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Impact of operative timing for proximal humerus fracture dislocations on development of neurologic injury
Journal article   Open access   Peer reviewed

Impact of operative timing for proximal humerus fracture dislocations on development of neurologic injury

Alex Demers, Maria Bozoghlian, Natalie Glass, Brendan Patterson, James Nepola, Matthew Hogue, Michael Willey, Matthew Karam, J. Lawrence Marsh and Joseph Galvin
European journal of orthopaedic surgery & traumatology, Vol.36(1), 376
09/12/2026
DOI: 10.1007/s00590-026-04956-y
PMCID: PMC13570932
PMID: 42730781
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1007/s00590-026-04956-yView
Published (Version of record) Open Access

Abstract

Purpose Operative management of proximal humerus fractures with glenohumeral dislocation is often delayed until a shoulder specialist is available. This study aims to assess whether time from presentation to operative intervention impacts incidence of neurologic injury in the preoperative waiting period. Methods Retrospective review was performed for patients undergoing operative management of a proximal humerus fracture dislocation at a level 1 trauma center. Patient charts were reviewed for patient factors, injury characteristics, neurologic status, and postoperative complications. Statistical analysis comparing patients undergoing operative intervention ≤ 5 and > 5 days from injury was performed (α ≤ 0.05). Results Of 52 proximal humerus fracture dislocations, 14% had a neurologic deficit at presentation, and 1.9% had a change in neurologic status prior to operative intervention. 32 injuries (61.5%) underwent operative intervention ≤ 5 days from presentation and 20 (38.5%) > 5 days. There was no difference in neurologic deficit at time of presentation (18.8% vs. 10.0%, p =.077), incidence of preoperative neurologic exam change (0% vs. 5.0%, p =.38), or residual neurologic deficit at final follow-up (9.4% vs. 5.0%, p  = 1.0) for the ≤ 5 or > 5 day cohorts, respectively. Conclusion Through this exploratory retrospective study, no differences were identified for rates of neurologic injury development in the preoperative waiting period between patients undergoing operative intervention ≤ 5 days or > 5 days from presentation for proximal humerus fractures with glenohumeral dislocation, however, this is limited by only 1 patient experiencing a preoperative neurologic change in the > 5 days group. Given the rarity of neurologic injury in the preoperative waiting period and low power of this study, future larger prospective studies are needed to better define the impact of waiting for operative intervention for these injuries. Level of Evidence Level IV Case Series.
 Proximal humerus fracture Dislocation Neurologic injury UIOWA OA Agreement

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