PHF is the third most common appendicular fracture. Non-operative treatment can lead to nonunion which causes pain and functional impairment. Operative treatment is recommended to avoid poor outcomes from delayed intervention. The study analyzed 2230 PHF cases to identify risk factors for nonunion. It found a 10% nonunion rate, with 18% nonunion for fractures with valgus head angulation and 12% for neutral or varus angulation. Variables like head-shaft angle ≤1400, head-shaft translation, varus deformity, and metaphyseal comminution were associated with higher nonunion risk. Older age, female sex, comorbidities, osteoporosis, and smoking also

1. Journal Club on
Presenter: Dr. Shubhanshu Ranjan Singh
Guide: Dr. John Mukhopadhaya

2. Introduction
• Proximal Humerus Fractures (PHF) is third
most common appendicular fracture
• Can be manage by Non operative
• Non union most common complication
• Having pain, functional impairment,
dependency
• Delay operative intervention produces poor
outcome

3. Proximal Humerus fracture
• Occurs when fall on outstretched arm, RTA, old
patient with osteoporotic bone following ground
level fall
• Site
• Surgical neck
• Anatomic neck
• Greater tuberosity
• Lesser tuberosity
• Two part surgical neck frature most common type

4. Treatment
• Non operative by sling followed by
physiotherapy
• Operative
• CRPP
• ORIF
– Plating
– IM Nailing
– Arthroplasty)

5. Head Shaft Angle(HAS)
• Angle subtended by
the diaphyseal axis
and a line drawn
perpendicular to the
anatomic neck
segment plane.

6. Head shaft translation(HST)
• Medial or lateral
displacement of the head
relative to the overall
diameter of the metaphysis
measured at the medial or
lateral cortical level
(dependent on the direction
of displacement) of the
fracture

7. Material and methods
• Sample size – 2230
• With inclusion exclusion criteria
• Final follow-up after 24 weeks
• Univariate logistic regression and multivariate
logistic regression statistical analysis
• External validity assessed

8. Variable Final outcome (2230) HSA ≤140⁰(1835) HSA >140⁰(395)
Healed
(1999)
NonUnion
(231)
Healed
(1607)
NonUnion
(228)
Healed
(392)
NonUnion
(3)
Age (yr) 72 73 73 73 68 72
Sex M
F
482/88% 65/12% 417/86
%
65/14% 65/100
%
0
1517/90 166/10 1190/8
8
163/12 327/99
%
3/1%
Comorbidities ASA
I/II
90% 10% 88 12 99 1
ASA III-V 88% 12% 86 14 98 2

10. Other studies for Rate of Nonunion

11. PHF Assessment Risk of Nonunion
[PHARON]

12. NONUNION Result in study
• Non Union prevalence after 24 weeks follow
up was 10%
• 18% with valgus angulation of humeral head
• 12% with Neutral and varus angulation of
head

13. Take Home Message
• HST, HSA, varus head deformity, metaphyseal
comminution association with Nonunion.
• Several co-morbidities, osteoporotic bone,
smoking affects non operative PHF treatment
• Old age group and females more prone to
nonunion.