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Dahm F, Feichtinger X, Vallant SM, Haffner N, Schaden W, Fialka C, Mittermayr R. High-energy extracorporeal shockwave therapy in humeral delayed and non-unions. Eur J Trauma Emerg Surg 2021; 48:3043-3049. [PMID: 34515810 DOI: 10.1007/s00068-021-01782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. MATERIALS AND METHODS A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. RESULTS A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002). CONCLUSION The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.
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Affiliation(s)
- Falko Dahm
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria. .,Women's College Hospital, University of Toronto Orthopaedics Sports Medicine, Toronto, Canada.
| | - Xaver Feichtinger
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | - Nicolas Haffner
- Department for Orthopedics and Trauma Surgery, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Wolfgang Schaden
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Qurbani K, Hamzah H. Intimate communication between Comamonas aquatica and Fusarium solani in remediation of heavy metal-polluted environments. Arch Microbiol 2020; 202:1397-1406. [DOI: 10.1007/s00203-020-01853-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/28/2022]
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Ramos Poroes F, Desmarchelier R, Bauer S. Atypical biceps-related complication of proximal humerus fracture leading to internal shoulder impingement due to tendon stump dislocation. BMJ Case Rep 2020; 13:13/2/e232124. [PMID: 32041757 DOI: 10.1136/bcr-2019-232124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Non-displaced proximal humerus fractures are usually managed non-operatively despite of minor malalignment. Biceps tendon rupture due to attrition after malunion is rare around the proximal humerus. Rupture of the long head of biceps (LHB) tendon usually occurs inside the joint close to the origin at the labrum. Treatment is usually non-operative with good outcomes. We report a rare case of a 48-year-old female patient with persistent locking and internal impingement 8 months after a proximal humerus fracture with anterior angulation leading to extra-articular reversed LHB tendon rupture with intra-articular dislocation of the proximal stump. Interposition of the tendon (3.5 cm) between the glenoid and the humeral head was confirmed on MRI arthrogram. Arthroscopic proximal tenotomy and stump removal resulted in immediate relief with improved function (subjective shoulder value 95%; Constant Score: 96). False interpretation of symptoms as posttraumatic stiffness should be avoided by a thorough examination and complementary MRI arthrogram investigation.
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Affiliation(s)
| | | | - Stefan Bauer
- Department of Orthopedic Surgery, EHC, Morges, Switzerland
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