Effectiveness of simultaneous versus delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Jiying ^1,2 , TAO Zhongliang ² , LI Jun ² ,  YIN Zongsheng ¹

1. Department of Orthopaedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China;
2. Department of Orthopaedics, the People’s Hospital of Xuancheng, Xuancheng Anhui, 242000, P.R.China;

Corresponding author：

YIN Zongsheng, Email: yinzongsheng@sina.com

Keywords：

Proximal humerus fracture; rotator cuff injury; shoulder arthroscopy; operation timing

DOI：

10.7507/1002-1892.201902017

Video：

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Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.

Citation： TANG Jiying, TAO Zhongliang, LI Jun, YIN Zongsheng. Effectiveness of simultaneous versus delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1141-1146. doi: 10.7507/1002-1892.201902017 Copy

1.	Howard L, Berdusco R, Momoli F, et al. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord, 2018, 19(1): 299.
2.	Chen Y, Jia X, Qiang M, et al. Computer-assisted virtual surgical technology versus three-dimensional printing technology in preoperative planning for displaced three and four-part fractures of the proximal end of the humerus. J Bone Joint Surg (Am), 2018, 100(22): 1960-1968.
3.	Sanchez-Sotelo J, Wagner ER, Sim FH, et al. Allograft-prosthetic composite reconstruction for massive proximal humeral bone loss in reverse shoulder arthroplasty. J Bone Joint Surg (Am), 2017, 99(24): 2069-2076.
4.	秦本刚, 李平, 杨建涛, 等. 肱骨近端内固定锁定系统治疗肱骨近端骨折临床疗效. 中国修复重建外科杂志, 2016, 30(10): 1195-1199.
5.	Choo A, Sobol G, Maltenfort M, et al. Prevalence of rotator cuff tears in operative proximal humerus fractures. Orthopedics, 2014, 37(11): e968-e974.
6.	Bahrs C, Rolauffs B, Stuby F, et al. Effect of proximal humeralfractures on the age-specific prevalence of rotator cuff tears. J Trauma, 2010, 69(4): 901-906.
7.	Jerosch J, Sokkar SM, Neuhaeuser C, et al. Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results. Eur J Orthop Surg Traumatol, 2014, 24(7): 1075-1083.
8.	Teratani T. Comparison of the epidemiology and outcomes of traumatic and non-traumatic rotator cuff tears. J Orthop, 2017, 14(1): 166-170.
9.	Rouleau DM, Laflamme GY, Mulch J. Fractures of the greater tuberosity of the humerus: a study of associated rotator cuff injury and atrophy. Shoulder Elbow, 2016, 8(4): 242-249.
10.	Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Sur, 2002, 11(4): 389-400.
11.	Gallo RA, Altman DT, Altman GT. Assessment of rotator cuff tendons after proximal humerus fractures: is preoperative imaging necessary? J Trauma, 2009, 66(3): 951-953.
12.	Gallo RA, Sciulli R, Daffner RH, et al. Defining the relationship between rotator cuff injury and proximal humerus fractures. Clin Orthop Relat Res, 2007, (458): 70-77.
13.	Fjalestad T, Hole MØ, Blücher J, et al. Rotator cuff tears in proximal humeral fractures: an MRI cohort study in 76 patients. Arch Orthop Trauma Surg, 2010, 130(5): 575-581.
14.	Aagaard KE, Abu-Zidan F, Lunsjo K. High incidence of acute full-thickness rotator cuff tears. Acta Orthop, 2015, 86(5): 558-562.
15.	Monica J, Vredenburgh Z, Korsh J, et al. Acute shoulder injuries in adults. Am Fam Physician, 2016, 94(2): 119-127.
16.	Nanda R, Goodchild L, Gamble A, et al. Does the presence of a full-thickness rotator cuff tear influence outcome after proximal humeral fractures? J Trauma, 2007, 62(6): 1436-1439.
17.	李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
18.	Pitcher A, Langhammer C, Feeley BT. Utility of MRI in the evaluation of acute greater tuberosity proximal humeral fractures. Orthop J Sports Med, 2019, 7(6): 1-5.
19.	Shukla DR, McAnany S, Pean C, et al. The results of tension band rotator cuff suture fixation of locked plating of displaced proximal humerus fractures. Injury, 2017, 48(2): 474-480.
20.	Ji JH, Jeong JJ, Kim YY, et al. Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus. Arch Orthop Trauma Surg, 2017, 137(1): 9-17.

1. Howard L, Berdusco R, Momoli F, et al. Open reduction internal fixation vs non-operative management in proximal humerus fractures: a prospective, randomized controlled trial protocol. BMC Musculoskelet Disord, 2018, 19(1): 299.
2. Chen Y, Jia X, Qiang M, et al. Computer-assisted virtual surgical technology versus three-dimensional printing technology in preoperative planning for displaced three and four-part fractures of the proximal end of the humerus. J Bone Joint Surg (Am), 2018, 100(22): 1960-1968.
3. Sanchez-Sotelo J, Wagner ER, Sim FH, et al. Allograft-prosthetic composite reconstruction for massive proximal humeral bone loss in reverse shoulder arthroplasty. J Bone Joint Surg (Am), 2017, 99(24): 2069-2076.
4. 秦本刚, 李平, 杨建涛, 等. 肱骨近端内固定锁定系统治疗肱骨近端骨折临床疗效. 中国修复重建外科杂志, 2016, 30(10): 1195-1199.
5. Choo A, Sobol G, Maltenfort M, et al. Prevalence of rotator cuff tears in operative proximal humerus fractures. Orthopedics, 2014, 37(11): e968-e974.
6. Bahrs C, Rolauffs B, Stuby F, et al. Effect of proximal humeralfractures on the age-specific prevalence of rotator cuff tears. J Trauma, 2010, 69(4): 901-906.
7. Jerosch J, Sokkar SM, Neuhaeuser C, et al. Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results. Eur J Orthop Surg Traumatol, 2014, 24(7): 1075-1083.
8. Teratani T. Comparison of the epidemiology and outcomes of traumatic and non-traumatic rotator cuff tears. J Orthop, 2017, 14(1): 166-170.
9. Rouleau DM, Laflamme GY, Mulch J. Fractures of the greater tuberosity of the humerus: a study of associated rotator cuff injury and atrophy. Shoulder Elbow, 2016, 8(4): 242-249.
10. Neer CS 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Sur, 2002, 11(4): 389-400.
11. Gallo RA, Altman DT, Altman GT. Assessment of rotator cuff tendons after proximal humerus fractures: is preoperative imaging necessary? J Trauma, 2009, 66(3): 951-953.
12. Gallo RA, Sciulli R, Daffner RH, et al. Defining the relationship between rotator cuff injury and proximal humerus fractures. Clin Orthop Relat Res, 2007, (458): 70-77.
13. Fjalestad T, Hole MØ, Blücher J, et al. Rotator cuff tears in proximal humeral fractures: an MRI cohort study in 76 patients. Arch Orthop Trauma Surg, 2010, 130(5): 575-581.
14. Aagaard KE, Abu-Zidan F, Lunsjo K. High incidence of acute full-thickness rotator cuff tears. Acta Orthop, 2015, 86(5): 558-562.
15. Monica J, Vredenburgh Z, Korsh J, et al. Acute shoulder injuries in adults. Am Fam Physician, 2016, 94(2): 119-127.
16. Nanda R, Goodchild L, Gamble A, et al. Does the presence of a full-thickness rotator cuff tear influence outcome after proximal humeral fractures? J Trauma, 2007, 62(6): 1436-1439.
17. 李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
18. Pitcher A, Langhammer C, Feeley BT. Utility of MRI in the evaluation of acute greater tuberosity proximal humeral fractures. Orthop J Sports Med, 2019, 7(6): 1-5.
19. Shukla DR, McAnany S, Pean C, et al. The results of tension band rotator cuff suture fixation of locked plating of displaced proximal humerus fractures. Injury, 2017, 48(2): 474-480.
20. Ji JH, Jeong JJ, Kim YY, et al. Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus. Arch Orthop Trauma Surg, 2017, 137(1): 9-17.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of simultaneous versus delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture

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