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Humeral head inferior subluxation in proximal humerus fractures

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Abstract

Purpose

The objectives of this study are to propose a reliable radiologic method for detecting static inferior subluxation of humeral head, to calculate the relative intra- and inter-observer reliability, and to evaluate its presence pre- and post-surgery.

Methods

This is a retrospective observational study of patients surgically treated for a fracture of the proximal humerus. Fractures were classified using Codman-Lego criteria (radiographic, CT images), osteoporosis was assessed. To identify inferior subluxation, an original method is proposed. This measurement was done pre-operatively, at three and 12 month post-operatively. Clinical evaluation was recorded at final follow-up using Constant Score.

Results

One hundred fifty fractures surgically treated were studied. Intra- and inter-observer reliabilities were excellent and high, respectively. In pre-operative x-rays, a significant inferior subluxation was noted in 17/150 cases (11.3%), with significant correlation with fracture pattern (p=0.045), female sex (p=0.038), age older than 70 (p=0.003), obesity (BMI>30, p=0.03), and local osteoporosis (p=0.002). At three month of follow-up, 22 cases (14.6%) had inferior subluxation, with significant correlation with female sex (p=0.04), age older than 70 (p=0.002), obesity (p=0.02), pin or screw articular surface perforation (p<0.001). At 12 month of follow-up, seven cases showed persistent inferior subluxation, with significant correlation with age older than 70 (p=0.032), obesity (p=0.041), screw joint perforation and lower Constant Score (p<0.001).

Discussion

Inferior subluxation was mostly found in osteoporotic fractures of the elderly, obese, and of female sex both pre- and post-operatively. The intra- and inter-observer reliabilities of proposed radiographic measurement were high and excellent, respectively.

Conclusions

In the early postoperative months, we found a high correlation between inferior subluxation and articular surface perforation; when persisting at later follow-ups, we might speculate that it could represent an early phase of avascular necrosis of the humeral head.

Level of evidence

Level III, observational study.

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References

  1. Neer CSII (1970) Displaced proximal humerus fractures. Part II. Treatment of a three and four-part displacement. J Bone Joint Surg Am 52A:1090–1103

    Article  Google Scholar 

  2. Pritchett J (1997) Inferior subluxation of the humeral head after trauma or surgery. J Shoulder Elbow Surg 6:356–359

    Article  CAS  PubMed  Google Scholar 

  3. Cotton FJ (1921) Subluxation of the shoulder—downward. Boston Med Surg J 185:405–407

    Article  Google Scholar 

  4. Yosipovitch Z, Goldberg I (1989) Inferior subluxation of the humeral head after injury to the shoulder. A brief note. J Bone Joint Surg Am 71:751–753

    Article  CAS  PubMed  Google Scholar 

  5. Brooke MM, de Lateur BJ, Diana-Rigby GC, Questad KA (1991) Shoulder subluxation in hemiplegia: effects of three different supports. Arch Phys Med Rehabil 72:582–586

    CAS  PubMed  Google Scholar 

  6. Kumar R, Metter EJ, Mehta AJ, Chew T (1990) Shoulder pain in hemiplegia: the role of exercise. Am J Phys Med Rehabil 69:205–208

    Article  CAS  PubMed  Google Scholar 

  7. Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 22:542–549. https://doi.org/10.1016/j.jse.2012.06.008

    Article  PubMed  Google Scholar 

  8. Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433. https://doi.org/10.1016/j.jse.2004.01.034

    Article  CAS  PubMed  Google Scholar 

  9. Mather J, MacDermid JC, Faber KJ, Athwal GS (2013) Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. J Shoulder Elbow Surg 22:732–738. https://doi.org/10.1016/j.jse.2012.08.018

    Article  PubMed  Google Scholar 

  10. Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  11. Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  12. Bahrs C, Bauer M, Blumenstock G, Eingartner C, Bahrs SD, Tepass A, Weise K, Rolauffs B (2013) The complexity of proximal humeral fractures is age and gender specific. J Orthop Sci 18:465–470. https://doi.org/10.1007/s00776-013-0361-x

    Article  PubMed  Google Scholar 

  13. Dudko S, Wojciechowski P, Kusz D, Wróbel W (2002) Inferior subluxation of humerus after surgery of fractures of proximal humerus. Chir Narzadow Ruchu Ortop Pol 67:175–180

    PubMed  Google Scholar 

  14. Haasters F, Siebenbürger G, Helfen T, Daferner M, Böcker W, Ockert B (2016) Complications of locked plating for proximal humeral fractures-are we getting any better? J Shoulder Elbow Surg 25:e295–e303. https://doi.org/10.1016/j.jse.2016.02.015

    Article  PubMed  Google Scholar 

  15. Carbone S, Papalia M (2016) The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation. Osteoporos Int 27:627–633. https://doi.org/10.1007/s00198-015-3304-x

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy

    Stefano Carbone

  2. San Camillo de Lellis Hospital, Rieti, Italy

    Stefano Carbone

  3. Via Giulio Pittarelli 114, 00166, Roma, Italy

    Stefano Carbone

  4. Clinica Nuova Itor, Department of Orthopedic and Traumatology, Rome, Italy

    Matteo Papalia

  5. Ospedale San Camillo de Lellis, Rieti, Italy

    Valerio Arceri, Stefano Placidi & Riccardo Mezzoprete

  6. Sapienza University of Rome, Rome, Italy

    Andrea Carbone

Authors
  1. Stefano Carbone
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  2. Matteo Papalia
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  3. Valerio Arceri
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  4. Stefano Placidi
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  5. Andrea Carbone
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  6. Riccardo Mezzoprete
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Correspondence to Stefano Carbone.

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Carbone, S., Papalia, M., Arceri, V. et al. Humeral head inferior subluxation in proximal humerus fractures. International Orthopaedics (SICOT) 42, 901–907 (2018). https://doi.org/10.1007/s00264-017-3682-0

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  • DOI: https://doi.org/10.1007/s00264-017-3682-0

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