Anterior translation may have a negative impact on proximal humerus fracture union
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Presented results showed substantial anterior translation of the humeral shaft of at least 80% was associated with failure of nonoperative care, symptomatic malunion and secondary surgery in patients with proximal humerus fractures.
“Over the course of time, I have noticed that a specific deformity of anterior translation on the lateral view seemed to give people a problem,” Paul Tornetta III, MD, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “So, we wanted to look at the effect of translation on the outcome of humerus fractures that were treated closed, regarding the need for future surgery and symptomatic malunion.”
Tornetta and colleagues performed an analysis of 210 patients (mean age of 64 years) who were treated nonoperatively for isolated, low-energy proximal humerus fractures at five different centers. According to the abstract, 171 patients were injured in a fall. Average follow-up was 231 days or until surgery was required. Outcome measures included failure of nonoperative treatment, symptomatic malunion and radiographic translation.
Of the 4% of patients who ultimately required surgery, 100% had an anterior translation of greater than 80%. Compared with no or posterior translation, anterior translation was associated with failure of nonoperative management requiring surgery. Additionally, an anterior translation of greater than or equal to 80% was associated with surgery compared with an anterior translation of less than 80%. Symptomatic malunion was reported in 26 patients, 24 of which had anterior translation, Tornetta noted.
According to Tornetta, it is important to note the presence of anterior translation did not change over time and was present on the Y view of all initial radiographs – allowing this deformity to be seen and addressed early.
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Tornetta P, et al. Paper 127. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20 - 23, 2021; Fort Worth, Texas.
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