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Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures.
J Shoulder Elbow Surg. 2016 Apr; 25(4):624-631.e3.JS

Abstract

BACKGROUND

Open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and anatomic or reverse total shoulder arthroplasty (TSA/RTSA) are surgical treatment options for proximal humeral fractures (PHFx). Little is known about comparative complication rates. We aimed to determine whether ORIF for PHFx has fewer 30-day complications than HA and TSA/RTSA and to define independent risk factors for 30-day complications.

METHODS

Patients who underwent ORIF, HA, or TSA/RTSA for PHFx between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database. Potential patient and surgical risk factors and 30-day postoperative complications were extracted. Univariate and multivariate analyses were conducted.

RESULTS

We identified 1791 patients (1262 ORIF, 404 HA, and 125 TSA/RTSA). The overall complication rate was 13.0% in ORIF, 22.0% in HA, and 23.2% in TSA/RTSA (P < .001), driven primarily by rates of blood transfusion. Multivariate analyses demonstrated ORIF was an independent protective factor against minor complications (P = .009) and overall complications (P = .028) but not against major complications (P = .351). Risk factors for overall complications included preoperative sepsis (P < .001), higher American Society of Anesthesiologists Physical Status Classification (P < .001), dependent functional status (P = .002), transfusion of at least 5 units in the 72 hours before surgery (P = .002), longer operative time (P = .003), and a history of chronic obstructive pulmonary disease (P = .028).

CONCLUSIONS

After adjusting for patient factors, ORIF for PHFx remains an independent protective factor against overall complications and minor complications compared with HA and TSA/RTSA, primarily due to lower rates of blood transfusion. Patient comorbidities play a larger role than the procedure selected in predicting short-term complications.

Authors+Show Affiliations

Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: gregory.cvetanovich@gmail.com.Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26686759

Citation

Cvetanovich, Gregory L., et al. "Open Reduction Internal Fixation Has Fewer Short-term Complications Than Shoulder Arthroplasty for Proximal Humeral Fractures." Journal of Shoulder and Elbow Surgery, vol. 25, no. 4, 2016, pp. 624-631.e3.
Cvetanovich GL, Chalmers PN, Verma NN, et al. Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2016;25(4):624-631.e3.
Cvetanovich, G. L., Chalmers, P. N., Verma, N. N., Nicholson, G. P., & Romeo, A. A. (2016). Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures. Journal of Shoulder and Elbow Surgery, 25(4), 624-e3. https://doi.org/10.1016/j.jse.2015.09.011
Cvetanovich GL, et al. Open Reduction Internal Fixation Has Fewer Short-term Complications Than Shoulder Arthroplasty for Proximal Humeral Fractures. J Shoulder Elbow Surg. 2016;25(4):624-631.e3. PubMed PMID: 26686759.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures. AU - Cvetanovich,Gregory L, AU - Chalmers,Peter N, AU - Verma,Nikhil N, AU - Nicholson,Gregory P, AU - Romeo,Anthony A, Y1 - 2015/12/10/ PY - 2015/06/23/received PY - 2015/09/06/revised PY - 2015/09/15/accepted PY - 2015/12/22/entrez PY - 2015/12/22/pubmed PY - 2016/9/28/medline KW - Proximal humeral fractures KW - hemiarthroplasty KW - open reduction and internal fixation KW - shoulder arthroplasty SP - 624 EP - 631.e3 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 25 IS - 4 N2 - BACKGROUND: Open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and anatomic or reverse total shoulder arthroplasty (TSA/RTSA) are surgical treatment options for proximal humeral fractures (PHFx). Little is known about comparative complication rates. We aimed to determine whether ORIF for PHFx has fewer 30-day complications than HA and TSA/RTSA and to define independent risk factors for 30-day complications. METHODS: Patients who underwent ORIF, HA, or TSA/RTSA for PHFx between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database. Potential patient and surgical risk factors and 30-day postoperative complications were extracted. Univariate and multivariate analyses were conducted. RESULTS: We identified 1791 patients (1262 ORIF, 404 HA, and 125 TSA/RTSA). The overall complication rate was 13.0% in ORIF, 22.0% in HA, and 23.2% in TSA/RTSA (P < .001), driven primarily by rates of blood transfusion. Multivariate analyses demonstrated ORIF was an independent protective factor against minor complications (P = .009) and overall complications (P = .028) but not against major complications (P = .351). Risk factors for overall complications included preoperative sepsis (P < .001), higher American Society of Anesthesiologists Physical Status Classification (P < .001), dependent functional status (P = .002), transfusion of at least 5 units in the 72 hours before surgery (P = .002), longer operative time (P = .003), and a history of chronic obstructive pulmonary disease (P = .028). CONCLUSIONS: After adjusting for patient factors, ORIF for PHFx remains an independent protective factor against overall complications and minor complications compared with HA and TSA/RTSA, primarily due to lower rates of blood transfusion. Patient comorbidities play a larger role than the procedure selected in predicting short-term complications. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/26686759/Open_reduction_internal_fixation_has_fewer_short_term_complications_than_shoulder_arthroplasty_for_proximal_humeral_fractures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(15)00521-2 DB - PRIME DP - Unbound Medicine ER -