Short-term clinical and radiographic outcomes in patients treated with a modern intramedullary nailing system for 2-part proximal humerus fractures.

OBJECTIVES: The optimal surgical treatment of displaced proximal humerus fractures (PHFs) remains controversial. There are advocates for both open reduction and internal fixation with plate and screws (ORIF) and intramedullary nailing (IMN). The purpose this study was to evaluate the early-term clinical and radiographic outcomes of IMN for isolated, displaced 2-part surgical neck PHFs using a modern, straight nail system and to determine the effect of preoperative patient and fracture characteristics on outcome. METHODS: This was a case series of 23 patients with displaced 2-part surgical neck PHFs who were treated with ORIF using a straight IMN with minimum follow-up of 1 year (mean 2.5 years [range, 1.1-4.6]). Patients were identified retrospectively and contacted for measurement of active range of motion (AROM) and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons (ASES) score, Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE), EuroQol-5D (EQ-5D), and Visual Analog Scale Pain score (VAS Pain). Plain radiographs were evaluated to assess the quality of the reduction and failure of fixation. Complications and reoperations were identified. RESULTS: Reduction was anatomic in 12 (52%) patients, acceptable in 9 (39%), and 2 (9%) were malreduced. There were no differences in reduction quality based on sex (p = 0.37), age at surgery (p = 0.68), calcar comminution (p = 0.68), number of screws in the head (p = 0.99), or medial hinge disruption (p = 0.06). At final follow-up, the mean ASES score was 92 ± 10, OSS was 45 ± 4, SANE was 93 ± 7, EQ-5D of 0.85 ± 0.17, and VAS Pain was 0 ± 1. The mean active forward flexion was 143° ± 16°, active external rotation was 68° ± 20°, and internal rotation was T11 ± 4 vertebrae. Two (9%) patients underwent reoperation and 2 (9%) patients experienced clinical failure not requiring reoperation. CONCLUSIONS: Straight IMN is a reliable treatment for displaced 2-part surgical neck PHFs with excellent radiographic and clinical outcomes in early follow-up. The implant facilitated anatomic or acceptable alignment of the fracture in the vast majority of patients.

Human-Factor Risk Mitigation in Outdoor Climbing Areas: Survey of Existing Policies in Regulated Climbing Areas.

INTRODUCTION: Popular climbing areas in the United States are frequently on public lands under administrative purview of land management entities. During climbing, climbers may be subject to injury. This study aimed to describe existing climbing risk mitigation tactics used to protect climbers by oversight agencies responsible for these public climbing areas and to identify strategies perceived by the oversight agency to be successful. METHODS: We identified publicly managed US bouldering, sport, or traditional climbing areas through a state-by-state search of Mountain Project. We assessed climbing-related visitation, injury, rescue, and risk mitigation strategies using a 10-item survey targeting land-use managers, rangers, outdoor recreation planners, and park managers. Quantitative analysis included univariate and multivariate analysis. Qualitative analyses of survey responses with thematic grouping of mitigation interventions were performed. RESULTS: One hundred fifty-seven publicly managed US climbing areas were contacted, and 76 (48%) provided data. Thirty-six (47%) of those that provided data stated that programs are in place to reduce climbing-related injury. There were no associations between demographic variables and the presence of risk mitigation strategies. Four themes of climbing risk mitigation strategies emerged: coordination with climbing coalitions (25% of respondents), permitting (22% of respondents), publication of accident reports (22% of respondents), and preventative search and rescue (17% of respondents). CONCLUSIONS: Nearly half of survey respondents reported having climbing risk mitigation programs. There is opportunity to assess the efficacy of risk mitigation strategies through intra-area and inter-area assessments. A centralized climbing injury database may prove useful for assessing the efficacy of and need for risk mitigation techniques.