OTA 2012 Posters

Scientific Poster #95 Upper Extremity OTA-2012

Fixation Utilizing an Endosteal Strut Augment Allows for Similar Outcomes Between Neer 2, 3, and 4-Part Proximal Humerus Fractures

Marschall B. Berkes, MD; Milton T. M. Little, MD; Nadine C. Pardee, BS;
Patrick C. Schottel, MD; Lauren E. Lamont, MD; Lionel E. Lazaro, MD;
David L. Helfet, MD; Dean G. Lorich, MD;
Hospital for Special Surgery, New York, New York, USA

Purpose/Hypothesis: Prior studies of proximal humerus fractures treated with open reduction and internal fixation (ORIF) have demonstrated a correlation between the number of parts according to the Neer classification and worsening clinical outcomes, with 4-part fractures faring the worst. Recent investigations have demonstrated the value of an endosteal strut augment in terms of enhancing fixation and limiting complications when treating these fractures. We hypothesize that fractures treated with an endosteal augment will experience uniformly good results, regardless of Neer classification.

Methods: A prospective database of 143 proximal humerus fractures treated with ORIF using a lateral locking plate and an endosteal strut augment by a single surgeon were retrospectively evaluated. Injury radiograph and CT scan were used to determine Neer fracture classification. Immediate postoperative radiographs were assessed for quality of reduction, and compared to final follow-up radiographs to quantify loss of reduction according to the method of Gardner et al. Range of motion at final clinical follow-up was recorded, along with postoperative complications including osteonecrosis (ON). Subjective clinical outcome was assessed through the following questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH); University of California, Los Angeles Shoulder Rating Scale (UCLA); and the Short-Form-36 (SF-36). The cohort was divided according to the Neer classification system and outcomes were compared between these classification groups.

Results: 91 proximal humerus fractures met inclusion criteria with average radiographic follow-up of 12 months. 32 fractures were classified as Neer 2-part fractures, 35 as 3-part, and 24 as 4-part. There was no difference between these groups with regard to age, gender distribution, mechanism of injury, or rate of anatomic reduction. There was no difference between 2, 3 and 4-part fractures with regard to loss of reduction, final postoperative range of motion, or the results of DASH, UCLA, and SF-36 questionnaires. ON was more frequent among 4-part fractures (16.7%, 4 of 24) compared to 2-part (3.1%, 1 of 32) or 3-part fractures (3%, 1 of 35), although this difference was not statistically significant. Among the 6 patients with ON, the average DASH, UCLA, and SF-36 mental and physical component summary scores were 31.2, 23.25, 48.9, and 61.7 and none have required a salvage operation.

Conclusions: The Neer classification was not predictive of clinical or radiographic outcomes among proximal humerus fractures treated with a plate and screw construct supplemented with an endosteal strut augment. The biomechanical and biologic properties of this construct may allow for more durable osteosynthesis and predictable clinical results regardless of initial fracture pattern.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.