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Roux 2012
Roux 2012
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REVIEW ARTICLE
a
Department of Trauma and Orthopaedic Surgery, Saint-Roch Hospital, Nice Teaching Hospital Center, 15, rue Pierre-Devoluy,
06000 Nice, France
b
Department of Orthopaedic and Trauma Surgery, Purpan Hospital, Toulouse Teaching Hospital Center, place du Dr-Baylac,
31059 Toulouse cedex 9, France
c
Pasteur Lanroze Orthopaedic Surgical Center, 18, rue Amiral-Desfossés, 29200 Brest, France
d
Department of Orthopaedic Surgery, l’Archet Hospital, Nice Teaching Hospital Center, 151, route Saint-Antoine-de-Ginestière,
06200 Nice, France
KEYWORDS Summary Proximal humerus fractures (PHF) are osteoporotic fractures that affect women
Epidemiology; over 70 years of age. Like fractures of the femoral neck they have become a public health
Fracture; concern. As the population ages there is an increase in the number of people in poor general
Proximal humerus; condition with an increased risk of falls on fragile bones. The incidence of these fractures
Prevalence; has increased by 15% per year. All patients managed for PHF in our center in the past year
Osteoporosis were included in this prospective study (prospective cohort study; level 2). Three hundred and
twenty-five patients were included with 329 fractures. There was a ratio of two women to one
man. At the final follow-up 50 patients had died (15%) and 25 patients were lost to follow-up.
The mean age was 70 years old. There were two types of risk factors. The first was fragile bones,
and the second was patient specific risk of falls. The severity of the fracture increased with the
age of the population. In the study by Charles S. Neer in 1970, 85% of PHF were not or were
only slightly displaced, while this category percentage was only 42% in our study. Hospitalization
was necessary in 43% of the cases in our study. Surgical management was necessary in 21%. This
lack of relationship between the percentage of displaced fractures (58%) and the percentage
of surgically treated fractures is a sign of the difficulties of managing this population, which is
usually in poor general condition.
© 2012 Elsevier Masson SAS. All rights reserved.
∗ Corresponding author.
E-mail address: [email protected] (A. Roux).
1877-0568/$ – see front matter © 2012 Elsevier Masson SAS. All rights reserved.
doi:10.1016/j.otsr.2012.05.013
716 A. Roux et al.
Introduction
Falling from standing height 189 37 152 score is 50 for each). There was a history of shoulder injury
Road accident 34 18 16 in 10 patients (4%), (three fractures, two dislocations, five
Violent fall 17 7 10 rotator cuff tears, one arthritis and two anti-inflammatory
Aggression 9 3 6 injections). Fig. 3 shows the distribution of the different
Suicide attempt 1 0 1 fractures according to the Neer classification. Forty-two
percent of the fractures were NEER type 1; these are con-
sidered to be slightly or not displaced. Fifty-nine percent
respectively in Tables 2 and 3. The patients felt that they of the fractures were displaced. The type of fracture var-
were in good general condition in 154 cases (62%), average ied depending upon the age group. Under the age of 40,
in 66 cases and poor in 30 cases. The objective measure- 41% were slightly or not displaced (Neer type 1), the rest
ment of the general condition of this population based on were two part fractures (Neer type 3, 4 or 6). Following this,
the MOS SF12 quality of life scale showed a mean 41 for the fracture displacement worsened. In the 41—70 year old age
physical score and 53 for the psychological score (the normal group, the percentage of Neer type 1 fractures was similar
(43%) but three or four part fractures are found and repre-
sent 16% of all fractures. In the 71—100 year old age group,
Table 2 Risk factors for fracture. the percentage of type 1 Neer fractures was only 33% and
the percentage of three or four part fractures was 19%; this
Risk factors for fracture Number of patients %
is also the only age group with six patients with articular
Osteoporosis 85 34 fractures of the humeral head. Fractures were managed by
History of falling 82 33 conservative treatment in 79% of the cases (256 patients)
Limited physical activity 75 30 and surgery in 21% (69 patients). Surgical treatment included
History of femoral neck 31 12 internal fixation in 57 cases (53 intramedullary nails and
fracture in mother four ORIF with screws in the greater/lesser tuberosity) and
Trouble walking 62 25 12 shoulder arthroplasties (four anatomical replacements
Pain in the lower limbs 47 19 and eight reverse total shoulder replacements). Hospital-
Trouble seeing 66 26 ization was necessary in 43% of the patients (139 patients).
Trouble hearing 41 16 Therapeutic management varied depending upon the type
Alcoholism 37 15 of fracture. Surgery was performed in three Neer type 1
Tobacco use 71 28 fractures. Two presented with a diaphyseal fracture of the
humerus associated with the PHF, while the third presented
with a bilateral fracture, and it was decided to stabilize both
Table 3 Comorbidities. shoulder fractures for the patient’s comfort. Neer type 3
fractures (surgical neck fracture) were treated surgically in
Comorbidities Number of patients % 39% of cases, Neer type 8 fractures (surgical neck fractures
Diabetes 26 10 and the greater tuberosity) in 41% of the cases and Neer type
Epilepsy 7 3 12 (four part fractures) in 45% of cases. The other types of
Depression 53 21 fractures were rarely operated on (Table 4). Thirty-seven
Dementia 26 10 percent of the patients (125) who presented with displaced
Parkinson’s disease 4 1.6 PHF were not operated on. Conservative treatment was indi-
Psychosis 8 3 cated because of the patient’s poor general condition and
Cardiopathy 21 8 the risk of anesthesia. This population was a mean 78 years
HTA 10 4 old, older than the overall population, and in poorer general
History of stroke 8 3 condition (22% had died at 10 months, 14% had dementia,
20% had comorbidities, 26% had difficulty walking). At the
718 A. Roux et al.