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Joint Diseases and
Related Surgery
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Original Article · Open access

Factors influencing shoulder stiffness after open reduction and internal fixation of proximal humeral fractures

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Li Wang

Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People’s Republic of China Hand and Foot Microsurgery, Third Hospital of Baotou City, Baotou, People’s Republic of China Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China

ORCID: 0009-0002-7459-5994

Fei Lyu

Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People’s Republic of China Orthopedic Center (Sports Medicine Center), Inner Mongolia Autonomous Region People’s Hospital, Hohhot, People’s Republic of China Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China

ORCID: 0009-0002-4602-1627

Jingjing Rong

Second Department of Pulmonary Disease, Third Hospital of Baotou City, Baotou, People’s Republic of China

ORCID: 0009-0006-4945-6967

Hongwu Sun

Hand and Foot Microsurgery, Third Hospital of Baotou City, Baotou, People’s Republic of China

ORCID: 0009-0002-6937-8346

Bing Li

Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People’s Republic of China Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China

ORCID: 0009-0008-9221-6170

Jun Liu

Clinical College of Orthopedics, Tianjin Medical University, Tianjin, People’s Republic of China Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China

ORCID: 0009-0009-7053-997X

Abstract

Objectives: The study aimed to investigate the factors associated with shoulder stiffness following open reduction and internal fixation (ORIF) of proximal humeral fractures.

Patients and methods: The retrospective study included a total of 151 patients who underwent ORIF of proximal humeral fractures between January 2016 and May 2021. Based on their shoulder joint motion at the latest follow-up, the patients were divided into two groups. The stiffness group (n=32; 8 males, 24 females; mean age: 62.4±9.3 years; range, 31 to 79 years), exhibited restricted shoulder forward flexion (<120°), limited arm lateral external rotation (<30°), and reduced back internal rotation below the L3 level. The remaining patients were included in the non-stiffness group (n=119; 52 males, 67 females; mean age: 56.4±13.4 years; range, 18 to 90 years). Various factors were examined to evaluate the association with shoulder stiffness following ORIF of proximal humeral fractures by multivariate unconditional logistic regression models.

Results: The mean follow-up duration was 31.8±12.6 (range, 12 to 68) months. Based on the results of the multivariate regression analysis, it was found that high-energy injuries [compared to low-energy injuries; adjusted odds ratio (aOR)=7.706, 95% confidence interval (CI): 3.564-15.579, p<0.001], a time from injury to surgery longer than one week (compared to a time from injury to surgery equal to or less than one week; aOR=5.275, 95% CI: 1.7321-9.472, p=0.031), and a body mass index (BMI) >24.0 kg/m2 (compared to a BMI between 18.5 and 24.0 kg/m2 ; aOR=4.427, 95% CI: 1.671-11.722, p=0.023) were identified as risk factors for shoulder stiffness following ORIF of proximal humeral fractures.

Conclusion: High-energy injury, time from injury to surgery longer than one week, and BMI >24.0 kg/m2 were identified as independent risk factors for shoulder stiffness after proximal humeral fracture surgery, which should be treated with caution in clinical treatment.

* The three authors contributed equally to this study

Declarations

Ethics Committee Approval

The study protocol was approved by the Baotou No.3 Hospital Ethics Committee (date: 17.11.2021, No. 04). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

A written informed consent was obtained from each patient.

Author Contributions

Conceptualization and writingoriginal draft preparation: L.W.; Methodology: F.L.; Software and data curation: J.R.; Resources: H.S.; Writing-review and editing: B.L., J.L.; Supervision: B.L.; Contributed equally to this work and share first authorship: L.W., F.L., J.R.; All authors have read and agreed to the published version of the manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This study was supported by the Tianjin Municipal Science and Technology Bureau (Grant 21JCZDJC01000).

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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