Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures

J Shoulder Elbow Surg. 2016 Apr;25(4):624-631.e3. doi: 10.1016/j.jse.2015.09.011. Epub 2015 Dec 10.

Abstract

Background: Open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and anatomic or reverse total shoulder arthroplasty (TSA/RTSA) are surgical treatment options for proximal humeral fractures (PHFx). Little is known about comparative complication rates. We aimed to determine whether ORIF for PHFx has fewer 30-day complications than HA and TSA/RTSA and to define independent risk factors for 30-day complications.

Methods: Patients who underwent ORIF, HA, or TSA/RTSA for PHFx between 2006 and 2013 were identified from the National Surgical Quality Improvement Program database. Potential patient and surgical risk factors and 30-day postoperative complications were extracted. Univariate and multivariate analyses were conducted.

Results: We identified 1791 patients (1262 ORIF, 404 HA, and 125 TSA/RTSA). The overall complication rate was 13.0% in ORIF, 22.0% in HA, and 23.2% in TSA/RTSA (P < .001), driven primarily by rates of blood transfusion. Multivariate analyses demonstrated ORIF was an independent protective factor against minor complications (P = .009) and overall complications (P = .028) but not against major complications (P = .351). Risk factors for overall complications included preoperative sepsis (P < .001), higher American Society of Anesthesiologists Physical Status Classification (P < .001), dependent functional status (P = .002), transfusion of at least 5 units in the 72 hours before surgery (P = .002), longer operative time (P = .003), and a history of chronic obstructive pulmonary disease (P = .028).

Conclusions: After adjusting for patient factors, ORIF for PHFx remains an independent protective factor against overall complications and minor complications compared with HA and TSA/RTSA, primarily due to lower rates of blood transfusion. Patient comorbidities play a larger role than the procedure selected in predicting short-term complications.

Keywords: Proximal humeral fractures; hemiarthroplasty; open reduction and internal fixation; shoulder arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement / adverse effects*
  • Arthroplasty, Replacement / methods
  • Blood Transfusion / statistics & numerical data
  • Comorbidity
  • Databases, Factual
  • Female
  • Fracture Fixation, Internal / adverse effects*
  • Hemiarthroplasty / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Shoulder Fractures / epidemiology
  • Shoulder Fractures / surgery*
  • Shoulder Joint / surgery
  • United States / epidemiology