title: Effect of proximal humeral fractures on the age-specific prevalence of rotator cuff tears.
abstract: BACKGROUND
  This study examined the effect of proximal humeral fractures on the age- and shoulder-specific prevalence of rotator cuff tears (RCTs) as well as the association with fracture severity, patient age, and clinical outcome.
  
  
  METHODS
  Sixty-three fractures were treated conservatively; in 114 cases, minimally invasive osteosynthesis, and in 125 cases, open reduction and plate fixation were performed without rotator cuff reconstruction. After 4.4 years, all 302 patients were clinically and sonographically examined.
  
  
  RESULTS
  We examined 139 two-part, 95 three-part, and 68 four-part fractures according to Neer and 134 A, 86 B, and 82 C fractures according to the AO classification. There were 52 patients (17%) with a complete rotator tear (RCT) only at the injured shoulder and 11 patients (4%) with a complete RCT only at the contralateral shoulder (p < 0.0001). Independent of the patient's age at follow-up, the prevalence of an RCT in the fractured shoulder was 13% higher than the prevalence in the opposite shoulder. Four-part fractures showed a significant association with a complete RCT (p = 0.047).Of 74 patients with a satisfactory or poor Constant Score, 33 (44.6%) had RCTs. In the remaining 228 patients with a good to excellent result, only 26 (11.4%) had RCTs. We showed that 66% of the RCTs observed at the fractured shoulder were caused by trauma. There was no association between treatment modality and a complete RCT.
  
  
  CONCLUSIONS
  RCTs may need special attention in initial diagnostics, management, and follow-up especially in severe proximal humeral fractures.
authors.affiliation: BG Trauma Center, Hospital for Traumatology and Reconstructive Surgery, Eberhard-Karls-University, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.forename: Bernd
authors.initials: B
authors.lastname: Rolauffs
authors.forename: Fabian
authors.initials: F
authors.lastname: Stuby
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Kuno
authors.initials: K
authors.lastname: Weise
authors.forename: Peter
authors.initials: P
authors.lastname: Helwig
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D001864:Bone Wires; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012306:Risk; D017006:Rotator Cuff / Q000601:surgery / Q000648:ultrastructure; D000070636:Rotator Cuff Injuries; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D014463:Ultrasonography; D055815:Young Adult