Operative treatment is associated with improved 3-year survival after periprosthetic humerus fracture

IF 2 Q2 Medicine

JSES International Pub Date : 2026-05-01 Epub Date: 2026-03-05 DOI:10.1016/j.jseint.2026.101688

Alyssa R. Henriquez BS, Bryan Crook MD, Lindsey V. Ruderman BA, Aaron Therien BS, Eoghan T. Hurley MB, MCh, PhD, Christopher Klifto MD, Oke Anakwenze MD MBA, Michael A. Moverman MD

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Abstract

Background

This study examines the survival implications of operative versus nonoperative management of periprosthetic humerus fractures in a large, single-center cohort.

Methods

Patients at a single tertiary care center with periprosthetic humerus fractures about a shoulder prosthesis between January 2013 and March 2024 were retrospectively identified. Patients were stratified according to operative versus nonoperative treatment. The primary outcome was all-cause mortality. Survival was compared using Kaplan–Meier curves and log-rank tests. Prespecified time horizons were 90 days, 1 year, 2 years, and 3 years.

Results

Ninety patients with periprosthetic fractures were identified (23 nonoperative, 67 operative). There were 13 total deaths (8/23 [35%] nonoperative, 5/67 [7.5%] operative). Baseline characteristics were largely similar aside from a higher body mass index in the operative group (32 vs. 29 kg/m², P = .046). Age (nonoperative: 74 vs. operative: 71 years, P = .30), sex (P = .40), hand dominance (P > .9), race (P = .07), smoking (P = .40), comorbidity burden (Elixhauser weighted and count P = .20 and P = .60, respectively), and Charlson distribution (P = .20) were all similar between groups. On Kaplan–Meier analysis, early mortality was rare: 90-day survival was 95.7% in the nonoperative group versus 100.0% in the operative group (P = .09). Survival differences widened over time, becoming significant at 3 years after the injury: 1 year (nonoperative: 95.7%; operative: 98.5%; P = .42), 2 years (nonoperative: 90%, operative: 98.5%; P = .09), and 3 years (nonoperative: 72.2%; operative: 96.5%; P = .004).

Conclusions

Surgical fixation of periprosthetic humerus fractures is associated with lower mortality that becomes apparent in a delayed fashion and grows over time. By 3 years after the injury, the mortality difference approached 25% between operatively and nonoperatively treated patients. These findings should be validated in larger, multicenter studies.

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手术治疗与肱骨假体周围骨折后3年生存率的提高有关

本研究在一个大型单中心队列研究中探讨了手术与非手术治疗肱骨假体周围骨折的生存意义。方法回顾性分析2013年1月至2024年3月在同一三级医疗中心接受肩关节假体肱骨周围骨折治疗的患者。根据手术与非手术治疗对患者进行分层。主要结局为全因死亡率。生存率比较采用Kaplan-Meier曲线和log-rank检验。预先指定的时间范围为90天、1年、2年和3年。结果本组共确诊假体周围骨折90例（非手术23例，手术67例）。死亡13例(非手术8/23（35%)，手术5/67(7.5%)）。除了手术组体重指数较高（32 vs 29 kg/m2, P = 0.046），基线特征基本相似。年龄（非手术年龄：74岁vs手术年龄：71岁，P = 0.30）、性别（P = 0.40）、手优势（P = 0.9）、种族（P = 0.07）、吸烟（P = 0.40）、共病负担（Elixhauser加权P = 0.20、计数P = 0.60）、Charlson分布（P = 0.20）组间差异无统计学意义。Kaplan-Meier分析显示，早期死亡非常罕见：非手术组90天生存率为95.7%，而手术组为100.0% （P = 0.09）。生存率差异随着时间的推移而扩大，在伤后3年变得显著：1年（非手术：95.7%；手术：98.5%;P = 0.42）， 2年（非手术：90%，手术：98.5%;P = 0.09）， 3年（非手术：72.2%；手术：96.5%;P = 0.004）。结论肱骨假体周围骨折的手术固定与较低的死亡率相关，这种死亡率随着时间的推移逐渐显现出来。损伤后3年，手术和非手术治疗患者的死亡率差异接近25%。这些发现应该在更大的、多中心的研究中得到验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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