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Scientific Articles   |    
Intermediate Outcomes Following Percutaneous Fixation of Proximal Humeral Fractures
Alicia K. Harrison, MD1; Konrad I. Gruson, MD2; Benjamin Zmistowski, BS3; Jay Keener, MD4; Leesa Galatz, MD4; Gerald Williams, MD3; Bradford O. Parsons, MD1; Evan L. Flatow, MD1
1 Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for E.L. Flatow: Evan.flatow@mountsinai.org
2 Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 1695 Eastchester Road, Suite 200, Bronx, NY 10461
3 Shoulder and Elbow Center, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107
4 Department of Orthopaedics, Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for E.L. Flatow: Evan.flatow@mountsinai.org
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 1695 Eastchester Road, Suite 200, Bronx, NY 10461
Shoulder and Elbow Center, The Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107
Department of Orthopaedics, Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110
Investigation performed at the Mount Sinai School of Medicine, New York, NY, Barnes-Jewish Hospital, St. Louis, Missouri, and the University of Pennsylvania Health System, Philadelphia, Pennsylvania

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 03;94(13):1223-1228. doi: 10.2106/JBJS.J.01371
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Abstract

Background: 

Mini-open reduction and percutaneous fixation of proximal humeral fractures historically results in good outcomes and a low prevalence of osteonecrosis reported with short-term follow-up. The purpose of this study was to determine the midterm results of our multicenter case series of proximal humeral fractures treated with percutaneous fixation.

Methods: 

Between 1999 and 2006, thirty-nine patients were treated with percutaneous reduction and fixation for proximal humeral fractures at three tertiary shoulder referral centers. Twenty-seven of these patients were available for intermediate follow-up at a minimum of three years (mean, eighty-four months; range, thirty-seven to 128 months) after surgery; the follow-up examination included use of subjective outcome measures and radiographic analysis to identify osteonecrosis and posttraumatic osteoarthritis on radiographs.

Results: 

Osteonecrosis was detected in seven (26%) of the total group of twenty-seven patients at a mean of fifty months (range, eleven to 101 months) after the date of percutaneous fixation. Osteonecrosis was observed in five (50%) of the ten patients who had four-part fractures, two (17%) of the twelve patients who had three-part fractures, and none (0%) of the five patients who had two-part fractures. Posttraumatic osteoarthritis, including osteonecrosis, was present on radiographs in ten (37%) of the total group of twenty-seven patients. Posttraumatic osteoarthritis was observed in six (60%) of the ten patients who had four-part fractures, four (33%) of the twelve patients who had three-part fractures, and none (0%) of the five patients who had two-part fractures.

Conclusions: 

Intermediate follow-up of patients with percutaneously treated proximal humeral fractures demonstrates an increased prevalence of osteonecrosis and posttraumatic osteoarthritis over time, with some patients with these complications presenting as late as eight years postoperatively. Development of osteonecrosis did not have a universally negative impact on subjective outcome scores.

Level of evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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