Herbosa Carolyn F, Adams Jack C, Ganta Abhishek, Konda Sanjit, Egol Kenneth A
NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA.
NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA.
J Shoulder Elbow Surg. 2025 Mar 13. doi: 10.1016/j.jse.2025.02.019.
The purpose of this study is to compare the quality and clinical outcomes of patients who underwent open reduction and internal fixation (ORIF) for a proximal humerus fracture in a "timely manner," which was defined to be within 5 days of injury compared with those with "delayed intervention" (>5 days) to determine the effect this had.
This IRB-approved study evaluated patients who sustained a proximal humerus fracture treated with plate and screw fixation (ie, ORIF) between January 2004 and October 2022 and had time from injury to surgery documented. Patients were grouped based on the time to surgery (TTS): less than 5 days (L5) vs. more than 5 days (M5). TTS was also evaluated as a continuous variable. Univariable and multivariable analysis compared patient demographics, injury/surgical characteristics, postoperative complications, and clinical outcomes to determine effect of TTS. Clinical outcomes included shoulder range of motion (ROM) and Disabilities of the Arm, Shoulder and Hand (DASH) score at least 1 year following the date of injury. Standard statistical tests were used (P < .05 considered significant).
A total of 175 patients met criteria and were analyzed: 74 (42.2%) were L5 and 101 (57.8%) were M5. The cohorts were similar in age, sex, race, body mass index, and Charleston Comorbidity Index. Both cohorts had, based on the Neer classification, similar fracture patterns (P = .68). Complication rates were similar (16% vs. 15%, P = .81). These postoperative complications included avascular necrosis, infection, malunion, nonunion, screw penetration, loss of reduction, nerve symptoms, and painful hardware, which were similar for both cohorts (P = .26). The shoulder mobility of patients at the 1-year time point was similar for all patients regardless of TTS. ROM included active (139° ± 32° vs. 142° ± 29°, P = .61) and passive (152° ± 24° vs. 152° ± 24°, P = .96) forward elevation, and external rotation (52° ± 19° vs. 55° ± 21°, P = .24). Finally, the DASH scores for both groups were similar (15.36 ± 17.72 vs. 20.06 ± 18.96, P = .09). Multivariable analysis confirmed that timing of surgery was not associated with complications or functional outcomes. However, piecewise analysis demonstrated that at a delay of 14 days (151° ± 25° vs. 161° ± 19°, P = .04, β = 0.29, 95% CI 1.05-28.80) and 21 days (149° ± 25° vs. 161° ± 19°, P = .03, β = -0.27, 95% CI -41.71 to -2.89), surgery was associated with less passive forward elevation.
Timing of surgery did not impact outcomes of patients who underwent ORIF for proximal humerus fractures. Surgical intervention after 14 days was associated with diminished passive forward elevation only.
本研究的目的是比较“及时”接受肱骨近端骨折切开复位内固定术（ORIF）的患者与“延迟干预”（>5天）的患者的质量和临床结果，以确定其影响。“及时”定义为受伤后5天内。
这项经机构审查委员会批准的研究评估了2004年1月至2022年10月期间接受钢板螺钉固定（即ORIF）治疗的肱骨近端骨折患者，并记录了从受伤到手术的时间。患者根据手术时间（TTS）分组：少于5天（L5）与多于5天（M5）。TTS也作为连续变量进行评估。单变量和多变量分析比较了患者的人口统计学、损伤/手术特征、术后并发症和临床结果，以确定TTS的影响。临床结果包括受伤日期后至少1年的肩关节活动范围（ROM）和手臂、肩部和手部功能障碍（DASH）评分。使用标准统计测试（P <.05被认为具有统计学意义）。
共有175例患者符合标准并进行了分析：74例（42.2%）为L5，101例（57.8%）为M5。两组在年龄、性别、种族、体重指数和查尔斯顿合并症指数方面相似。根据Neer分类，两组的骨折类型相似（P =.68）。并发症发生率相似（16%对15%，P =.81）。这些术后并发症包括缺血性坏死、感染、畸形愈合、不愈合、螺钉穿透、复位丢失、神经症状和内固定物疼痛，两组相似（P =.26）。无论TTS如何，所有患者在1年时间点的肩关节活动度相似。ROM包括主动前屈（139°±32°对142°±29°，P =.61）和被动前屈（152°±24°对152°±24°，P =.96），以及外旋（52°±19°对55°±21°，P =.24）。最后，两组的DASH评分相似（15.36±17.72对20.06±18.96，P =.09）。多变量分析证实手术时机与并发症或功能结果无关。然而，分段分析表明，延迟14天（151°±25°对161°±19°，P =.04，β = 0.29，95%CI 1.05 - 28.80）和21天（149°±25°对161°±19°，P =.03，β = -0.27，95%CI -41.71至 -2.89）时，手术与较少的被动前屈相关。
手术时机对接受肱骨近端骨折ORIF的患者的结果没有影响。仅在14天后进行手术干预与被动前屈减少有关。
