Complications Of Fractures Research Articles

A novel semi-explicit numerical algorithm for efficient 3D phase field modelling of quasi-brittle fracture

Phase field models have become an effective tool for predicting complex crack configurations including initiation, propagation, branching, intersecting and merging. However, several computational issues have hindered their utilisation in engineering practice, such as the convergence challenge in implicit algorithms, numerical stability issues in explicit methods and significant computational costs. Aiming to providing a more efficient numerical algorithm, this work integrates the explicit integral operator with the recently developed neighbored element method, for the first time, to solve the coupled governing equations in phase field models. In addition, the damage irreversibility can be ensured automatically, avoiding the need to introduce extra history variable for the maximum driving force in traditional algorithms. Six representative fracture benchmarks with different failure modes are simulated to verify the effectiveness of the proposed method, including the multiple cracks in heterogeneous concrete at mesoscale. It is found that this semi-explicit numerical algorithm yields consistent crack profiles and load capacities for all examples to the available experimental data and literature. In particular, the computational cost is significantly reduced when compared to the traditional explicit modelling. Therefore, the presented numerical algorithm is highly attractive and promising for phase-field simulations of complicated 3D solid fractures in structural-level engineering practices.

Comparative analysis of radiological outcomes among cephalomedullary nails: helical, screw and winged screw.

Cephalomedullary nails (CMN) are implants with a high success rate in the surgical treatment of trochanteric fractures. The aim of this study is to compare the radiological outcomes and mechanical complications of femoral trochanteric fractures treated with three different CMNs. Intertrochanteric fractures in patients aged 50 years and older treated with CMN between January 2016 and December 2021 were reviewed retrospectively. A total of 158 cases meeting the criteria were included to final analysis. Cases were divided into three groups based on the type of nail used (helical blade: group 1, n=54; screw: group 2, n=53; winged screw: group 3, n=51). Demographic characteristics, mechanical complications, reduction quality, tip-apex distances (TAD) and Cleveland zones were compared between the groups. Femoral neck shortening, varus collapse, lag sliding, changes in abductor length were compared between study groups. Factors affecting mechanical complications were also analyzed. Study groups were homogenic in terms of demographic characteristics, fracture type and reduction quality. Regarding mechanical complications, no statistically significant difference was found between groups. All three implants had similar outcomes on femoral neck shortening, varus collapse and lag sliding. Pooled analysis of 158 cases showed that mechanical complications increase as the quality of reduction decreases (p=0.000) same applies when TAD alters from the desired range (p=0.025) and with non-optimally implanted blade according to Cleveland zones (p=0,000). The radiological outcomes and mechanical complications of helical blade, screw type blade and winged screw type blade proximal femoral nails are similar in selected group. Regardless of the device type, it is necessary to obtain high reduction quality, obtain TAD within described range and optimally place the blade according to Cleveland Zones to reduce the failure rate and avoid complications.

The Impact of Frailty and Gender Differences on Hospitalization and Complications in Proximal Femoral Pathological Fractures: A Cross-Sectional Study.

Frailty associated with aging increases the risk of falls, disability, and death. The aim of this study is to explore gender-related disparities in the survival outcomes of pathological femoral fractures in older frail patients, while analyzing potential specific prognostic factors. This study is a retrospective observational analysis conducted at a single medical center. It enrolled all patients aged 65 and above who were admitted to our emergency department between 2016 and 2020 with a diagnosis of pathological femur fracture requiring surgical intervention. The primary study endpoint was evaluating gender-related differences in survival outcomes. The secondary endpoint involves investigating gender-specific prognostic factors through the analysis of clinical and laboratory parameters. The average Charlson Comorbidity Index (CCI) was slightly lower in men, but the difference was not statistically significant (p = 0.53). The Clinical Frailty Scale (CFS) showed similar results, with men and women 5.23 (SD 1.46), also not significant (p = 0.83). An evaluation comparing patients aged 75 years or younger to those older than 75 years found significant differences in health metrics. The average CCI was higher in the over 75 group compared to the under 75 group, with a p-value of 0.001. Similarly, the CFS average was also greater in the over 75 group than in the under 75 group, with a p-value of 0.0001. Complications were more frequent in patients over 75 and those with lower educational qualifications. The evaluation analyzed cardiac patients compared to a control group, revealing that the average age of cardiac patients was 75.22 years, while the control group was younger at 73.98 years (p = 0.5119). The CCI for cardiac patients averaged 6.53, significantly higher than 4.43 for non-cardiac patients (p = 0.0003). Frailty assessment is therefore essential in patients with pathological fracture of the proximal femur and is an important predictor of both gender differences and hospital complications. Enhancing gender analysis in this field is crucial to gather more robust evidence and deeper comprehension of potential sex- and gender-based disparities.

Vertebral bone quality score as a new tool for osteoporosis diagnosis in patients undergoing lumbosacral fusion surgery: a single center cohort study.

Osteoporosis, a common bone disorder, increases fracture and spinal surgery complications risk. This study evaluates the potential of the Magnetic Resonance Imaging (MRI)-based Vertebral Bone Quality (VBQ) score as an alternative for assessing bone density in lumbosacral fusion surgery patients. In a prospective cohort study from April 2021 to November 2022, 134 patients with lumbar degenerative diseases underwent lumbar Dual-Energy X-ray Absorptiometry (DXA) and lumbosacral non-contrast T1-weighted MRI. VBQ scores were calculated and analyzed using IBM SPSS Statistics and MedCalc software. Osteopenia/Osteoporosis patients exhibited significantly higher VBQ scores than normal bone mineral density patients (3.37 ± 0.51 vs. 2.99 ± 0.44, P<0.001). VBQ correlated significantly with lumbar DXA T scores (r value= -0.415, p<0.001). Receiver Operating Characteristic (ROC) analysis showed VBQ AUC values of 0.730 (CI 95% 0.647-0.803, P<0.001) and 0.839 (CI 95% 0.765-0.897, P<0.001) for Osteopenia/Osteoporosis and osteoporosis diagnosis, respectively. The study suggests MRI-derived VBQ scores may benefit pre-lumbosacral fusion surgery bone density assessment, potentially improving patient care and aiding osteoporosis detection in spinal surgery candidates.

Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures-a prospective comparative study.

To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This prospective interventional study was conducted among 30 patients by dividing into two equal groups over oneyear and sixmonths. All patients were followed up for a minimum of at least sixmonths. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. The majority of patients (26.7%) were between 18 to 30years, overall mean age was 44.4years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Fragment Reattachment For Complicated Crown Root Fracture – A Case Report

Complicated crown-root fractures are challenging dental injuries that involve both enamel and dentin structures and extend into the root. They often necessitate a multifaceted approach to achieve successful reattachment and functional restoration. This case report describes the management and outcomes of a complicated crown-root fracture using a reattachment technique

Management of complicated crown fracture in maxillary incisor using fragment reattachment - 5-year follow-up

Complicated crown-root fractures of maxillary incisors are a relatively common occurrence in cases of trauma to the facial region. Patients with such fractures are in acute pain and usually require emergency care on their first clinical visit. Pain management and restoration of function, esthetics, and phonetics should be the prime objective in handling such patients. The reattachment of fractured tooth fragments is a relatively simple procedure that provides natural esthetics and conservation of tooth structure. This case report describes such a reattachment procedure in a complicated crown-root fracture and its success at 5 years of follow-up.

Management of ZMC Fractures - A Review Article

Fractures of the zygomaticomaxillary complex (ZMC) are frequent face injuries treated with two- or three-point fixation procedures. This review examines the benefits and drawbacks of each strategy. For less complicated fractures, two-point fixation is less invasive and also requires less time during surgery, but it may not provide adequate stability. More structural support is provided with three-point fixation, especially in cases of comminuted or displaced fractures, although the procedure takes longer and may raise the risk of infection. In order to determine the best fixing option based on fracture severity and patient-specific characteristics, this article contrasts clinical and biomechanical investigations. A tailored approach is recommended for the best outcomes.

Open Reduction and Fixation of Late-Presenting Pediatric Supracondylar Humeral Fractures: A Prospective Study.

Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures. This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria. All fractures (100%) united within 3-5.5weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome. Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Analysis of postoperative complications of orbital fracture.

To analyze the types and causes of complications following orbital fracture reconstruction and enhance clinicians' capacity to manage or prevent such complications. We conducted a retrospective case series analysis, retrospectively collecting and analyzing clinical data of patients with orbital fractures who received surgical treatment at the Affiliated Eye Hospital of Nanchang University from May 2012 to May 2022. Descriptive statistics were employed to document common postoperative complications, and we recorded complications persisting after a minimum 6-month follow-up period. Among the 227 patients who underwent orbital fracture surgery, they were followed up for 6 to 36 months, and complications occurred in 15 cases, resulting in an incidence rate of 6.61%. These complications included implant material infections and rejections (4 cases), persistent diplopia (3 cases), intraorbital hematomas (2 cases), epiphora (2 cases), lower eyelid eversion or retraction (2 cases), and skin scars (2 cases). The primary cause of postoperative infection was chronic inflammation in the paranasal sinuses or closed cavities within the fracture area. Postoperative complications in orbital fractures were associated with various factors, including the timing of surgery, surgical approach, repair materials, surgical skills, and auxiliary techniques. Standardizing surgical techniques and implementing precise auxiliary technologies may reduce the incidence of complications and enhance the operation's success rate.

Management of Complicated Crown Root Fracture Using Chamfer Reattachment Technique

Abstract The reattachment of the tooth fragment is one of the viable treatment options if the original intact tooth fragment is available following dental trauma. The reattachment of the remaining fractured tooth can provide better aesthetics, improved function and generate a positive psychological response amongst patients. This case report consists of three cases of crown root fracture that was successfully treated using tooth fragment reattachment technique.

Mechanical properties and multi-field ferroelastic response of Nb/Mn Co-doped CaBi4Ti4O15 high-temperature ferroelectric ceramics

CaBi4Ti4O15 (CBT) ceramics are promising piezoelectric materials that have been widely studied for high-temperature applications. Despite significant advancements in the electrical performance of CBT ceramics, the understanding of their mechanical behaviors remains limited, which is unfavorable for designing ceramics with high stability and reliability during high-temperature service. This work investigated the mechanical properties and fracture behaviors of Nb/Mn co-doped CaBi4Ti4O15 (CBTNM) with various doping levels, focusing on stress-strain responses and ferroelastic deformation behaviors under uniaxial compression and multi-field coupling conditions. HRTEM analysis reveals small-scale layered domain wall structures on the surface of plate-like grains. The fracture and compressive strengths of CBTNM ceramics initially decrease and then increase with an increase in doping content, and the underlying mechanisms are related to grain size, defects, and densification. CBTNM ceramics exhibit nonlinear stress-strain responses due to ferroelastic deformation under compressive loading, and the resultant irreversible domain switching strain increases with an increase in doping content, while poling can further increase the residual strain. Under multi-field loading conditions, CBTNM ceramics undergo more ferroelastic deformation events and exhibit larger residual strain. The micro-cracks, pores, complicated fracture modes, and degraded fracture surfaces with fragmental and rough features are mainly responsible for the lower elastic modulus and inferior mechanical response. This work enhances our understanding of the mechanical behaviors of high-temperature piezoelectric ceramics and provides guidance for designing high-performance piezoelectric materials for complex environmental applications.

Management of isolated favourable compound mandibular fractures: A retrospective study of outpatient versus inpatient in a tertiary health institution

AbstractBackgroundHospital admission is often a prerequisite for those who endure mandibular fractures, but disagreement arises among patients whose fractures are isolated and favourable.ObjectivesTo determine the rate and types of complications between the two cohorts of patients categorized as outpatient and inpatient treatment groups, and also the effect of outpatient management after closed reduction and maxillomandibular fixation.Materials and MethodsClinical and demographic data were collected retrospectively about patients who were treated for isolated, favourable, compound mandibular fractures between 1998 and 2022 to explore whether outpatient management is an independent variable influencing post‐operative complications. Bivariate and descriptive statistics were computed.ResultsSix‐hundred and sixty‐four (664) patients were evaluated (n = 335 in the study group and n = 329 in the control). There was equitable distribution of subjects between the two groups investigated in relation to their sex, age, aetiology of fractures, sites of fracture and their combinations per subject including number of fractures and duration of injury before treatment. Unifocal fractures occurred in 40.7% of subjects while multifocal fractures were seen in 59.3% (p = 0.04). The overall complication rate was 11.7%, more prevalent in multifocal than unifocal fractures (p = 0.001). Conversely, the complication rates of outpatient and inpatient cases were 11.4% and 12.1%, respectively with no significant difference (p = 0.81).ConclusionsThere was no difference between outpatient and inpatient treatment groups. Outpatient management was not a risk factor affecting post‐operative isolated favourable mandible fracture complications, if demographic and clinical confounding variables affecting treatment outcomes were controlled.

Functional mechanism and clinical implications of LINC00339 in delayed fracture healing

ObjectiveDelayed fracture healing is a common complication of fractures that significantly impacts human health. This study aimed to explore the role of LINC00339 (lncRNA) in delayed fracture healing to provide new directions for its treatment.MethodsThis study included 82 patients with fractures healing in a normal manner and 90 patients experiencing delayed fracture healing. Levels of LINC00339, miR-16-5p, and osteogenic marker-related mRNAs were measured using RT-qPCR. The predictive potential of LINC00339 for delayed fracture healing was validated using ROC curve analysis. The interaction between LINC00339 and miR-16-5p was validated using dual-luciferase reporter assays and RIP experiments. CCK-8 was used to assess cell proliferation, and apoptosis rates were measured by flow cytometry.ResultsLINC00339 was significantly upregulated in delayed fracture healing patients and exhibited strong predictive ability for this condition. Overexpression of LINC00339 inhibited osteoblast proliferation, promoted apoptosis, and reduced mRNA levels of osteogenic markers (P < 0.05). miR-16-5p was recognized as a target mRNA of LINC00339, with LINC00339 exerting negative regulation on miR-16-5p, while overexpression of miR-16-5p mitigated the inhibitory effects of LINC00339 on fracture healing (P < 0.05).ConclusionThis research indicated that LINC00339 may serve as a diagnostic marker for delayed fracture healing and revealed the function of the LINC00339/miR-16-5p axis on fracture healing by regulating osteoblasts.

Evaluation of the effect of osteosynthesis wires on the structural reorganization of metaepiphyseal cartilage (an experimental and morphological study)

Introduction Premature arrest of bone growth is the most common complication of bone fractures at the growth plate level.The purpose of the work was to evaluate the structural reorganization of metaepiphyseal cartilage following its direct injury with metal and biodegradable wires in an experiment.Materials and methods The metaepiphyseal cartilage of the distal femur of 18 lambs of both sexes was studied. The age of the animals at the beginning of the study was (43.92 ± 0.8) days, by 60 and 120 days (102.63 ± 0.82) and (161.1 ± 0.9) days, respectively. The animals underwent transphyseal insertion of wires/ pins: series 1 — Kirschner wires, series 2 — titanium wires, series 3 — poly-L-lactic acid pins. The duration of the experiment was 60 and 120 days. Clinical and radiographic studies were carried out. Histomorphometry was performed using an AxioScope.A1 microscope and Zenblue software (CarlZeissMicroImagingGmbH, Germany).Results Reactive changes in the growth plate at the interface with the wire were manifested by proliferation of chondrocytes in the zone of proliferating cartilage and in the reserve zone; the minimally expressed changes were noted in series 2, the most pronounced were in series 1. By the end of the experiment, at the interface with the wire in series 1, blood vessels penetrated into the metaepiphyseal cartilage; in series 3 the amount of the fibrous component was increased, which indicates further formation of “bone bridges” and “fibrous bridges,” respectively. In undamaged areas of the growth plate in all series, the zonal structure was preserved. By the end of the experiment, increased values of the thickness of the metaepiphyseal cartilage were noted (1.2 times higher than the control), differences between series were a tendency; in series 2 and 3 the ratio of metaepiphyseal cartilage zones was comparable to the control; in series 1 the proportion of the proliferating cartilage zone was increased by 4 %.Discussion The main problem with growth plate injuries is the formation of bone tissue or fibrosis, which affects the growing process. Currently, the question of choosing a treatment tactic for growth plate injury depending on the size of the “bone bridges” is debatable. Relevant are future comparative studies of the regeneration of metaepiphyseal cartilage defects after the use of fixators made from different materials.Conclusion Histomorphometric characteristics of the growth zone reliably showed that the insertion of wires, regardless of their material, was not accompanied by inhibition of the bone-forming function of the distal metaepiphyseal cartilage of the femur.

Fracture Evolution during CO2 Fracturing in Unconventional Formations: A Simulation Study Using the Phase Field Method

With the introduction of China’s “dual carbon” goals, CO2 is increasingly valued as a resource and is being utilized in unconventional oil and gas development. Its application in fracturing operations shows promising prospects, enabling efficient extraction of oil and gas while facilitating carbon sequestration. The process of reservoir stimulation using CO2 fracturing is complex, involving coupled phenomena such as temperature variations, fluid behavior, and rock mechanics. Currently, numerous scholars have conducted fracturing experiments to explore the mechanisms of supercritical CO2 (SC-CO2)-induced fractures in relatively deep formations. However, there is relatively limited numerical simulation research on the coupling processes involved in CO2 fracturing. Some simulation studies have simplified reservoir and operational parameters, indicating a need for further exploration into the multi-field coupling mechanisms of CO2 fracturing. In this study, a coupled thermo-hydro-mechanical fracturing model considering the CO2 properties and heat transfer characteristics was developed using the phase field method. The multi-field coupling characteristics of hydraulic fracturing with water and SC-CO2 are compared, and the effects of different geological parameters (such as in situ stress) and engineering parameters (such as the injection rate) on fracturing performance in tight reservoirs were investigated. The simulation results validate the conclusion that CO2, especially in its supercritical state, effectively reduces reservoir breakdown pressures and induces relatively complex fractures compared with water fracturing. During CO2 injection, heat transfer between the fluid and rock creates a thermal transition zone near the wellbore, beyond which the reservoir temperature remains relatively unchanged. Larger temperature differentials between the injected CO2 fluid and the formation result in more complicated fracture patterns due to thermal stress effects. With a CO2 injection, the displacement field of the formation deviated asymmetrically and changed abruptly when the fracture formed. As the in situ stress difference increased, the morphology of the SC-CO2-induced fractures tended to become simpler, and conversely, the fracture presented a complicated distribution. Furthermore, with an increasing injection rate of CO2, the fractures exhibited a greater width and extended over longer distances, which are more conducive to reservoir volumetric enhancement. The findings of this study validate the authenticity of previous experimental results, and it analyzed fracture evolution through the multi-field coupling process of CO2 fracturing, thereby enhancing theoretical understanding and laying a foundational basis for the application of this technology.

Enhanced differentiation of mesenchymal stem cells in coral-incorporated PCL/elastin scaffold enables 3D defect healing in osteoporosis rat model

In osteoporosis, bone quality adversely affects the tissue structural competence which increases the risk of a complicated fracture healing. In the present study highly potent scaffold containing natural coral particles was designed and considered for the healing of critical size bone defect in osteoporosis rat model. Scaffold morphological evaluation confirmed the porous nanofibrous structure. Water uptake of about 900 % was obtained for the fabricated scaffold as the result of its composition and three-dimensional structure. Mechanical analysis revealed the compressive modulus of about 50 kPa for the fabricated coral-incorporated nanofibrous structure. In vitro cellular assessments revealed that the designed scaffold induces no toxicity and provides the proper substrate for cell attachment together with increased and prolonged cell proliferation. In vivo experiments demonstrated that implantation of the fabricated scaffold in the femoral defects of osteoporotic rats significantly increased the number of osteocytes and osteoblasts, and enhanced the BTV, and BMP-2 expression compared with the control group. Furthermore, it was observed that seeding the scaffolds with MSCs prior to implantation, resulted in substantial improvements in mRNA expression of the BMP-2 and VEGF genes and considerable enhancement in stereological findings such as significantly higher number of osteoblasts, osteocytes, TVB, and BTV.

Proximal humeral fractures with vascular compromise.

Vascular compromise due to arterial injury is a rare but serious complication of a proximal humeral fracture. The aims of this study were to report its incidence in a large urban population, and to identify clinical and radiological factors which are associated with this complication. We also evaluated the results of the use of our protocol for the management of these injuries. A total of 3,497 adult patients with a proximal humeral fracture were managed between January 2015 and December 2022 in a single tertiary trauma centre. Their mean age was 66.7 years (18 to 103) and 2,510 (72%) were female. We compared the demographic data, clinical features, and configuration of those whose fracture was complicated by vascular compromise with those of the remaining patients. The incidence of vascular compromise was calculated from national population data, and predictive factors for its occurrence were investigated using univariate analysis. A total of 18 patients (0.5%) had a proximal humeral fracture and clinical evidence of vascular compromise, giving an annual incidence of 0.29 per 100,000 of the population. Their mean age was 68.7 years (45 to 92) and ten (56%) were female. Evidence of a mixed pattern neurological deficit (brachial plexus palsy) (odds ratio (OR) 380.6 (95% CI 85.9 to 1,685.8); p < 0.001), complete separation of the proximal shaft from the humeral head with medial displacement (OR 39.5 (95% CI 14.0 to 111.8); p < 0.001), and a fracture-dislocation (OR 5.0 (95% CI 1.6 to 15.3); p = 0.015) were all associated with an increased risk of associated vascular compromise. A policy of reduction and fixation of the fracture prior to vascular surgical intervention had favourable outcomes without vascular sequelae. The classic signs of distal ischaemia are often absent in patients with proximal injuries to major vessels. We were able to identify specific clinical and radiological 'red flags' which, particularly when present in combination, should increase the suspicion of a fracture with an associated vascular injury, and facilitate early diagnosis and appropriate combined orthopaedic and vascular intervention.

Greater Socioeconomic Deprivation is Associated with Increased Complication Rates and Lower Patient-Reported Outcomes Following Open Reduction and Internal Fixation of Humeral Shaft Fractures.

This study explored the hypothesis that social determinants of health (SDOH), including racial and economic differences, may impact orthopaedic trauma outcomes in patients undergoing open reduction and internal fixation (ORIF) of humeral shaft fractures. Design: Retrospective. Single, academic, tertiary Level-I trauma center. Adults with midshaft humerus fractures (AO/OTA 12) treated operatively with plate fixation from 05/2011 to 05/2021 with a minimum follow-up of nine months. Radiographic fracture healing, complication rates, and patient-reported outcomes were investigated. SDOH were assessed using the Area Deprivation Index (ADI). Demographics, complications rates, and patient-reported clinical outcomes were compared between the first and fourth ADI quartiles. 196 patients fit the study criteria. The average age of the cohort was 47 years with 50 women (51%). Comparisons of the least deprived quartile (n=49) to the most deprived quartile (n=49) yielded similar sex distribution (59% vs 43% female, p=0.15), fewer non-white patients (8% vs 51%, p<0.01), older average age (51 years vs 43 years, p=0.05), similar BMI (30.5 vs. 31.8, p=0.45), and higher Charlson Comorbidity Index (CCI) (2.2 vs.1.1, p=0.03). While nonunion rates were similar (p=0.20) between groups, the most deprived quartile had 2.3 times greater odds of post-operative complications (p=0.04). Patients in the most deprived group exhibited higher PROMIS Pain Interference (PI) scores (p<0.01) and PROMIS Depression (D) scores (p=0.01), with lower PROMIS Physical Function (PF) scores (p<0.01) at 6-month follow-up than the least depriver cohort. The most deprived cohort had three times higher odds of missing scheduled appointments within the first post-operative year (p<0.01), resulting in a significantly higher no-show rate (p<0.01) than the least deprived cohort. Regression analysis including several demographic and injury factors identified that ADI was significantly associated with the occurrence of any missed appointments (p<0.01), no-show rates (p=0.04), and experiencing one of the following post-operative complications during recovery: Nonunion, radial nerve injury, or dysfunction (p=0.03). Patients experiencing greater resource deprivation faced increased odds of complications, missed appointments, and poorer PROMIS outcomes following humeral shaft fracture fixation, emphasizing that baseline socioeconomic disparities predict unfavorable post-operative outcomes even given favorable baseline health status according to the CCI score. Level III. See Instructions for Authors for a complete description of levels of evidence.

Complications after reverse shoulder arthroplasty for proximal humerus nonunion

BackgroundProximal humerus nonunion is a challenging complication of fractures that can be treated surgically with either open reduction internal fixation (ORIF) or reverse total shoulder arthroplasty (RTSA). The few studies published on this subject have shown high rates of complications and revision surgery when RTSA has been performed for proximal humerus nonunion. The purpose of this study was to determine the rates of complications and revision of this procedure at our institution, as well as to identify any variables that may impact risks of complications and reoperations. MethodsA single-institution retrospective review of all patients who underwent RTSA for proximal humerus nonunion between 2005 and 2021 was performed. Nonunion was defined as imaging evidence of lack of union, at least 90 days after the index fracture. Patients with less than one year of clinical follow-up were excluded. Fifty patients were included, with the majority being female (78%). The mean age at time of RTSA was 71 (range: 54-86) years and most patients were initially treated nonoperatively (74%). Mean total follow-up was 49 (range: 11-130) months. Demographic and surgical variables were recorded. Primary outcomes were complications and reoperations. Complications were divided into surgical (those directly related to RTSA), or other (those unrelated to RTSA). Secondary outcomes included VAS pain scores and range of motion. ResultsA total of 17 shoulders (34%) sustained complications after RSA, with 10 (20%) requiring reoperation. Six patients (12%) sustained dislocations and 5 (10%) had radiographic evidence of humeral loosening. No variables examined, including nonoperative vs surgical management of the index fracture, prosthesis type, or management of tuberosities, influenced the risk of dislocation. Survivorship free from reoperation at 2 years was 73%. Younger age at time of RTSA and the presence of diabetes mellitus both increased the risk of reoperation significantly (p=0.013 and p=0.037, respectively). There was a trend towards increased risk of reoperation in patients who were treated with initial ORIF (HR=2.95); however, this did not reach statistical significance (p=0.088). Three patients (6%) sustained a periprosthetic fracture after a fall. ConclusionRTSA provides improved pain and function for properly selected patients with proximal humerus nonunion. Dislocation, humeral loosening, and reoperation rates remain high when RTSA is performed for nonunion compared to other diagnoses. In this study, younger age and diabetes mellitus increased the odds of reoperation. Every effort must be made to optimize implant stability and humeral component fixation when RTSA is performed for proximal humerus nonunion.