Sat., 10/6/12 Upper Extremity Injuries, PAPER #90, 11:19 am OTA-2012
The Impact of Preoperative Coronal Plane Deformity on Proximal Humerus Fixation With Endosteal Augmentation
Milton T.M. Little, MD; Marschall B. Berkes, MD; Patrick C. Schottel, MD;
Lionel E. Lazarao, MD; Lauren E. Lamont, MD; Nadine C. Pardee, BS; David L. Helfet, MD;
Dean G. Lorich, MD;
Hospital for Special Surgery/New York Presbyterian-Cornell, New York, New York, USA
Purpose/Hypothesis: The development of angular stable implants has increased the frequency of proximal humerus fracture fixation, but risk factors for poor outcomes remain prevalent. Literature suggests that varus deformity at presentation is associated with poorer clinical and radiographic outcomes. The purpose of this study was to compare radiographic, clinical, and functional outcomes among fractures treated with endosteal augmentation in patients presenting with varus or valgus deformity of the proximal humerus. We hypothesize that endosteal augmentation may help to overcome the fixation difficulties associated with varus presentation and yield equivalent outcomes between the two groups.
Methods: All proximal humerus fractures presenting to a single surgeon at a Level I trauma center from 2005 to 2011 were compiled in a prospectively collected database. A retrospective review of this database was performed. All patients were treated through the anterolateral approach with endosteal strut augmentation of laterally placed angular stable plating. Three separate reviewers independently examined preoperative, postoperative, and final radiographs; injury radiographs were evaluated for medial calcar comminution (>3 fracture fragments). Postoperative radiographs were reviewed to assess the quality of reduction (<5 mm of calcar reduction, neck-shaft angle between 120° and 145°) and compared to final follow- up radiographs to assess for loss of reduction as described by Gardner et al. Functional outcome scores were compiled by an independent reviewer for University of California at Los Angeles (UCLA) shoulder rating score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and Short Form 36 health survey (SF-36) at least 1 year postoperatively.
Results: 91 patients fulfilled our inclusion criteria with a mean of 12 months of radiographic follow-up. The mean age was 63 years old (range, 26-90) and 66% were female. 49 fractures presented with varus displacement (mean neck-shaft angle 112.42°, standard deviation [SD] 14.61) and 42 with valgus (mean neck-shaft angle 168.7°, SD 15.14) displacement. There was no significant difference in the rate of fracture reduction (varus 86% vs valgus 71%, P = 0.10), loss of reduction (varus 10% vs valgus 24%, P = 0.25), calcar comminution, DASH, or UCLA scores between the two cohorts. Despite those findings, the varus group had on average significantly worse forward flexion (150° vs 161°, P = 0.023) and lower SF-36 physical component summary scores (55.3 vs 66.7, P = 0.03).
Conclusion: Despite equivalent rates of fracture reduction and maintenance of reduction, fractures presenting with varus coronal deformity had worse functional outcome as measured by the SF-36 physical component summary and forward flexion. Further investigation is warranted to evaluate other factors associated with varus presentation and their propensity for poor outcomes despite adequate reduction.Alphabetical Disclosure Listing (808K PDF)
• 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.