Impact of operative timing for proximal humerus fracture dislocations on development of neurologic injury.

Abstract

Purpose: Operative management of proximal humerus fractures with glenohumeral dislocation is often delayed until a shoulder specialist is available. This study aims to assess whether time from presentation to operative intervention impacts incidence of neurologic injury in the preoperative waiting period.

Methods: Retrospective review was performed for patients undergoing operative management of a proximal humerus fracture dislocation at a level 1 trauma center. Patient charts were reviewed for patient factors, injury characteristics, neurologic status, and postoperative complications. Statistical analysis comparing patients undergoing operative intervention ≤ 5 and > 5 days from injury was performed (α ≤ 0.05).

Results: Of 52 proximal humerus fracture dislocations, 14% had a neurologic deficit at presentation, and 1.9% had a change in neurologic status prior to operative intervention. 32 injuries (61.5%) underwent operative intervention ≤ 5 days from presentation and 20 (38.5%) > 5 days. There was no difference in neurologic deficit at time of presentation (18.8% vs. 10.0%, p =.077), incidence of preoperative neurologic exam change (0% vs. 5.0%, p =.38), or residual neurologic deficit at final follow-up (9.4% vs. 5.0%, p = 1.0) for the ≤ 5 or > 5 day cohorts, respectively.

Conclusion: Through this exploratory retrospective study, no differences were identified for rates of neurologic injury development in the preoperative waiting period between patients undergoing operative intervention ≤ 5 days or > 5 days from presentation for proximal humerus fractures with glenohumeral dislocation, however, this is limited by only 1 patient experiencing a preoperative neurologic change in the > 5 days group. Given the rarity of neurologic injury in the preoperative waiting period and low power of this study, future larger prospective studies are needed to better define the impact of waiting for operative intervention for these injuries.

Level of evidence: Level IV Case Series.