Osteoporosis does not affect bone mineral density change in the proximal humerus or the functional outcome after ORIF of unilateral displaced 3- or 4-part fractures at 12 months follow-up

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INTRODUCTION: The aim of this prospective study was to investigate BMD changes in the proximal humerus of the shoulder during a healing period of 12 months after displaced 3- or 4-part proximal humerus fractures treated with open reduction and internal fixation (ORIF) with an anatomic angular stable locking plate and the influence on fracture healing and functional outcomes.

METHODS: In a prospective multicenter study, 36 patients (29F and 7M, age range: 38-83) with unilateral displaced 3- or 4-part proximal humerus fractures were included for ORIF. Dual-energy x-ray absorptiometry (DXA) for osteoporosis status was employed. Postoperative and at 6 weeks, 3-, 6-, and 12-months shoulder radiographs and DXA of the shoulder with BMD measures in four templated regions of interest (ROIs) were performed. Functional outcomes: Western Ontario Osteoarthritis of the Shoulder index (WOOS), Constant Score (CS), visual analogue scale pain (VAS), and 36-Item Short Form Survey (SF-36) were collected.

RESULTS: 17 of 36 patients had osteoporosis. We found no differences in BMD changes, functional outcomes, radiology or need for revision surgery between the osteoporosis and non-osteoporosis groups. The BMD values gradually declined from baseline to 3 months follow-up in all four ROIs of the operated shoulders. All four ROIs in the operated shoulder presented with a reduction in BMD at 3, 6 and 12 months compared with baseline, while no significant BMD changes were seen in the healthy shoulder during the study period. The functional outcomes displayed an increase in CS score from 3 to 12 months, but a decrease in domains of the SF-36 from pre-injury to 12 months (physical functioning, general health and bodily pain). Preinjury and at 12 months WOOS, VAS pain at rest and activity were comparable.

CONCLUSION: BMD changes appeared swiftly in the proximal humerus, after treatment of displaced 3- or 4-parts fractures with ORIF, particularly affecting the proximal diaphysis of the humerus. Shoulder function was restored to preinjury levels for most of the patients. Osteoporosis may not be regarded as a contraindication for treatment of displaced 3- or 4-parts fractures with ORIF.

OriginalsprogEngelsk
TidsskriftJournal of Shoulder and Elbow Surgery
ISSN1058-2746
DOI
StatusE-pub ahead of print - 20 aug. 2022

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