Skip to main content
SpringerLink
Log in

Epidemiology and treatment reality of proximal humeral fractures at a level-1 trauma center

Epidemiologie und Versorgungsrealität proximaler Humerusfrakturen an einem spezialisierten Level‑1 Traumazentrum

  • Original Contribution
  • Published:
Obere Extremität Aims and scope Submit manuscript

Abstract

Background

The treatment of proximal humeral fractures (PHF) is challenging. Recently, more restrictive displacement criteria have been introduced and the lack of treatment algorithms in the literature has been emphasized.

Purpose

The primary purpose of this study was to evaluate the epidemiology and treatment reality of PHF at a specialized level-1 trauma center according to current displacement criteria. The secondary aim was to assess whether a standardized treatment algorithm can be adhered to during daily clinical routine.

Methods

In all, 566 patients (71.4 % female; average age, 68.1 ± 15 years) with 569 PHF were included in this retrospective cohort study. All medical records and existing x‑rays as well as computed tomography scans were analyzed. Only fractures with ad latus displacement of max 0.5 cm and/or a humeral head angulation of less than 20º were classified as nondisplaced. Patients with displaced fractures were included for evaluation of a standardized treatment algorithm.

Results

The most common fracture type was a three-part fracture (39.9 %, n = 227); 70.9 % of fractures (389/569) were displaced and therefore treated operatively. The accordance between the final operative treatment that patients received and the recommended surgical treatment on the basis of the algorithm was 90.2 % (351/389).

Conclusion

In contrast to the rate of 15 % dislocated fractures reported by Charles Neer in 1970, more than 70 % of fractures were found to be displaced when more restrictive displacement criteria were applied. More than 90 % of displaced fractures were treated as recommended by the treatment algorithm. Fractures that fitted the least into the treatment scheme were more complex fractures of patients aged 60 years and older.

Zusammenfassung

Hintergrund

Die Behandlung proximaler Humerusfrakturen stellt eine Herausforderung dar. In den vergangenen Jahren wurden neue, striktere Dislokationskriterien eingeführt und das Fehlen von Therapiealgorithmen beklagt.

Ziel der Arbeit

Das primäre Ziel dieser Studie war es die Epidemiologie und Versorgungsrealität von proximalen Humerusfrakturen (PHF) an einem spezialisierten Level-1 Traumazentrum entsprechend neuer Dislokationskriterien zu evaluieren. Das sekundäre Ziel war es zu erfassen, ob ein Therapiealgorithmus im Versorgungsalltag eingehalten werden kann.

Material und Methoden

566 Patienten (71,4 % weiblich; Durchschnittsalter 68,1 ± 15 Jahre) mit 569 PHF wurden in diese retrospektive Studie eingeschlossen. Die Patientenakten, Röntgenbilder und CT Untersuchungen aller Patienten wurden analysiert. Frakturen mit ad-latus Dislokation von max. 0,5 cm und/oder Humeruskopfangulation von weniger als 20° wurden als undisloziert klassifiziert. Patienten mit dislozierten Frakturen wurden in die Auswertung des operativen Therapiealgorithmus eingeschlossen.

Ergebnisse

Der häufigste Frakturtyp war eine 3‑Segment Fraktur (39,9 %, n = 227). 70,9 % der Frakturen (389/569) waren disloziert und wurden operativ versorgt. Die durchgeführte operative Therapie stimmte in 90,2 % (351/389) mit der Empfehlung des Therapiealgorithmus überein.

Diskussion

Im Gegensatz zu 15 % dislozierter Frakturen entsprechend Charles Neer in 1970, waren bei Anwendung der aktuelleren Dislokationskriterien mehr als 70 % der PHF disloziert. Über 90 % der dislozierten PHF wurden entsprechend des empfohlenen Therapiealgorithmus behandelt. Bei komplexen Frakturen von über 60-jährigen Patienten wich die Behandlung am stärksten vom Therapiealgorithmus ab.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bahrs C, Bauer M, Blumenstock G, Eingartner C, Bahrs SD, Tepass A, Weise K, Rolauffs BJ (2013) The complexity of proximal humeral fractures is age and gender specific. Orthop Sci 18:465–470

    Article  Google Scholar 

  2. Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP (2013) The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int 110:591–597

    PubMed  PubMed Central  Google Scholar 

  3. Codman EA (1934) Fractures in relation to the subacromial bursa. In: Codman EA (ed) The shoulder, rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Krieger, Malabar, pp 313–331

    Google Scholar 

  4. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: A review. Injury 37:691–697

    Article  PubMed  Google Scholar 

  5. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371

    Article  CAS  PubMed  Google Scholar 

  6. Edelson G, Saffuri H, Obid E, Vigder F (2009) The three-dimensional anatomy of proximal humeral fractures. J Shoulder Elbow Surg 18:535–544

    Article  PubMed  Google Scholar 

  7. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191

    Article  PubMed  Google Scholar 

  8. Gerber C, Werner CML, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Jt Surg 86-B:848–855

    Article  Google Scholar 

  9. Gradl G, Knobe M, Pape H‑C, Neuhaus PV, Ring D, Guitton T (2015) Decision making in displaced fracture of the proximal humerus: fracture or surgeon based? Int Orthop 39:329–334

    Article  PubMed  Google Scholar 

  10. Haaster F, Prall WC, Himmler M, Polzer H, Schieker M, Mutschler W (2015) Prevalence and management of osteoporosis in trauma surgery. Implementation of national guidelines during inpatient fracture treatment. Unfallchirurg 118:138–145

    Article  Google Scholar 

  11. Hadji P, Klein S, Gothe H, Häussler B, Kless T, Schmidt T, Steinle T, Verheyen F, Linder R (2013) The epidemiology of osteoporosis – Bone Evaluation Study (BEST). Dtsch Arztebl Int 110:52–57

    PubMed  PubMed Central  Google Scholar 

  12. Handoll HH, Ollivere BJ, Rollins KE (2012) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 12:CD000434

    PubMed  Google Scholar 

  13. Lill H, Voigt C (2010) Proximal humeral fracture. Z Orthop Unfall 148:353–360

    Article  CAS  PubMed  Google Scholar 

  14. Lind T, Krøner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108:285–287

    Article  CAS  PubMed  Google Scholar 

  15. Merschin D, Stangl R (2014) Stability and functional aspects after reversed modular fracture arthroplasty in case of 3‑ and 4‑part fractures of the humeral head. Obere Extremität 9:280–288

    Article  Google Scholar 

  16. Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    PubMed  Google Scholar 

  17. Osterhoff G, Hoch A, Wanner GA, Simmen H‑P, Werner CML (2013) Calcar comminution as prognostic factor of clinical outcome after locking plate fixation of proximal humeral fractures. Injury 43:1651–1656

    Article  Google Scholar 

  18. Osterhoff G, Wanner GA, Simmen H‑P, Werner CML (2013) Medial support with cortical intramedullary graft and locking plate osteosynthesis of proximal humeral fractures. Case report and review of the literature. Obere Extremität 8:170–175

    Article  Google Scholar 

  19. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92See

    Article  PubMed  Google Scholar 

  20. Resch H (2011) Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 20:827–832

    Article  PubMed  Google Scholar 

  21. Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, Boileau P, Peretti F de (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719

    Article  CAS  PubMed  Google Scholar 

  22. Siebenbürger G, Biermann N, Haasters F et al (2014) Longer-term functional outcomes (median 5 years) after locked plating for displaced fractures of the proximal humerus. Obere Extrem 9:215–221

    Article  Google Scholar 

  23. Sonderegger J, Simmen HP (2003) Epidemiology, treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area. Zentralbl Chir 128:119–124

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dimitri S. Tahal for proofreading and language editing.

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany

    J. Christoph Katthagen, Svenja Grabowski, Meret Huber,  Gunnar Jensen,  Christine Voigt &  Helmut Lill

  2. Steadman Philippon Research Institute, 181 W Meadow Dr, Suite 1000, 81657, Vail, Colorado, USA

    J. Christoph Katthagen

Authors
  1. J. Christoph Katthagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svenja Grabowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meret Huber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunnar Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine Voigt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helmut Lill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helmut Lill.

Ethics declarations

Conflict of interest

H. Lill is consultant with Arthrex (Karlsfeld, Deutschland) and DePuy Synthes (Umkirch, Deutschland). J.C. Katthagen, S. Grabowski, M. Huber, G. Jensen, and C. Voigt state that there are no conflicts of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was IRB approved.

Additional information

Work performed at the Department of Orthopaedic and Trauma Surgery, DIAKOVERE Friederikenstift gGmbH.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Katthagen, J.C., Grabowski, S., Huber, M. et al. Epidemiology and treatment reality of proximal humeral fractures at a level-1 trauma center. Obere Extremität 11, 112–118 (2016). https://doi.org/10.1007/s11678-016-0362-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-016-0362-4

Keywords

Schlüsselwörter

Search

Navigation