Factors influencing shoulder stiffness after open reduction and internal fixation of proximal humeral fractures
Li Wang1,2,5*
, Fei Lyu1,3,5*, Jingjing Rong4*, Hongwu Sun2, Bing Li1,5, Jun Liu1,5
1Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People’s Republic of China
2Hand and Foot Microsurgery, Third Hospital of Baotou City, Baotou, People’s Republic of China
3Orthopedic Center (Sports Medicine Center), Inner Mongolia Autonomous Region People’s Hospital, Hohhot, People’s Republic of China
4Second Department of Pulmonary Disease, Third Hospital of Baotou City, Baotou, People’s Republic of China
5Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China
Keywords: Fracture internal fixation, function, proximal humerus fracture, range of motion, risk factors, shoulder stiffness.
Abstract
Objectives: The study aimed to investigate the factors associated with shoulder stiffness following open reduction and internal fixation (ORIF) of proximal humeral fractures.
Patients and methods: The retrospective study included a total of 151 patients who underwent ORIF of proximal humeral fractures between January 2016 and May 2021. Based on their shoulder joint motion at the latest follow-up, the patients were divided into two groups. The stiffness group (n=32; 8 males, 24 females; mean age: 62.4±9.3 years; range, 31 to 79 years), exhibited restricted shoulder forward flexion (<120°), limited arm lateral external rotation (<30°), and reduced back internal rotation below the L3 level. The remaining patients were included in the non-stiffness group (n=119; 52 males, 67 females; mean age: 56.4±13.4 years; range, 18 to 90 years). Various factors were examined to evaluate the association with shoulder stiffness following ORIF of proximal humeral fractures by multivariate unconditional logistic regression models.
Results: The mean follow-up duration was 31.8±12.6 (range, 12 to 68) months. Based on the results of the multivariate regression analysis, it was found that high-energy injuries [compared to low-energy injuries; adjusted odds ratio (aOR)=7.706, 95% confidence interval (CI): 3.564-15.579, p<0.001], a time from injury to surgery longer than one week (compared to a time from injury to surgery equal to or less than one week; aOR=5.275, 95% CI: 1.7321-9.472, p=0.031), and a body mass index (BMI) >24.0 kg/m2 (compared to a BMI between 18.5 and 24.0 kg/m2 ; aOR=4.427, 95% CI: 1.671-11.722, p=0.023) were identified as risk factors for shoulder stiffness following ORIF of proximal humeral fractures.
Conclusion: High-energy injury, time from injury to surgery longer than one week, and BMI >24.0 kg/m2 were identified as independent risk factors for shoulder stiffness after proximal humeral fracture surgery, which should be treated with caution in clinical treatment.
* The three authors contributed equally to this study
Citation: Wang L, Lyu F, Rong J, Sun H, Li B, Liu J. Factors influencing shoulder stiffness after open reduction and internal fixation of proximal humeral fractures. Jt Dis Relat Surg 2024;35(2):285-292. doi: 10.52312/jdrs.2024.1529.
The study protocol was approved by the Baotou No.3 Hospital Ethics Committee (date: 17.11.2021, No. 04). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Conceptualization and writingoriginal draft preparation: L.W.; Methodology: F.L.; Software and data curation: J.R.; Resources: H.S.; Writing-review and editing: B.L., J.L.; Supervision: B.L.; Contributed equally to this work and share first authorship: L.W., F.L., J.R.; All authors have read and agreed to the published version of the manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
This study was supported by the Tianjin Municipal Science and Technology Bureau (Grant 21JCZDJC01000).
The data that support the findings of this study are available from the corresponding author upon reasonable request.