Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures

Sandra Boesmueller; Margit Wech; Markus Gregori; Florian Domaszewski; Adam Bukaty; Christian Fialka; Christian Albrecht

doi:10.1016/j.injury.2015.10.001

Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures

Injury. 2016 Feb;47(2):350-5. doi: 10.1016/j.injury.2015.10.001. Epub 2015 Oct 22.

Authors

Sandra Boesmueller¹, Margit Wech², Markus Gregori², Florian Domaszewski², Adam Bukaty³, Christian Fialka⁴, Christian Albrecht²

Affiliations

¹ Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Electronic address: sandra.boesmueller@meduniwien.ac.at.
² Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
³ Medical University of Vienna, Division of General Anaesthesia and Intensive Care Medicine, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
⁴ AUVA Trauma Center Vienna Meidling, Kundratstraße 37, A-1120 Vienna, Austria.

PMID: 26706457
DOI: 10.1016/j.injury.2015.10.001

Abstract

Aim: The aim of this study was to evaluate risk factors for the development of humeral head necrosis and non-union after proximal humeral fractures-in particular, general risk factors that exist independent of fracture type.

Materials and methods: This study included patients (n=154) treated for proximal humeral fracture by means of open reduction and internal fixation (ORIF) using the Philos plate at a single level I trauma centre between January 2005 and December 2013. Follow-up monitoring included radiographic examination before hospital discharge, and again at 6 weeks, 12 weeks, and 6 months after surgery. At a minimum follow-up time of 6 months, radiographs taken in the anteroposterior and axial projection were evaluated in regard to the development of humeral head necrosis, non-union, and secondary screw cut out.

Results: A total of 154 patients (61 males, 93 females) were available for radiological checkup. Mean age was 55.8 years (range: 19-91 years). There were statistically significant correlations between the development of avascular necrosis (AVN) and fracture type, non-union and smoking, and screw cut out - as well as overall complication rate - and age. The time to surgery did not influence the risk for AVN or non-union, independent of fracture type. In this study population, the risk of developing non-union after ORIF was 3.9-fold higher in heavy smokers (i.e., >20 cigarettes per day). The risk for screw cut out was 4.1-fold higher in patients over 60 years of age, and the overall risk for complications was 3.3-fold higher.

Conclusion: The older the patient, the more carefully one must consider the decision between conservative and operative treatments. If surgical treatment is performed, screw length should be selected depending on the patient's age. Heavy smokers must be informed preoperatively of the increased risk for bony non-union after ORIF.

Keywords: Avascular humeral head necrosis; Non-union; Plating; Proximal humeral fracture; Risk factors; Screw cut out.

MeSH terms

Adult
Aged
Aged, 80 and over
Bone Plates
Female
Follow-Up Studies
Fracture Fixation, Internal* / methods
Fracture Healing
Fractures, Ununited / diagnostic imaging
Fractures, Ununited / physiopathology*
Fractures, Ununited / surgery
Humans
Male
Middle Aged
Osteonecrosis / diagnostic imaging*
Osteonecrosis / etiology
Osteonecrosis / pathology
Postoperative Complications / diagnostic imaging*
Postoperative Complications / pathology
Postoperative Complications / surgery
Reoperation
Risk Factors
Shoulder Fractures / diagnostic imaging
Shoulder Fractures / physiopathology*
Shoulder Fractures / surgery
Treatment Outcome