John P. Ketz, MD: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA

Journal volume & issue: Vol. 6, no. 5
pp. 755 – 762

Abstract

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Background: This study compares patient-reported outcomes and range of motion (ROM) between adults with an AO Foundation/Orthopaedic Trauma Association type C proximal humerus fracture managed nonoperatively, with open reduction and internal fixation (ORIF), and with reverse shoulder arthroplasty (RSA). Methods: This is a retrospective cohort study of patients >60 years of age treated with nonoperative management, ORIF, or RSA for AO Foundation/Orthopaedic Trauma Association type 11C proximal humerus fractures from 2015 to 2018. Visual analog scale pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, ROM values, and complication and reoperation rates were compared using analysis of variance for continuous variables and chi square analysis for categorical variables. Results: A total of 88 patients were included: 41 nonoperative, 23 ORIF, and 24 RSA. At the 2-week follow-up, ORIF and RSA had lower visual analog scale scores and lower PROMIS pain interference scores (P < .05) than nonoperative treatment. At the 6-week follow-up, ORIF and RSA had lower visual analog scale, PROMIS pain interference, and PF scores and better ROM (P < .05) than nonoperative treatment. At the 3-month follow-up, ORIF and RSA had better ROM and PROMIS pain interference and PF scores (P < .05) than nonoperative treatment. At the 6-month follow-up, ORIF and RSA had better ROM and PROMIS PF scores (P < .05) than nonoperative treatment. There was a significantly higher complication rate in the ORIF group than in the non-operative and RSA groups (P < .05). Conclusion: The management of AO Foundation/Orthopaedic Trauma Association type 11C proximal humerus fractures in older adults with RSA or ORIF led to early decreased pain and improved physical function and ROM compared to nonoperative management at the expense of a higher complication rate in the ORIF group.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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