Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort

BackgroundIn the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment.MethodsRadiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum-collum-diaphyseal (CCD) angle were analyzed.ResultsA total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 828 years showed advanced CTA with acetabularization of the acromion (>= stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158 degrees +/- 18 degrees. Patients with CTA >= grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6-1.9; p<0.0001) of sustaining a valgus fracture compared to patients without or with CTA

Automated summary

This study examined fracture patterns in patients with advanced CTA, finding that they mostly had valgus fractures. The research showed that patients with CTA had nearly twice the risk of sustaining a valgus fracture compared to those without or with mild CTA.