Three- and 4-part proximal humeral fracture fixation with an intramedullary cage: 1-year clinical and radiographic outcomes

Joshua Hudgens, Jessica Jang, Keith Aziz, Matthew J. Best, Uma Srikumaran

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Reverse total shoulder arthroplasty is a treatment option for 3- and 4-part proximal humeral fractures in elderly patients. However, arthroplasty has drawbacks in younger patients because of their greater activity level and more likely need for revision surgery. In such patients, an intramedullary cage may allow for reconstruction of the proximal humerus. Methods: We reviewed the outcomes of patients with proximal humeral fractures treated with expandable intramedullary cages from 2016 to 2017. We included patients with closed 3- or 4-part fractures (Neer classification), no osteoarthritis of the glenohumeral joint, and minimum 12-month follow-up. We assessed range of motion, pain, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value. Results: Eleven patients (mean follow-up, 54 weeks [range, 49-61 weeks]) were included. Two patients had 3-part fractures, and nine had 4-part fractures. At final follow-up, the mean visual analog scale score for pain was 1.4 (range, 0-6), the mean Subjective Shoulder Value was 69 (range, 20-90), and the mean American Shoulder and Elbow Surgeons score was 80 (range, 27-98). Mean forward flexion was 123° (range, 45°-160°), mean abduction was 82° (range, 30°-90°), and mean external rotation in 90° of abduction was 71° (range, 30°-90°). At final radiographic evaluation, all fractures were healed. No wound-related or neurologic complications were noted. Avascular necrosis developed in 1 patient; conversion to shoulder arthroplasty was performed. Conclusion: Treatment of 3- and 4-part proximal humeral fractures with an expandable intramedullary cage produced good clinical outcomes and a 100% union rate.

Original languageEnglish (US)
Pages (from-to)S131-S137
JournalJournal of Shoulder and Elbow Surgery
Volume28
Issue number6
DOIs
StatePublished - Jun 2019

Keywords

  • Case Series
  • Clinical outcomes
  • Level IV
  • Treatment Study
  • fracture fixation
  • intramedullary cage
  • pain
  • proximal humeral fracture
  • range of motion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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