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

Dec 22, 2015Journal of shoulder and elbow surgery

Fixing upper arm fractures with open surgery has fewer short-term problems than shoulder replacement

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Abstract

The overall complication rate was 13.0% for open reduction and internal fixation (ORIF), compared to 22.0% for hemiarthroplasty (HA) and 23.2% for total shoulder arthroplasty (TSA/RTSA).

ORIF is associated with fewer overall complications and minor complications compared to HA and TSA/RTSA.
The reduction in complications is primarily influenced by lower rates of blood transfusion in ORIF patients.
Independent risk factors for overall complications include preoperative sepsis, higher anesthesia classification, dependent functional status, and recent blood transfusions.
Longer operative time and a history of chronic obstructive pulmonary disease are also linked to increased complication rates.

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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.

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

Abstract

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