Article
Path analysis of factors for functional outcome at one year in 463 proximal humerus fractures
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Authors
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N.P. Südkamp
- Albert-Ludwigs-Universität, Universitätsklinikum Freiburg, Department Orthopädie & Traumatologie, Freiburg, Germany
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L. Audige
- AO Clinical Investigation and Documentation, Dübendorf, Switzerland
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S. Lambert
- Royal National Orthopaedic Hospital Trust, Shoulder & Elbow Service, Stanmore, United Kingdom
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R. Hertel
- Lindenhofspital, Department Orthopädie und Unfallchirurgie, Bern, Switzerland
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G.G. Konrad
- Kreiskrankenhaus Erding, Unfallchirurgie und Orthopädie, Erding, Germany
| Published: | October 18, 2011 |
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Outline
Text
Questionnaire: Achievement of good shoulder function following fracture treatment is critical for affected patients. This study was implemented to investigate the prognostic value of ten patient- and treatment-related factors for the functional outcome of 463 proximal humerus fractures measured as one year follow up Constant score, as well as the complex interrelationships between the study factors.
Methods: Data were originated from a large prospective cohort study that was performed as a series of four study arms, with three operative groups using either PHN, PHILOS or LPHP in each of the 23 participating centers, and one non-operative group, which was enrolled in one center. The technique of path analysis was used whereby plausible causal relationships between study factors are tested using multivariable regression methods and presented as a visual diagram.
Results and conclusions: Our final multivariable regression model for Constant score after one year included the following six factors: age, gender, treatment, occurrence of intra- and local post-treatment complications and anatomical restoration. Being a women older than 40 years, treatment with LPHP, having experienced intra-operative and local post-treatment complications, and showing a bone deformity of >30° varus were identified as negative predictors of the Constant score, i.e. poor shoulder function one year after initiation of treatment. Three factors ("Dominant side fractured", "Neer classification” and "AO classification") showed only significant association on intermediate factors, and “Concomitant disease” did not show any significant direct or indirect effect. A final diagram was drawn which shows these associations and interrelationships. Path analysis provides a powerful visual support to help understanding the interrelationship between study factors and thus interpreting the identified associations. Prevention of local complications, in particular those leading to severe varus deviation, appears essential to improving shoulder function after proximal humerus fractures.
