Avascular Necrosis, Avascular Necrosis of Humerus, Dislocation, Dislocation Shoulder, Proximal Humeral Fracture
Conditions
Brief summary
The purpose of the study is to see if there is a connection between a proximal humerus fracture dislocation direction and the likelihood of developing avascular necrosis. Utilizing a retrospective cohort from the last ten years we hope to bring consenting patients back for a single visit to have x-rays and complete patient reported outcome measures to assess for evidence of avascular necrosis.
Detailed description
The incidence of proximal humerus fractures continues to increase and is among one of the more common fractures seen in the adult population. Proximal humerus fracture dislocations, however, are less common. Despite the decreased prevalence, fracture dislocations have unique challenges with respect to obtaining an anatomical reduction and more frequently involve an open surgical reduction. In addition, depending on other fracture characteristics, there are various treatment options for the fracture itself. While fracture dislocations ultimately lead to increased AVN and revision surgery, further discussion surrounding the direction of dislocation and how it may influence overall outcomes has not been addressed in the previous literature. The study design utilizes a retrospective cohort from the last ten years, by asking patients who have had a previously surgically treated proximal humerus fracture dislocations to come back to the surgeon's private clinic to complete a single visit assessment. During this assessment the consenting participant will receive x-rays and complete patient reported outcome measures. In conjunction, these will be utilized to assess overall function and the existence of avascular necrosis.
Interventions
DIAGNOSTIC_TESTX-Ray
Consenting participants will be asked to come into the clinic for a single visit, during this visit they will be asked to complete an x-ray to check for evidence of avascular necrosis.
Sponsors
Fraser Orthopaedic Research Society
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients 18 years of age or older * Patients who underwent operative fixation of proximal humerus fracture dislocation at Royal Columbian Hospital between January 2011 and July 2021 * Willing and able to consent and complete patient reported outcome measures * Willing and able to follow the protocol and attend a follow-up visit * Able to read and understand English or have an interpreter available
Exclusion criteria
* Skeletally immature patients * Patient with pathological fractures * Patients who have had previous operative fixation of proximal humerus * Patients treated non-operatively * patients presenting outside of the study duration window * Patients treated by a non-participating surgeon * Deceased patients * Patients unable to complete patient reported outcome measures * Patients declining to come back to the clinic for updated x-rays * Dementia * Incarceration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rates of Avascular Necrosis | At least 2 years post fracture fixation | The presence and advancement of avascular necrosis (as classified by the Cruess Classification System) and as assessed on radiographs. |
| Direction of the Humeral Fracture Dislocation | At least 2 years post fracture fixation | As characterized by the direction of the humeral head in relation to the glenoid, based on AP, Lateral, or Axillary x-ray views. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| DASH (functional outcome) | At least 2 years post fracture fixation | Asking participants to complete the Disabilities of the Arm, Shoulder, and Hand outcome measure as a way of assessing function. |
| Constant Score (functional outcome) | At least 2 years post fracture fixation | Asking participants to complete the Constant Score patient reported outcome measure as a way of assessing participant function. |
Countries
Canada
Outcome results
None listed