Artikel
The influence of local bone quality on fracture pattern in proximal humerus fractures
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Autoren
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Ruben Mazzucchelli
- Departement Orthopädie – Spital Grabs, Grabs, Switzerland
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Katharina Jenny
- Kantonsspital St. Gallen, St. Gallen, Switzerland
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Vilijam Zdravkovic
- Kantonsspital St. Gallen, St. Gallen, Switzerland
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Bernhard Jost
- Kantonsspital St. Gallen, St. Gallen, Switzerland
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Christian Spross
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: The significance of bone mineral density in the treatment of proximal humerus fractures has been widely discussed in the literature. Also the fracture pattern is a relevant factor when considering the different treatment options for these fractures. It was the aim of this study to assess the influence of local bone mineral density on the fracture pattern in proximal humerus fractures.
Methods: From January 2014 to August 2015 we prospectively analyzed all acute, isolated and non-pathological proximal humerus fractures admitted at our emergency department. Two independent board certified orthopaedic trauma surgeons retrospectively classified the fractures according to Neer and measured the humeral head impaction angle (varus/valgus). On the fracture X-ray we also assessed the local bone quality using the Deltoid Tuberosity Index (DTI). Chi-squared test was used to analyse the distribution between DTI and fracture pattern.
Results and Conclusion: 191 proximal humerus fractures were included in the study (61 men, mean age 59 years, range 15-91 years; 130 women, mean age 69.5, range 19-99). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48 (SD=0.19, range 1.11 - 2.35). Valgus fracture impaction significantly correlated with good bone quality (DTI >= 1.4; p=0.047) whereas no such statistical significance was found for the Neer fracture types.
This is the first study comparing bone quality and fracture morphology. We found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand good local bone quality does not prevent fracture comminution.
