Proximal Humerus Fracture Dislocation Direction and Avascular Necrosis

Study Overview
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Brief Summary
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The purpose of the study is to see if there is a connection between a proximal humerus fracture dislocation direction and the likelihood of developing avascular necrosis. Utilizing a retrospective cohort from the last ten years we hope to bring consenting patients back for a single visit to have x-rays and complete patient reported outcome measures to assess for evidence of avascular necrosis.

Detailed Description
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The incidence of proximal humerus fractures continues to increase and is among one of the more common fractures seen in the adult population. Proximal humerus fracture dislocations, however, are less common. Despite the decreased prevalence, fracture dislocations have unique challenges with respect to obtaining an anatomical reduction and more frequently involve an open surgical reduction. In addition, depending on other fracture characteristics, there are various treatment options for the fracture itself. While fracture dislocations ultimately lead to increased AVN and revision surgery, further discussion surrounding the direction of dislocation and how it may influence overall outcomes has not been addressed in the previous literature. The study design utilizes a retrospective cohort from the last ten years, by asking patients who have had a previously surgically treated proximal humerus fracture dislocations to come back to the surgeon's private clinic to complete a single visit assessment. During this assessment the consenting participant will receive x-rays and complete patient reported outcome measures. In conjunction, these will be utilized to assess overall function and the existence of avascular necrosis.

Official Title
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Association Between the Direction of Proximal Humerus Fracture Dislocation and Risk of Avascular Necrosis Following Open Reduction Internal Fixation - An Observational, Cohort Study

Conditions
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Proximal Humeral Fracture, Dislocation, Dislocation Shoulder, Avascular Necrosis, Avascular Necrosis of Humerus

Intervention / Treatment
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* Diagnostic Test: X-Ray


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients 18 years of age or older Patients who underwent operative fixation of proximal humerus fracture dislocation at Royal Columbian Hospital between January 2011 and July 2021 Willing and able to consent and complete patient reported outcome measures Willing and able to follow the protocol and attend a follow-up visit Able to read and understand English or have an interpreter available Exclusion Criteria: Skeletally immature patients Patient with pathological fractures Patients who have had previous operative fixation of proximal humerus Patients treated non-operatively patients presenting outside of the study duration window Patients treated by a non-participating surgeon Deceased patients Patients unable to complete patient reported outcome measures Patients declining to come back to the clinic for updated x-rays Dementia Incarceration

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Proximal Humerus Fracture Anterior Dislocation<br>The study doesn't provide any intervention. This group is defined as having a dislocation that is anterior to the glenoid. | |
| Proximal Humerus Fracture Posterior Dislocation<br>The study doesn't provide any intervention. This group is defined as having a dislocation that is posterior to the glenoid. | Diagnostic Test: X-Ray<br>* Consenting participants will be asked to come into the clinic for a single visit, during this visit they will be asked to complete an x-ray to check for evidence of avascular necrosis.<br>|
| Proximal Humerus Fracture Varus Dislocation<br>The study doesn't provide any intervention. This group is defined as having a dislocation that is in varus compared to the glenoid. | Diagnostic Test: X-Ray<br>* Consenting participants will be asked to come into the clinic for a single visit, during this visit they will be asked to complete an x-ray to check for evidence of avascular necrosis.<br>|
| Proximal Humerus Fracture Valgus Dislocation<br>The study doesn't provide any intervention. This group is defined as having a dislocation that is in valgus compared to the gelnoid. | Diagnostic Test: X-Ray<br>* Consenting participants will be asked to come into the clinic for a single visit, during this visit they will be asked to complete an x-ray to check for evidence of avascular necrosis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rates of Avascular Necrosis | The presence and advancement of avascular necrosis (as classified by the Cruess Classification System) and as assessed on radiographs. | At least 2 years post fracture fixation | 
| Direction of the Humeral Fracture Dislocation | As characterized by the direction of the humeral head in relation to the glenoid, based on AP, Lateral, or Axillary x-ray views. | At least 2 years post fracture fixation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| DASH (functional outcome) | Asking participants to complete the Disabilities of the Arm, Shoulder, and Hand outcome measure as a way of assessing function. | At least 2 years post fracture fixation | 
| Constant Score (functional outcome) | Asking participants to complete the Constant Score patient reported outcome measure as a way of assessing participant function. | At least 2 years post fracture fixation |