A standardized construct of blocked threaded wires for treating complex three-part proximal humerus fractures. A long-term follow-up of a previously published series

TL;DR

This study evaluates long-term results of treating complex shoulder fractures with blocked threaded wires, showing good outcomes and few complications.

Contribution

The study provides long-term follow-up data on a surgical technique for proximal humerus fractures using blocked threaded wires.

Findings

Clinical data from 47 out of 52 patients showed a mean Constant-Murley score of 83.5% after 8 years.

Only 5% of patients developed avascular necrosis and 5% showed arthritis signs.

Complications remained low with no major issues beyond those previously reported.

Abstract

Percutaneous pinning is classically considered an option for treating proximal humerus fractures (PHFs) in elderly low-demanding patients; recently, promising clinical and radiographic medium-term outcomes have been documented after the treatment of displaced PHF using different configurations of blocked threaded wires. However, long-term follow-up (FU) is still lacking. The aim of the present study was to evaluate the clinical and radiographic outcomes of a previously published midterm FU cohort after a minimum of 8 years.

In this observational study, all 52 patients from the midterm outcome paper were asked to visit our institution for consultation and X-rays. Patients who could not return for an on-site consultation because of poor health completed a self-administered questionnaire with the assistance of his/her general practitioner, and the responses were finalized via a telephone interview. The individual relative Constant-Murley score and the visual analog scale (VAS) were recorded. In radiographic evaluation, both arthritis progression and signs of avascular necrosis were recorded. Complications and reoperation were registered and classified as early (<2 years) and delayed (>2 years).

Of the initial 52 patients, 2 died before the long-term evaluation and 3 were lost to FU. Clinical data were thus obtained for 47 patients (90%), and radiographic data were obtained in 40 patients (77%). The minimum follow-up was 8 years [range: 96-118 months; mean (standard deviation): 102 (4.5) months]. The mean patient age was 68.7 years (standard deviation: 6.3). The mean individual relative Constant-Murley score at the final FU was 83.5%. Regarding the VAS, 36 patients referred their pain as 0 (76.5%), 8 as 1 (17%) and 3 as 2 (6.5%). According to the radiographic assessment, avascular necrosis was present in 2 patients (5%) while 2 patients developed signs of arthritis (Samilson Prieto 2). VAS score was 1/10 in patients with avascular necrosis, whereas a VAS of 2/10 was registered in patients with arthritis. No additional major complications occurred beyond the one previously reported in the midterm analysis: a fracture nonunion who refused any further treatment due to comorbidities. Two superficial infections treated with 5 days of oral antibiotics occurred during the midterm FU. One patient referred an arthroscopic rotator cuff repair 5 years postsurgery with symptoms starting 5 months before the procedure.

Treatment of complex PHF with a construct of blocked threaded wires after an anatomical open/mini-open reduction led to excellent clinical and radiological outcomes with a low rate of complications compared with published results of the other surgical options.

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