Delays beyond Five Days to Surgery Does Not Affect Outcome Following Plate and Screw Fixation of Proximal Humerus Fractures.

Abstract

Purpose: The purpose of this study is to compare the quality and clinical outcomes of patients who underwent open reduction internal fixation for a proximal humerus fracture in a "timely manner" which was defined to be within 5 days of injury compared to those with "delayed intervention" (>5 Days) to determine the effect this had.

Methods: This IRB-approved study evaluated patients who sustained a proximal humerus fracture treated with plate and screw fixation (ORIF) between January 2004 and October 2022 and had time from injury to surgery documented. Patients were grouped based on the time to surgery (TTS) - Less than 5 Days (L5) vs. More than 5 Days (M5). TTS was also evaluated as a continuous variable. Univariable and multivariable analysis compared patient demographics, injury/surgical characteristics, postoperative complications, and clinical outcomes to determine effect of TTS. Clinical outcomes included shoulder range of motion (ROM) and Disabilities of the Arm, Shoulder, and Hand (DASH) score at least 1 year following the date of injury. Standard statistical tests were used (p<0.05 considered significant).

Results: A total of 175 patients met criteria and were analyzed: Seventy-four (42.2%) were L5 and 101 (57.8%) were M5. The cohorts were similar in age, sex, race, BMI, and CCI. Both cohorts had, based on the Neer classification, similar fracture patterns (p=0.68). Complications rates were similar (16% vs. 15%, p=0.81). These postoperative complications included AVN, infection, malunion, nonunion, screw penetration, loss of reduction, nerve symptoms, and painful hardware which were similar for both cohorts (p=0.26). The shoulder mobility of patients at the 1 year time point was similar for all patients regardless of TTS. ROM included active (139±32^o vs. 142±29^o, p=0.61) and passive (152±24^o vs. 152±24^o, p=0.96) forward elevation, and external rotation (52±19^o vs. 55±21^o, p=0.24). Finally, the DASH scores for both groups were similar (15.36±17.72 vs. 20.06±18.96, p=0.09). Multivariable analysis confirmed that timing of surgery was not associated with complications or functional outcomes. However, piecewise analysis demonstrated at a delay of 14 days (151±25^o vs. 161±19^o, p=0.04, β = 0.29, 95% CI = 1.05-28.80) and 21 days (149±25^o vs. 161±19^o, p=0.03, β= -0.27, 95% CI = -41.71- -2.89) surgery was associated with less passive forward elevation.

Conclusion: Timing of surgery did not impact outcomes of patients who underwent open reduction internal fixation for proximal humerus fractures. Surgical intervention after 14 days was associated with diminished passive forward elevation only.