Top

MUSCULOSKELETAL SURGERY

Published in:

01-08-2021 | Original Article

Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice

Authors: Ana Belén Fernández-Cortiñas, Jesús Vidal Campos, Fernando Marco Martínez

Published in: MUSCULOSKELETAL SURGERY | Issue 2/2021

Abstract

Background

The purpose of this study was to evaluate the relevance of a commonly used morbidity prognostic tool, the Charlson comorbidity index (CCI), in determining the survival rate of patients with isolated proximal humeral fractures (PHFs) and to determine the impact of surgical treatment according to previous comorbidities (measured with CCI).

Materials and methods

All patients who were treated for a single PHF in our institution for 29 consecutive months were included in this retrospective study, with a minimum follow-up of 24 months (mean 52.8 months). Two groups were established according to the type of treatment received (surgical versus non-surgical). Preinjury comorbidities were identified, and the age-adapted CCI was calculated. All complications and mortality rates were prospectively recorded over the complete follow-up period.

Results

Patients with elevated preinjury comorbidities (CCI > 5) demonstrated a significant increase in mortality (HR = 4.64) compared to those with CCI ≤ 5. In addition, patients with high comorbidities (CCI > 5) who underwent surgical treatment demonstrated a statistically significant increase in mortality (HR = 6.92) compared to patients with similarly high comorbidities (CCI > 5) who underwent non-surgical treatment.

Conclusions

Patients with high preinjury comorbidities (CCI > 5) experienced an increased mortality risk if they underwent surgical treatment for isolated PHFs. The use of a morbidity prognostic tool, such as the CCI, can help predict the outcome (particularly mortality) in these patients and may aid in making decisions in terms of operative versus non-operative treatment to minimize patient mortality.

Level of evidence

Level III; Retrospective Comparative Study; Treatment Study.

Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371CrossRef

Karl JW, Olson PR, Rosenwasser MP (2015) The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 29:e242–e244CrossRef

Launonen AP, Lepola V, Saranko A, Flinkkila T, Laitinen M, Mattila VM (2015) Epidemiology of proximal humerus fractures. Arch Osteoporos 10:209CrossRef

Reyes C, Estrada P, Nogues X, Orozco P, Cooper C, Diez-Perez A, Formiga F, Gonzalez-Macias J, Prieto-Alhambra D (2014) The impact of common co-morbidities (as measured using the Charlson index) on hip fracture risk in elderly men: a population-based cohort study. Osteoporos Int 25:1751–1758CrossRef

LaMartina J, Christmas KN, Simon P, Streit JJ, Allert JW, Clark J, Otto RJ, Abdelfattah A, Mighell MA, Frankle MA (2018) Difficulty in decision making in the treatment of displaced proximal humerus fractures: the effect of uncertainty on surgical outcomes. J Shoulder Elbow Surg 27:470–477CrossRef

Hasty EK, Jernigan EW 3rd, Soo A, Varkey DT, Kamath GV (2017) Trends in surgical management and costs for operative treatment of proximal humerus fractures in the elderly. Orthopedics 40:e641–e647CrossRef

Khatib O, Onyekwelu I, Zuckerman JD (2014) The incidence of proximal humeral fractures in New York state from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elbow Surg 23:1356–1362CrossRef

Maravic M, Briot K, Roux C, Maravic M, Briot K, Roux C, Collège Français des Médecins Rhumatologues (CFMR) (2014) Burden of proximal humerus fractures in the French National Hospital Database. Orthop Traumatol Surg Res 100(8):931–934CrossRef

Anakwenze OA, Zoller S, Ahmad CS, Levine WN (2014) Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review. J Shoulder Elbow Surg 23:e73–e80CrossRef

10.

Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 22:542–549CrossRef

11.

Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, Tosteson AN (2011) Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 93:121–131CrossRef

12.

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42CrossRef

13.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef

14.

Voskuijl T, Hageman M, Ring D (2014) Higher Charlson comorbidity index scores are associated with readmission after orthopaedic surgery. Clin Orthop Relat Res 472:1638–1644CrossRef

15.

Fernandez-Cortiñas AB, Vidal CJ, Paredes-Carnero X, Marco F (2019) Is the Charlson comorbidity index a good predictor of mortality and adverse effects in proximal humerus fractures? Orthop Traumatol Surg Res 105(2):301–305CrossRef

16.

Neer CS (2006) Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res 442:77–82CrossRef

17.

Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF (2010) Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg 19:489–494CrossRef

18.

Handoll HH, Brorson S (2015) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev CD000434

19.

Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, Goodchild L, Chuang LH, Hewitt C, Torgerson (2015) Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 313:1037–1047CrossRef

20.

Roberson TA, Granade CM, Hunt Q, Griscom JT, Adams KJ, Momaya AM, Kwapisz A, Kissenberth MJ, Tolan SJ, Hawkins RJ, Tokish JM (2017) Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults. J Shoulder Elbow Surg 26:1017–1022CrossRef

21.

Court-Brown CM, Cattermole H, McQueen MM (2002) Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br 84:504–508CrossRef

22.

Foruria AM, de Gracia MM, Larson DR, Munuera L, Sanchez-Sotelo J (2011) The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br 93:378–386CrossRef

23.

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark (2011) Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20:1025–1033CrossRef

24.

Shukla DR, McAnany S, Kim J, Overley S, Parsons BO (2016) Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg 25:330–340CrossRef

25.

Neuhaus V, Bot AG, Swellengrebel CH, Jain NB, Warner JJ, Ring DC (2014) Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus. J Shoulder Elbow Surg 23:800–806CrossRef

26.

Amundsen A, Rasmussen JV, Olsen BS, Brorson S (2016) Mortality after shoulder arthroplasty: 30-day, 90-day, and 1-year mortality after shoulder replacement–5853 primary operations reported to the Danish Shoulder Arthroplasty Registry. J Shoulder Elbow Surg 25:756–762CrossRef

27.

Inacio MC, Dillon MT, Miric A, Anthony F, Navarro RA, Paxton EW (2014) Mortality after shoulder arthroplasty. J Arthroplasty 29:1823–1826CrossRef

28.

Beks RB, Ochen Y, Frima H, Smeeing DPJ, van der Meijden O, Timmers TK, van der Velde D, van Heijl M, Leenen LPH, Groenwold RHH, Houwert RM (2018) Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg 27:1526–1534CrossRef

29.

Launonen AP, Lepola V, Flinkkila T, Laitinen M, Paavola M, Malmivaara A (2015) Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients. Acta Orthop 86:280–285CrossRef

30.

Neuhaus V, Swellengrebel CH, Bossen JK, Ring D (2013) What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture? Clin Orthop Relat Res 471:1698–1706CrossRef

Title: Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice
Authors: Ana Belén Fernández-Cortiñas
Jesús Vidal Campos
Fernando Marco Martínez
Publication date: 01-08-2021
Publisher: Springer Milan
Published in: MUSCULOSKELETAL SURGERY / Issue 2/2021
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-020-00642-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2021

Epidemiology and microbiology of prosthetic joint infections: a nine-year, single-center experience in Pavia, Northern Italy

Olecranon fractures in the elderly during the COVID-19 pandemic: Is non-operative treatment reasonable? Review of the current evidence

Paratricipital approach for distal humerus fractures

Revisiting the tibial crest as reference for the mechanical alignment of the tibial component in total knee arthroplasty: a cadaveric study on Caucasian tibiae

Outcomes of cementless fixation in medial unicompartmental knee arthroplasty: review of recent literature

Comparison of efficacy of supraspinatus tendon tears diagnostic tests: a prospective study on the “full-can,” the “empty-can,” and the “Whipple” tests