Simple radiographic assessment of bone quality is associated with loss of surgical fixation in patients with proximal humeral fractures |
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| Affiliation: | 1. Core surgical trainee, Mersey Deanery, UK;2. Specialist registrar in trauma and orthopaedics, Mersey Deanery, UK;3. Consultant upper limb trauma and orthopaedic surgeon, Countess of Chester Hospital, UK;1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, United States;2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan;2. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel;3. Department of Orthopedic Surgery, Ziv Medical Center, Safed, Israel;4. Interventional Radiology Unit, Ziv Medical Center, Safed, Israel;5. Department of Vascular Surgery, Carmel Medical Center, Haifa, Israel;6. The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel;7. Department of General and Hepatobiliary Surgery, Ziv Medical Center, Safed, Israel;8. Department of Surgery, Ziv Medical Center, Safed, Israel;1. Department of Trauma Surgery, Trauma Center, Murnau, Germany;2. Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria;3. Department of Trauma Surgery, University Hospital, Zurich, Switzerland;1. Department of Orthopaedics and Trauma Surgery, University Hospital Freiburg, Germany;2. Department of Radiology, University Hospital Freiburg, Germany;3. Department of Radiology, Kreiskrankenhaus Emmendingen, Germany |
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| Abstract: | AimThis study aimed to determine if the ratio of cortical thickness to shaft diameter of the humerus, as measured on a simple anterior-posterior shoulder radiograph, is associated with surgical fixation failure.Patients and Methods64 consecutive fractures in 63 patients (mean age 66.1years, range 35–90) operated with surgical fixation between March 2011 and July 2014 using PERI-LOC locking plate and screws (Smith and Nephew, UK) were identified. Predictors of bone quality were measured from preoperative radiographs, including ratio of the medial cortex to shaft diameter (medial cortical ratio, MCR). Loss of fixation (displacement, screw cut out, or change in neck-shaft angle >4 degrees) was determined on follow-up radiographs.ResultsLoss of fixation occurred in 14 patients (21.9%) during the follow up. Patients were older in the failure group 72.8 vs. 64.2 years (p = 0.007). The MCR was significantly lower in patients with failed fixation 0.170 vs 0.202, p = 0.019. Loss of fixation is three times more likely in patients with a MCR <0.16 (41% vs. 14%, p = 0.015). Increased fracture parts led to increased failure rate (p = 0.0005).ConclusionMedial cortex ratio is significantly associated with loss of surgical fixation and may prove to be a useful adjunct for clinical decision making in patients with proximal humeral fractures. |
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| Keywords: | Proximal humerus fracture Fixation failure Medial cortical ratio |
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