title: Outcomes of Proximal Humerus Fracture Open Reduction Internal Fixation with Concomitant Ipsilateral Shoulder Girdle Injuries: a Case Control Study.
abstract: BACKGROUND
  Proximal humerus fractures treated in the face of ipsilateral injuries to the shoulder girdle may be predisposed to worse clinical outcomes.
  
  
  OBJECTIVE
  The purpose of this investigation was to examine outcomes of proximal humerus fractures treated with open reduction internal fixation (ORIF) using an endosteal augment in the presence of a concomitant shoulder girdle injury in comparison to isolated proximal humerus fractures treated with ORIF and endosteal augment.
  
  
  METHODS
  A prospective database was used to identify proximal humerus fractures with ipsilateral shoulder girdle injuries (glenohumeral and acromioclavicular dislocation, fractures of the acromion, clavicle, scapula, or humeral diaphysis). These were compared to isolated proximal humerus fractures treated in the same fashion (ORIF with endosteal augment). Minimum of 1 year follow-up was required for inclusion. Outcomes assessed included range of motion (ROM), development of avascular necrosis (AVN), hardware-related complications, reoperation, and subjective outcome assessments including the Disabilities of Arm Shoulder and Hand questionnaire (DASH), Constant score, UCLA rating scale, and the Short Form-36 (SF-36).
  
  
  RESULTS
  Fifteen ipsilateral injuries were seen in 14 patients. Seventy-seven isolated proximal humerus fractures were available for comparison. The ipsilateral injury group had significantly worse forward flexion (141 vs 156°, p = 0.02), external rotation (56 vs 64°, p = 0.03), higher rates of avascular necrosis (4 of 14, 28.6% vs 1 of 77, 1.3%, p = 0.002), and inferior SF-36 physical health scores (48.5 vs 63.5; p = .04). Despite these differences, no significant differences were seen with hardware-related complications or DASH, Constant score, or UCLA rating scale results. No patients required secondary reconstructive procedures.
  
  
  CONCLUSIONS
  Despite a statistically higher rate of AVN and decreased ROM, patient-based outcomes of proximal humerus fractures with ipsilateral shoulder injuries approached those seen in isolated proximal humerus fractures. This suggests that these injuries can achieve similarly good clinical results provided any associated shoulder pathology is identified and treated appropriately.
authors.affiliation: Landstuhl Regional Medical Center, PSC 2 Box 5846, APO, AE 09012 Landstuhl, Germany.
authors.forename: Marschall B
authors.initials: MB
authors.lastname: Berkes
authors.affiliation: Cedars-Sinai Orthopaedic Center, 444 S San Vicente Blvd, Mark Goodson Building, St 603, Los Angeles, CA 90048 USA.
authors.forename: Milton T M
authors.initials: MT
authors.lastname: Little
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Nadine C
authors.initials: NC
authors.lastname: Pardee
authors.affiliation: University of Vermont Medical Center, 192, South Burlington, VT 05403 USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Schottel
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
keywords: acromioclavicular separation; acromion fracture; avascular necrosis; clavicle fracture; dislocation; proximal humerus fracture