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Wendt KW, Jaeger M, Verbruggen J, Nijs S, Oestern HJ, Kdolsky R, Komadina R. ESTES recommendations on proximal humerus fractures in the elderly. Eur J Trauma Emerg Surg 2020; 47:381-395. [PMID: 32767081 DOI: 10.1007/s00068-020-01437-7] [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] [Received: 08/22/2019] [Accepted: 07/12/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The section for the skeletal trauma and sport's injuries of the European Society for Trauma and Emergency Surgery (ESTES) appointed a task force group to reach a consensus among European countries on proximal humeral fractures. MATERIAL/METHODS The task force group organized several consensus meetings until a paper with final recommendations was confirmed during the ESTES Executive Board meeting in Berlin on 25 October 2018. CONCLUSION The Recommendations compare conservative and four possible operative treatment options (ORIF, nailing, hemi- and total reverse arthroplasty) and enable the smallest common denominator for the surgical treatment among ESTES members.
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Affiliation(s)
- Klaus W Wendt
- Medical Coordinator, Trauma Centre Northern Netherlands, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Jaeger
- Clinic for Orthopedic and Trauma Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Verbruggen
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stefaan Nijs
- Department of Traumatology, UZ Leuven, Leuven, Belgium
| | - Hans-Jörg Oestern
- Conciliation Board of Medical Liability Cases Germany, Hannover, Germany
| | - Richard Kdolsky
- University Clinic for Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Radko Komadina
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Pautasso A, Lea S, Arpaia A, Ferrero G, Bellato E, Castoldi F. Six-year experience with antegrade intramedullary nail for the treatment of proximal and diaphyseal humeral fractures. Musculoskelet Surg 2018; 102:67-74. [PMID: 30343475 DOI: 10.1007/s12306-018-0561-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Proximal and shaft humeral fractures are very common worldwide; surgical treatment can be a viable option to reduce limb immobilization and to allow the patient an earlier return to daily activities. The aim of our study was to evaluate the outcomes of patients treated with intramedullary nail in our Institute from January 2010 to December 2016. MATERIALS AND METHODS This is an observational cohort study. Inclusion criteria were: traumatic proximal and diaphyseal humeral fractures treated with antegrade nail; a minimum follow-up of 6 months. We evaluated the fracture healing time, the functional recovery (using the Constant score) and postoperative complications (need of blood transfusion, infections and need of re-intervention). The t test was used for statistical analysis. RESULTS Ninety-five patients were included (20 proximal and 75 diaphyseal fractures). Bone callus formation was evident a mean of 57 days after surgery. In all patients, there was an improvement in the functional recovery over time, but those younger than 65 years had better outcomes. The type of fracture and patients' gender did not affect these results at one and 6 months of follow-up. In 18 cases, blood transfusions were needed; infections never occurred; finally, revision surgery was performed in 10 cases (two reverse total shoulder arthroplasties, one open reduction and internal fixation with plate and screws and seven nail removals for intolerance). CONCLUSION In our study, intramedullary nail proved to be a minimally invasive technique with a rapid improvement in range of motion, an earlier rehabilitation and acceptable pain.
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Affiliation(s)
- A Pautasso
- University of Studies in Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy.
| | - S Lea
- University of Studies in Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy
| | - A Arpaia
- San Luigi Gonzaga Hospital, Via Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - G Ferrero
- San Luigi Gonzaga Hospital, Via Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - E Bellato
- San Luigi Gonzaga Hospital, Via Regione Gonzole 10, 10043, Orbassano (Turin), Italy
| | - F Castoldi
- University of Studies in Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy
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Vegt P, Verbruggen J, Gausepohl T, Vroemen JP, Schafer W, Pennig D, Muir JM. The Photodynamic Bone Stabilization System in the Treatment of Humerus Fractures: A Prospective Clinical Trial. Cureus 2018; 10:e2809. [PMID: 32175197 PMCID: PMC7053794 DOI: 10.7759/cureus.2809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Fractures of the proximal humerus are among the most common long-bone fractures and present unique challenges to surgeons. Traditional internal fixation methods, such as intramedullary nails, are associated with drawbacks such as an inability to fully fill the trabecular space and a limited ability to utilize supplemental hardware in many cases. We evaluated the safety and effectiveness of a novel fracture fixation device that utilizes a light-cured monomer to stabilize the fracture in a cohort of patients suffering from humerus fractures. Methods We prospectively collected data from patients being treated surgically for humerus fractures. Fractures were treated using the photodynamic bone stabilization system (PBSS) consisting of a balloon and light-cured monomer. Patients were evaluated at 7-14, 30, 60, 90, 180, and 360 days post-procedure. Primary outcomes included normal and complete radiographic fracture healing. Secondary outcomes included pain (via visual analog scale), function (via the disability of the arm, shoulder, and hand (DASH) and constant shoulder scales), and the rate of complications. Results A total of 33 patients were included in the intent-to-treat analysis (mean age: 76.6 yrs). Of these patients, 88% demonstrated normal radiographic healing at their 90-, 180-, and 360-day visits. Complete radiographic healing was observed in 81%, 88%, and 96% of patients at 90, 180, and 360 days, respectively. Pain scores decreased significantly at day seven when compared with baseline (28.2+20.9 vs.53.6+32.2, p<0.001) and continued to decrease at the 90-day (24.7+15.5, p<0.001), 180-day (17.8+12.5, p<0.001) and 360-day (6.6+6.7, p<0.001) evaluations. DASH scores demonstrated statistically significant improvements over baseline (65.5+31.5) at 90 (37.0+14.9, p<0.001), 180 (30.6+15.7, p<0.001), and 360 days (23.9+15.0, p<0.001) post-procedure. The procedure-related event rate was 36.4%, with 5 (11.4%) device-related adverse events reported at the one-year follow-up. Conclusions Our study demonstrates the ability of a novel internal fixation device to safely and effectively treat fractures of the humerus in the elderly population.
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Affiliation(s)
- Paul Vegt
- Surgery, Albert Schweitzer Hospital, Dordrecht, NLD
| | - Jan Verbruggen
- Surgery, University Hospital Maastricht, Maastricht, NLD
| | | | | | - Walter Schafer
- Clinic for Orthopedics, Kreiskrankenhaus Gummersbach, Gummersbach, DEU
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4
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McSweeney AL, Zani BG, Baird R, Stanley JR, Hayward A, Markham PM, Kopia GA, Edelman ER, Rabiner R. Biocompatibility, bone healing, and safety evaluation in rabbits with an IlluminOss bone stabilization system. J Orthop Res 2017; 35:2181-2190. [PMID: 28135014 PMCID: PMC5534392 DOI: 10.1002/jor.23532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/23/2017] [Indexed: 02/04/2023]
Abstract
Bone healing, biocompatibility, and safety employing the IlluminOss System (IS), comprised of an inflatable balloon filled with photopolymerizable liquid monomer, was evaluated in New Zealand white rabbits. Successful bone healing and callus remodeling over 6 months was demonstrated radiologically and histologically with IS implants in fenestrated femoral cortices. Biocompatibility was demonstrated with IS implants in brushed, flushed femoral intramedullary spaces, eliciting no adverse, local, or systemic responses and with similar biocompatibility to K-wires in contralateral femurs up to 1 year post-implant. Lastly simulated clinical failures demonstrated the safety of IS implants up to 1 year in the presence of liquid or polymerized polymer within the intramedullary space. Polymerized material displayed cortical bone and vasculature effects comparable to mechanical disruption of the endosteum. In the clinically unlikely scenario with no remediation or polymerization, a high dose monomer injection resulted in marked necrosis of cortical bone, as well as associated vasculature, endosteum, and bone marrow. Overall, when polymerized and hardened within bone intramedullary spaces, this light curable monomer system may provide a safe and effective method for fracture stabilization. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2181-2190, 2017.
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Affiliation(s)
- Amanda L. McSweeney
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421,Author to whom all correspondence should be addressed: Amanda L. McSweeney, BS, RLATG, SRS, CBSET, Inc., 500 Shire Way, Lexington, MA 02421, Phone: 781-541-5567,
| | - Brett G. Zani
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Rose Baird
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - James R.L. Stanley
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Alison Hayward
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | - Peter M. Markham
- Concord Biomedical Sciences and Emerging Technologies, 500 Shire Way, Lexington, MA 02421
| | | | - Elazer R. Edelman
- Institute for Medical and Engineering Science, Massachusetts Institute of Technology, E25, 45 Carleton St., Cambridge, MA, 02139
| | - Robert Rabiner
- IlluminOss Medical Inc., 993 Waterman Ave., East Providence, RI 02914
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Dilisio MF, Nowinski RJ, Hatzidakis AM, Fehringer EV. Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg 2016; 25:e130-8. [PMID: 26895601 DOI: 10.1016/j.jse.2015.11.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Abstract
Proximal humerus fractures are the third most common fracture in the elderly. Although most fractures can be treated conservatively with acceptable outcomes, certain fracture patterns are at high risk for progression to humeral malunions, nonunions, stiffness, and post-traumatic arthrosis. The goal of antegrade humeral nailing of proximal humerus fractures is to provide stability to a reduced fracture that allows early motion to optimize patient outcomes. Certain technical pearls are pivotal in managing these difficult fractures with nails; these include rotator cuff management, respect of the soft tissues, anatomic tuberosity position, blood supply maintenance, knowledge of the deforming forces on the proximal humerus, fracture reduction, and rehabilitation strategies. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising outcomes. Humeral nail designs have undergone significant innovation during the past 40 years and now can provide stable fixation in the humeral shaft distally as well as improved stability in the head and tuberosity fragments, which were the common site of fixation failure with earlier generation implants. Compared with other fixation strategies, such as locking plate fixation, no compelling evidence exists to suggest one technique over another. The purpose of this review is to describe the history, results, new designs, and techniques that make modern intramedullary nailing of proximal humerus fractures a viable treatment option.
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Affiliation(s)
- Matthew F Dilisio
- Creighton University Orthopaedics, CHI Health Alegent Creighton Clinic, Omaha, NE, USA.
| | | | | | - Edward V Fehringer
- Columbus Community Hospital Orthopaedics and Sports Medicine, Columbus, NE, USA
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Zani BG, Baird R, Stanley JRL, Markham PM, Wilke M, Zeiter S, Beck A, Nehrbass D, Kopia GA, Edelman ER, Rabiner R. Evaluation of an intramedullary bone stabilization system using a light-curable monomer in sheep. J Biomed Mater Res B Appl Biomater 2015; 104:291-9. [PMID: 25772144 DOI: 10.1002/jbm.b.33380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/28/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022]
Abstract
Percutaneous intramedullary fixation may provide an ideal method for stabilization of bone fractures, while avoiding the need for large tissue dissections. Tibiae in 18 sheep were treated with an intramedullary photodynamic bone stabilization system (PBSS) that comprised a polyethylene terephthalate (Dacron) balloon filled with a monomer, cured with visible light in situ, and then harvested at 30, 90, or 180 days. In additional 40 sheep, a midshaft tibial osteotomy was performed and stabilized with external fixators or external fixators combined with the PBSS and evaluated at 8, 12, and 26 weeks. Healing and biocompatibility were evaluated by radiographic analysis, micro-computed tomography, and histopathology. In nonfractured sheep tibiae, PBSS implants conformably filled the medullary canal, while active cortical bone remodeling and apposition of new periosteal and/or endosteal bone was observed with no significant macroscopic or microscopic observations. Fractured sheep tibiae exhibited increased bone formation inside the osteotomy gap, with no significant difference when fixation was augmented by PBSS implants. Periosteal callus size gradually decreased over time and was similar in both treatment groups. No inhibition of endosteal bone remodeling or vascularization was observed with PBSS implants. Intramedullary application of a light-curable PBSS is a biocompatible, feasible method for fracture fixation.
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Affiliation(s)
- Brett G Zani
- Department of Applied Sciences, CBSET, Inc., Lexington, Massachusetts, 02421
| | - Rose Baird
- Department of Applied Sciences, CBSET, Inc., Lexington, Massachusetts, 02421
| | - James R L Stanley
- Department of Pathology, CBSET, Inc., Lexington, Massachusetts, 02421
| | | | - Markus Wilke
- AO Research Institute Davos, 7270, Davos, Switzerland
| | | | - Aswin Beck
- AO Research Institute Davos, 7270, Davos, Switzerland
| | - Dirk Nehrbass
- AO Research Institute Davos, 7270, Davos, Switzerland
| | | | - Elazer R Edelman
- Institute for Medical and Engineering Science, Massachusetts Institute of Technology E25, Cambridge, Massachusetts, 02139
| | - Robert Rabiner
- IlluminOss Medical, Inc., East Providence, Rhode Island, 02914
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O'Neill BJ, O'Briain D, Hirpara KM, Shaughnesy M, Yeatman EA, Kaar TK. Digital photography for assessment of shoulder range of motion: A novel clinical and research tool. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 7:23-7. [PMID: 23858292 PMCID: PMC3707333 DOI: 10.4103/0973-6042.109888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose: Maintenance of a pain-free functional range of motion is the aim of surgery for shoulder trauma. The aim of this study was to show that the range of motion can be accurately assessed using digital photographs. Materials and Methods: We reviewed 17 patients who had undergone surgery for shoulder trauma. Each patient's range of motion was assessed by two physicians and two physiotherapists. Digital photographs were taken of each patient at their functional limit. Photographs were assessed by two physicians and two physiotherapists, and by an external physician who had no previous contact with the patients. Results: Inter-observer and intra-observer reliability trials showed excellent correlation of results. There was no significant difference between observer's results, or between results of physical examination and photographic examination. Conclusions: Digital photography is a viable adjunct to assessment of range of motion of the shoulder. This has positive implications both clinically, and for shoulder research. Level of Evidence: Level 3.
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Affiliation(s)
- Barry J O'Neill
- Department of Trauma and Orthopaedics, Merlin Park Hospital, Galway, Ireland
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Kumar V, Datir S, Venkateswaran B. Intramedullary nailing for displaced proximal humeral fractures. J Orthop Surg (Hong Kong) 2010; 18:324-7. [PMID: 21187544 DOI: 10.1177/230949901001800313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate outcomes of 28 patients who underwent intramedullary nailing for displaced proximal humeral fractures. METHODS 24 women and 4 men aged 38 to 87 (mean, 65) years underwent intramedullary nailing for displaced proximal humeral fractures. 17 (61%) of them were aged >70 years. Fractures were classified into 2-part (n = 8), 3-part (n = 17), and 4-part (n = 3), and corresponded to AO 11 A3 (n = 8), B1 (n = 3), B2 (n = 9), and C2 (n = 8) types. The Constant and Oxford scores were assessed at the final follow-up. RESULTS All patients had bone union except for one who had tuberosity failure. 23 (82%) patients had satisfactory-to-excellent and 5 had poor Constant scores; outcomes were worse with more complex fractures. 20 (71%) patients had satisfactory Oxford scores. Seven (25%) patients had impingement of a nail tip. Other complications included avascular necrosis (n = 1), proximal locking screw back-out (n = 1), and screw penetration into the joint (n = 1). CONCLUSION Intramedullary nailing provides a stable fixation with minimal soft tissue dissection for displaced proximal humeral fractures. It enables early mobilisation and functional recovery.
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Affiliation(s)
- Vinod Kumar
- Department of Trauma and Orthopaedic Surgery, Dewsbury and District Hospital, Dewsbury, West Yorkshire, United Kingdom.
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Long-term results after non-plate head-preserving fixation of proximal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2009; 34:883-9. [PMID: 19705115 DOI: 10.1007/s00264-009-0848-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 07/01/2009] [Accepted: 07/17/2009] [Indexed: 11/27/2022]
Abstract
A retrospective study was conducted to evaluate displaced proximal humeral fractures treated with a non-plate head-preserving fixation and to detect factors predicting functional outcome. After a median follow-up period of 79.7 months, 105 patients with nine A-fractures, 36 B-fractures and 60 C-fractures (nine two-part-fractures, 41 three-part fractures and 55 four-part fractures) were assessed. Functional outcome was measured based on the Constant and UCLA scores. Of all patients, 70-75% had excellent or good Constant and UCLA scores. In 74% a good or satisfactory quality of initial reduction fracture was achieved. About one-fifth (21%) of the fractures showed a secondary displacement. Twenty-seven percent of the patients had signs of humeral head necrosis and 22% had implant related problems. There were significant correlations between a high final score and young age, low AO fracture severity, good quality of fracture reduction and residual osseous deformity, absence of secondary fracture displacement, implant-related complications, shoulder arthrosis and humeral head necrosis at the time of follow-up. In conclusion, the non-plate head-preserving fixation of proximal humeral fractures is an alternative treatment for displaced proximal humeral fractures. Especially in severely displaced C-fractures in older patients, non-anatomical reduction leads to a high rate of secondary displacement, residual osseous deformity and only a fair shoulder function. For these cases alternative methods such as prosthetic replacement should be chosen.
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