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Madeja R, Pometlová J, Brzóska R, Voves J, Bialy L, Pleva L, Stránský J, Vrtková A, Janošek J, Čabanová K. Outcomes of Mini-Invasive Arthroscopic Arthrolysis Combined with Locking Screw and/or Intramedullary Nail Extraction after Osteosynthesis of the Proximal Humerus Fracture. J Clin Med 2022; 11:jcm11020362. [PMID: 35054056 PMCID: PMC8778013 DOI: 10.3390/jcm11020362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
Data on the effectiveness of arthroscopic arthrolysis and extraction of osteosynthetic material after osteosynthesis of the proximal humerus in patients with persisting problems are rare and insufficient. In this study, we performed arthroscopic arthrolysis and extraction of fixation screws, and, where protruding, extraction of the nail in 34 patients with problems persisting 12 months after osteosynthesis of the proximal humerus using an intramedullary nail. The effectiveness of the treatment was assessed using the Constant-Murley shoulder score and forward flexion difference between the treated arm and the contralateral one. A median increase of 16 points in CMS score and 30 degrees reduction in the arm forward flexion difference was recorded 12 months after the arthroscopy. The improvement was significantly higher in the patient group with intramedullary nail extraction (however, this group had worse pre-operative values and the screw was only extracted where likely to cause problems). The median time to heal was 11 weeks; no serious peri- or post-procedural complications occurred. Mini-invasive arthroscopic arthrolysis combined with extraction of osteosynthetic material proved to be a safe and effective method for treatment of patients after osteosynthesis of the proximal humerus using an intramedullary nail with persisting pain and/or mobility limitation.
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Affiliation(s)
- Roman Madeja
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
- Correspondence:
| | - Jana Pometlová
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Roman Brzóska
- Department of Orthopedics, St. Luke’s Hospital, Bielsko-Biała, Bystrzańska 94b str., 43-300 Bielsko-Biała, Poland;
| | - Jiří Voves
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Lubor Bialy
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Leopold Pleva
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Jan Stránský
- Department of Trauma Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic; (J.P.); (J.V.); (L.B.); (L.P.); (J.S.)
- Faculty of Medicine, Institute of Emergency Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Adéla Vrtková
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB—Technical University of Ostrava, 708 00 Ostrava, Czech Republic;
- Department of the Deputy Director for Science and Research, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Jaroslav Janošek
- Center for Health Research, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic;
| | - Kristýna Čabanová
- Centre for Advanced Innovation Technologies, VŠB—Technical University of Ostrava, 708 33 Ostrava, Czech Republic;
- Faculty of Mining and Geology, VŠB—Technical University of Ostrava, 708 33 Ostrava, Czech Republic
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Antoni M, Lazarus P, Kempf JF, Clavert P. Arthroscopic intramedullary nailing of humeral fractures through the rotator interval. Orthop Traumatol Surg Res 2021; 107:102750. [PMID: 33321228 DOI: 10.1016/j.otsr.2020.102750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/03/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Antegrade nailing of humeral fractures is a proven technique with well-documented results. The standard surgical approach requires incision of the supraspinatus tendon to insert a nail, which comes with the risk of damaging the rotator cuff. The aims of this study were to describe a new surgical technique for arthroscopic humeral nailing that does not require opening the rotator cuff and to report the clinical and radiological outcomes of this technique. MATERIALS AND METHODS This was a single center, retrospective study of patients who had a humeral shaft or surgical neck fracture at our hospital in 2017 and underwent antegrade intramedullary nailing by arthroscopy. The nail was introduced through the rotator interval without opening the rotator cuff. All were reviewed at 1-year postoperative: clinical examination (joint range of motion and Constant score) plus AP and lateral radiographs of the shoulder. RESULTS Eighteen patients (12 women, 6 men) with a mean age of 65.4 years (37-84) were included retrospectively. One patient died during the follow-up period thus 17 patients were available for analysis. At the 1-year follow-up, the mean forward flexion was 152.1° (90-180), the mean external rotation was 56.1° (30-80), the mean absolute Constant score was 73.9 (54-88) points and the mean adjusted Constant score was 93.5 (67-100) points. Bone union was achieved in 16/17 patients (94%) with 1 patient experiencing a nonunion. There were no complications. CONCLUSION Arthroscopic antegrade nailing of humeral shaft and surgical neck fractures through the rotator interval yields good clinical and radiological results in our hands. This new, rotator cuff-sparing technique is a viable option for treating humeral fractures by arthroscopy. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Affiliation(s)
- Maxime Antoni
- Service de chirurgie du membre supérieur, CHU de Strasbourg, Strasbourg, France.
| | - Priscille Lazarus
- Service de chirurgie du membre supérieur, CHU de Strasbourg, Strasbourg, France
| | - Jean-François Kempf
- Service de chirurgie du membre supérieur, CHU de Strasbourg, Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, CHU de Strasbourg, Strasbourg, France
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Humerus Nail Retrieval: A Novel New Technique. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dedeoğlu SS, İmren Y, Çabuk H, Tekin AÇ, Kır MÇ, Gürbüz H. Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus. J Orthop Surg (Hong Kong) 2018; 25:2309499017727949. [PMID: 28862100 DOI: 10.1177/2309499017727949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes. METHODS This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score. RESULTS Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time ( p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group ( p = 0.000 and p = 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group ( p = 0.000). CONCLUSIONS Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.
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Affiliation(s)
- Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Yunus İmren
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Mustafa Çağlar Kır
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
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Liu CH, Yeh WL, Tsai PJ, Fan KF, Cheng HW, Chen JM. A novel implant removal technique by endoscopy. J Orthop Surg Res 2018; 13:74. [PMID: 29625614 PMCID: PMC5889551 DOI: 10.1186/s13018-018-0783-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Routine implant removal after fracture healing remains controversial. However, it has been suggested that implant removal should be performed in cases of joint impingement, painful scar adhesion, and implant malposition. Entrance selection is relatively critical in patients with poor soft tissue conditions or sloughing coverage. We propose an innovative technique using endoscopy. METHODS Consecutive surgeries of endoscopic implant removal performed between 2005 and 2016 by a single experienced arthroscopic surgeon were included. Overall, 73 patients were enrolled; 44 were not eligible for inclusion and were excluded from the study. RESULTS Twenty-nine patients, including 32 surgical sites, were included. Twenty-four plates and 166 screws were removed using this technique. There were five complications during the follow-up period (range, 0.5 to 104 months; mean, 8.8), including one broken screw, one persistent knee joint contracture, and three wound dehiscence. There were no infections or neurovascular injuries. CONCLUSION Implant removal using endoscopy is a minimally invasive surgery that ensures that the screw axis does not strip, and treats the intra-articular pathology concomitantly. This innovative technique may be considered as an alternative to the traditional open method in cases with good surgical indications.
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Affiliation(s)
- Chang Heng Liu
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Wen Lin Yeh
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Athletic Training and Health, National Taiwan Sports University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping Jui Tsai
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Kuo Feng Fan
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Hung Wei Cheng
- Department of Athletic Training and Health, National Taiwan Sports University, Taoyuan, Taiwan
| | - Jian Ming Chen
- Department of Orthopaedic surgery, Chang Gung Memorial Hospital, Linkou Medical Center, #5, Fusing Street, Gueishan Township, Taoyuan County, 33305, Taiwan, Republic of China. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Katthagen JC, Huber M, Grabowski S, Ellwein A, Jensen G, Lill H. Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level-1 trauma center. J Orthop Traumatol 2017; 18:265-274. [PMID: 28421293 PMCID: PMC5585092 DOI: 10.1007/s10195-017-0457-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aims of this study were to evaluate treatment failure and revision rates of proximal humeral fracture (PHF) treatment with a standardized treatment algorithm within the reality of a level-1 trauma center and to identify predictors of subsequent surgery. MATERIALS AND METHODS The medical database of a level-1 trauma center was screened for all primary treatments of PHFs between January 2009 and June 2012. Medical records and imaging were analyzed to identify the fracture morphology, pre-existing diseases, revision surgeries and treatment failures (conversion to another treatment). The patients were asked about subsequent surgeries by phone. A functional outcome questionnaire was mailed to participating patients. RESULTS Follow-up data were available for 423 of 521 patients (312 females, 111 males). The mean age at the time of primary treatment was 68.3 years; mean follow-up was 24.6 ± 12.3 months. The overall rate of mandatory re-operations was 15.6%, including a failure rate of 8.3%; another 7.6% of patients had additional arthroscopic surgeries. Treatment with anatomic hemi-prostheses was associated with the highest re-operation rates, and lowest outcomes. Involvement of the medial calcar region, complex fracture morphologies, cigarette smoking and alcohol-abuse were predictors for subsequent surgery. Patients without subsequent surgery had significantly higher functional outcome scores than patients with additional surgery. CONCLUSIONS With the use of a standardized treatment algorithm no treatment modality was at significantly higher risk for having additional surgery. Complex fracture types, involvement of the medial calcar, cigarette-smoking and alcohol-abuse were associated with subsequent surgeries. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Jan Christoph Katthagen
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany.
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Münster, Albert-Schweizer-Campus 1, 48149, Münster, Germany.
| | - Meret Huber
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany
| | - Svenja Grabowski
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany
| | - Alexander Ellwein
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany
| | - Gunnar Jensen
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany
| | - Helmut Lill
- Department of Trauma and Reconstructive Surgery, DIAKOVERE Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Germany
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Maroun C, Aliani D, Hass A, Werthel JD, Vidil A, Valenti P. Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:317-321. [PMID: 28289904 DOI: 10.1007/s00590-017-1938-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proximal humerus fractures are common injuries. Locking plates and anterograde medullary nails are the two most common fixation devices used when open reduction and internal fixation (ORIF) is indicated. Complications related to fracture and to hardware are numerous, especially shoulder stiffness. The goal of this study is to report the clinical outcomes of gleno-humeral arthroscopic arthrolysis combined with hardware removal. METHODS A total of 58 patients (25 men, 33 women) with a mean age of 58 years (24-79) were reviewed retrospectively. Forty of them were active workers (5 heavy workers), and 18 were retired. A total of 24 fractures were reported after sport accident, 26 after domestic accident, and 8 after high energy trauma. Thirty-four patients with 3 or 4 part fractures (fracture through the anatomic neck and tuberosities), 20 patients with two part (displaced surgical neck) fracture and 4 cases of fracture of the tuberosities were operated. We combined a gleno-humeral arthrolysis by arthroscopy and a removal of the hardware using the previous incision for the plate or by arthroscopy for the nail. RESULTS The average follow-up was 23 months (range 6-60). Pain in Constant Murley score (CS) increased from 7.3 ± 3.8 points preoperatively to 13 ± 2.76 points post-operatively (p < 0.05). CS increased from 36.8 ± 12.25 points to 68.45 ± 15.24 points. Subjective shoulder value (SSV) score increased from 45.8 ± 16.6 to 78.23 ± 14.74. A gain in all active range of motion was reported (forward flexion: 37.6°, abduction: 39.5°, external rotation: 24.3°, internal rotation: from L5-S1 to T12-L1). CONCLUSIONS Gleno-humeral arthrolysis by arthroscopy combined with hardware removal after proximal humerus ORIF in one step is safe and beneficial for post-traumatic stiffness of the shoulder. It provides significant pain relief and increase of range of motion and allows to treat associated articular pathology.
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Affiliation(s)
- Ch Maroun
- Paris Shoulder Unit, Clinique Bizet, Paris, France
| | - D Aliani
- Paris Shoulder Unit, Clinique Bizet, Paris, France
| | - A Hass
- Paris Shoulder Unit, Clinique Bizet, Paris, France
| | - J D Werthel
- Paris Shoulder Unit, Clinique Bizet, Paris, France
| | - Anne Vidil
- Paris Shoulder Unit, Clinique Bizet, Paris, France
| | - Ph Valenti
- Paris Shoulder Unit, Clinique Bizet, Paris, France.
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Euler SA, Hengg C, Kolp D, Wambacher M, Kralinger F. Lack of fifth anchoring point and violation of the insertion of the rotator cuff during antegrade humeral nailing: pitfalls in straight antegrade humeral nailing. Bone Joint J 2014; 96-B:249-53. [PMID: 24493192 DOI: 10.1302/0301-620x.96b2.31293] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antegrade nailing of proximal humeral fractures using a straight nail can damage the bony insertion of the supraspinatus tendon and may lead to varus failure of the construct. In order to establish the ideal anatomical landmarks for insertion of the nail and their clinical relevance we analysed CT scans of bilateral proximal humeri in 200 patients (mean age 45.1 years (sd 19.6; 18 to 97) without humeral fractures. The entry point of the nail was defined by the point of intersection of the anteroposterior and lateral vertical axes with the cortex of the humeral head. The critical point was defined as the intersection of the sagittal axis with the medial limit of the insertion of the supraspinatus tendon on the greater tuberosity. The region of interest, i.e. the biggest entry hole that would not encroach on the insertion of the supraspinatus tendon, was calculated setting a 3 mm minimal distance from the critical point. This identified that 38.5% of the humeral heads were categorised as 'critical types', due to morphology in which the predicted offset of the entry point would encroach on the insertion of the supraspinatus tendon that may damage the tendon and reduce the stability of fixation. We therefore emphasise the need for 'fastidious' pre-operative planning to minimise this risk.
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Affiliation(s)
- S A Euler
- Medical University Innsbruck, Department of Trauma Surgery and Sports Medicine, Anichstr 35, Innsbruck 6020, Austria
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Maqdes A, Levy B, Klouche S, Hardy P. The feasibility and results of an arthroscopic removal of humeral locking plates and glenohumeral arthrolysis after proximal humeral fractures. Knee Surg Sports Traumatol Arthrosc 2014; 22:456-61. [PMID: 23397421 DOI: 10.1007/s00167-013-2437-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 01/29/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE This study describes the use of standard shoulder arthroscopy techniques to remove a proximal humerus locking plate following proximal humerus fracture. The goal of this study was to assess the feasibility and results of this technique. METHODS This was a retrospective non-comparative study. Inclusion criteria were fracture union when hardware was removed, significant residual glenohumeral stiffness after 6 months of physiotherapy, arthrogenic screw(s) and/or osteonecrosis (partial or complete) of the humeral head resulting in significant pain. RESULTS Eleven patients were included in this study. Surgery was successful in all cases, and surgery lasted a mean of 105 ± 10.5 min. Patients' mean age was 54.6 ± 10.6 years and the mean hospital stay 1.6 ± 0.8 days. No patient was lost to follow-up. At the mean last follow-up of 17.7 ± 23.4 months, pain and all functional parameters improved significantly: the Constant score (43.4 ± 8.8 vs 60.5 ± 0.3, p = 0.003), the visual analogue pain score (4.7 ± 1.5 vs 2.8 ± 2.3, p = 0.012), the shoulder abduction (77.7 ± 18.6 vs 104.5 ± 27.3, p = 0.004), the flexion (85.9 ± 30.7 vs 97.7 ± 27.7, p = 0.026) and the external rotation (15 ± 12 vs 31.8 ± 13.6, p = 0.004). Internal rotation improved from L3 to T12. All seven patients who practiced sports before the initial fracture had returned to sports approximately 6 months postoperatively. No infections or wound dehiscence occurred. CONCLUSION Shoulder arthroscopy was found to be feasible for removal of hardware following proximal humeral fracture and can be associated with diagnostic and therapeutic arthroscopy and glenohumeral arthrolysis if required.
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Affiliation(s)
- Ali Maqdes
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, 92100, Boulogne-Billancourt, France,
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Lill H, Katthagen C, Hertel A, Gille J, Voigt C. All-arthroscopic intramedullary nailing of 2- and 3-part proximal humeral fractures: a new arthroscopic technique and preliminary results. Arch Orthop Trauma Surg 2012; 132:641-7. [PMID: 22101409 DOI: 10.1007/s00402-011-1430-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Indexed: 02/09/2023]
Abstract
PURPOSE The most criticism of antegrade humeral nailing is the potentially deleterious effect on the shoulder function, which is caused by the trauma to the M. supraspinatus (SSP) at the nail insertion site. We describe a new technique of all-arthroscopical intramedullary nailing, which preserves the rotator cuff, and compare it with the conventional open procedure. METHODS From 11/2009 to 12/2010 82 patients with unstable, displaced proximal humeral fractures were treated surgically. Twenty-one of these patients received an intramedullary nailing. Sixteen of 21 met the inclusion criteria. Based on the surgeon's arthroscopic experience, patients were assigned to the arthroscopic (group I, n = 8) or open group (group II, n = 8). Both groups were compared due to the replacement results, complications, time of surgery and fluoroscopy. Concomitant intraarticular pathologies were assessed (group I). First clinical results after a median follow-up of 13 months (group I) and 14 months (group II) were reported. RESULTS Between group I and II, no significant differences were seen in patients age [77 years (range 45-90 years) vs. 76 years (range 65-92 years)], gender (6 female/2 male vs. 5 female/3 male) and fracture pattern (six 2-/two 3-part fractures vs. five 2-/three 3-part fractures). The reduction was evaluated by the caput-diaphysis-angle, which was median 137° (range 120-147°) in group I and 132° (range 120-158°) in group II (p = 0.959). Postoperatively, group I showed one varus-, group II two varus- and valgus deformities. Median time of surgery was 75 min (range 45-182 min) versus 70 min (range 40-146 min) (p = 0.442), fluoroscopy time 1.5 min (range, 0.6-3.7 min) versus 1.2 min (range 0.3-2.2 min) in group I and II (p = 0.336). Concomitant pathologies like one traumatic bicipital tendon-lesion and three partial lesions of the SSP were observed and treated in group I. Constant Scores and Visual Analogue Scale did not differ significantly between both groups at the time of follow-up. CONCLUSIONS All-arthroscopical humeral nailing is possible, preserves the rotator cuff and provides equal replacement and functional results like the open technique. An arthroscopically visualized optimal nail insertion point provides less frequent head deformities. Level of evidence Level III.
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Affiliation(s)
- Helmut Lill
- Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169, Hannover, Germany,
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Abstract
Arthroscopic implant removal involves innovative minimally invasive surgical techniques which offer the advantages of minimally invasive surgery in addition to the possibility of glenohumeral inspection, arthrolysis and treatment of concomitant intraarticular pathologies compared to open surgical procedures. In the following article the surgical techniques and significance of arthroscopic implant removal from the shoulder joint will be described. The first results of a complete arthroscopic plate removal from the humeral head will be described. Compared to the open technique, greater satisfaction of the patients, more rapid pain relief and improvement of the shoulder function in the early postoperative time could be observed. During the follow-up interval the results of the two techniques converge.
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