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Speaker: Make every effort to fix proximal humerus fractures with ORIF
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KOHALA COAST, Hawaii — Open reduction and internal fixation (ORIF) is usually the best initial treatment of proximal humerus fractures despite the higher reoperation rate with this procedure, said a presenter here.
“Every effort should be made, for every one of these proximal humerus fractures that you decide are unstable and need to be operated on, [to] go in with the thought ‘I am going to try to fix this,’” Anthony A. Romeo, MD, said.
If you cannot fix the proximal humerus fracture because it is non-reconstructable and it is in a younger patient, then you would do a hemiarthroplasty, he said.
Anthony A. Romeo
“If it is an older patient and you just think there is no chance, then we are going to do a reverse [arthroplasty],” Romeo said.
Romeo said although there is a high reoperation rate with ORIF, the results are consistently better in some groups of patients when compared to hemiarthroplasty. Hemiarthroplasty and reverse shoulder arthroplasty are both effective with no significant difference in outcomes or complication rate. With age as a covariate, those conclusions do not change significantly, he noted.
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“Hemiarthroplasty is really for when you cannot get it fixed well in your hands,” Romeo said.
Reference:
Romeo AA. Should we really be performing HHR for proximal humeral fractures anymore? Presented at: Orthopedics Today Hawaii 2013; Jan. 13-16, 2013; Kohala Coast, Hawaii.
Disclosure: Romeo receives royalties from Arthrex, is a consultant for Arthrex and the Joint Restoration Foundation, receives miscellaneous support from Arthrex and DJOrtho, and receives basic science/research support from Arthrex, Smith & Nephew, Ossur, Miomed, DJOrtho, Conmed Linvatech, Athletico.