Orthopaedics and Traumatology, Universidad Autónoma de Nuevo León. Hospital Universitario "Dr. José E. González", Ave Madero and Gonzalitos, S/N, Mitras centro, Monterrey, Nuevo León, Mexico.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3267-3273. doi: 10.1007/s00402-024-05458-4. Epub 2024 Jul 15.
To evaluate the relationship between initial displacement in proximal humeral fractures and fatty degeneration of the rotator cuff measured by CT according to the Goutallier classification.
This cross-sectional observational study evaluated patients with proximal humeral fractures over a six-month period. The study included patients ≥ 18 years old with complete radiological views (anteroposterior, lateral, and Grashey) and a CT scan of the affected shoulder; previous fracture or ipsilateral shoulder surgery were excluded. Neer's classification system and Goutallier stages were used to evaluate the patients. Demographic data were collected and, two groups were analysed according to age (≤ 50 years and > 50 years).
Sixty-two patients were included (m = 36, f = 26, ratio 1.3:1); seven patients were excluded. Male patients (36, 58.1%), patients older than 50 years (33, 53.2%) and a low-energy injury mechanism (36, 58.1%) were the most frequent cases. According to the Neer system, the most common proximal humerus fracture was fracture-dislocation in 17 (27.4%) cases. The most common stage in Goutallier's classification was I (some fatty streaks) in 22 (35.4%) cases. Younger patients (≤ 50 years) had more displaced fractures with low fatty degeneration (p = < 0.001) than older patients (> 50 years), who had minimally displaced fractures with greater fatty degeneration (p = 0.567).
High-energy mechanisms are associated with younger patients and a more displaced fracture according to the Neer classification. Older patients had a more advanced Goutallier stage and lesser displaced fracture. We should consider a more aggressive approach in the treatment of non-displaced fractures in elderly patients, less conservative and more surgical management, to obtain a better clinical evolution after the treatment of these kinds of fractures.
IV.
根据 Goutallier 分级，评估肱骨近端骨折的初始位移与 CT 测量的肩袖脂肪变性之间的关系。
这是一项为期六个月的肱骨近端骨折患者的横断面观察性研究。纳入标准为年龄≥ 18 岁，具有完整的影像学视图（前后位、侧位和 Grashey 位）和受影响肩部的 CT 扫描；排除既往骨折或同侧肩部手术史。采用 Neer 分类系统和 Goutallier 分期评估患者。收集患者的人口统计学数据，并根据年龄（≤ 50 岁和> 50 岁）分为两组进行分析。
共纳入 62 例患者（男 36 例，女 26 例，男女比 1.3:1），排除 7 例患者。最常见的病例为男性（36 例，58.1%）、年龄大于 50 岁（33 例，53.2%）和低能量损伤机制（36 例，58.1%）。根据 Neer 系统，最常见的肱骨近端骨折为 17 例（27.4%）骨折脱位。Goutallier 分级中最常见的分期为 I 期（部分脂肪条纹），有 22 例（35.4%）。年轻患者（≤ 50 岁）的骨折移位程度更高，但脂肪变性程度较低（p < 0.001），而年龄较大患者（> 50 岁）的骨折移位程度较低，但脂肪变性程度更高（p = 0.567）。
根据 Neer 分类，高能量机制与年轻患者和更移位的骨折相关。年龄较大的患者 Goutallier 分期更高，骨折移位程度更小。对于老年患者的非移位骨折，我们应考虑采取更积极的治疗方法，避免过于保守，更多地采用手术治疗，以获得这些骨折治疗后的更好临床转归。
IV 级。
