Summary

I believe that it will be a useful study in terms of understanding the advantage of position in peri-shoulder surgeries.

Abstract

Objective

Proximal humeral fractures are challenging fractures with a long preoperative preparation phase. One of the most important components of surgical comfort is the appropriate positioning of the patients. The aim of this study was to evaluate and compare the effect of performing surgery in the supine-beacchair position on the clinical-functional outcomes of patients with similar types of proximal humerus fractures.

Method

Twelve of 21 patients operated for proximal humerus fracture were operated in supine position and nine were operated in beach chair position. The time interval between the onset of anaesthesia and the first incision (surgical preparation time), intra-operative mean blood pressure values (mean systolic and diastolic blood pressure at the beginning of surgery-during the first hour of surgery-during wound closure), haemoglobin changes, surgical time, intra-operative intra-operative scopy shots were evaluated and compared with each other. Early post-operative (day 1) congnitive status of the patients were evaluated and compared with mini-mental test.

Results

The mean age of the patients who underwent surgery in the supine position was 44.08 ±8.6 years (8 males, 4 females), while the mean age of the patients who underwent surgery in the beach-chair position was 52 ±8.3 years (5 males, 4 females). (p >0. 05) The mean surgical preparation time and duration of surgery were 29.5 ± 3.6 min and 154.5 ± 19 min, respectively, in patients who underwent surgery in the supine position, while the mean surgical preparation time and duration of surgery were 41.5 ± 8.3 min and 186.1 ± 14.3 min, respectively, in patients who underwent surgery in the beach chair position. There was a statistically significant difference between both groups in terms of surgical preparation time and surgical time (p<0.001, p<0.001). (p<0.001, p<0.001) The change in haemoglobin values of the patients in the supine position was 0.9±0.23 g/dL, while the change in haemoglobin values of the patients who underwent surgery in the beach chair position was 0.9±2. 6 g/dL. (p >0.05) The mean systolic and diastolic values of the 3 intra-operative blood pressure values (baseline-during the 1st hour of surgery-during wound closure) were 103.7±20.7 mmhg and 67.1±10.3 mmhg in patients in the supine position and 133.7±24.3 mmhg and 80.4±6.7 mmhg in patients in the beach chair position, respectively. A statistically significant difference was observed between both groups (p<0.001). The number of fluoroscopy shots of the patients in the first group was 40.7±6.06, while the number of fluoroscopy shots of the patients in the second group was 50.1±7.2. (p<0.05) The mini-mental test scores of the patients who underwent surgery in the supine position were 25.9±1.1, while the mini-mental test scores of the patients who underwent surgery in the beach chair position were 21.7±1.4, and a statistically significant difference was observed between both groups. (p<0.001)

Conclusion

In proximal humerus fractures, the supine position is advantageous, especially in single surgeon centres, due to shorter preparation time and better fracture control. It was also observed that patients who underwent surgery in the supine position had better cognitive function in the early post-operative period.