Delayed ORIF of proximal humerus fractures at a minimum of 3 weeks from injury: a functional outcome study

Short-term Clinical Outcome of Dual Plate Fixation in the Treatment of Proximal Humerus Fractures with Calcar Comminution

OBJECTIVE

Calcar comminution has been considered to be the main cause of the failure of internal fixation and fracture nonunion in proximal humerus surgery. Anatomical reduction and increasing the strength of internal fixation is the key to success. The purpose of this study was to investigate the short-term clinical effect of dual plate fixation in the treatment of proximal humeral fractures with calcar comminution.

METHODS

The data of 37 patients with proximal humeral fractures with calcar comminution, treated in our departments from July 2018 to April 2020, were retrospectively analyzed. These patients were treated with anterior plate and lateral PHILOS plate, and followed up for more than 12 months, including 25 cases in Tianjin Hospital and 12 cases in Shanghai General Hospital. The patients included 12 males and 25 females, their age was 54.89 ± 13.59 years (range from 32-79 years), and 21 patients had dominant hand injury. According to the Neer classification, there were 11 two-part fractures, 22 three-part fractures, and four four-part fractures. The range of motion of the shoulder joint, visual analog scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley shoulder score, neck-shaft angle, anterior-posterior angle, and other complication scores were recorded at the last follow-up.

RESULTS

All 37 patients were followed up after operation, and the follow-up time was 21.81 ± 7.35 months (range from 12-36 months). The fractures of all 37 patients had healed at the last follow-up visit. The neck-shaft angle measured immediately after operation was 132.59° ± 8.34°, and the neck-shaft angle measured at the last follow-up visit was 132.38 ± 8.53°. The anterior-posterior angle measured immediately after surgery was 3.45° ± 0.81°, and the anterior-posterior angle at the last follow-up visit was 3.66° ± 0.77°. The range of motion of the shoulder joint was as follows: the shoulder joint could be forward elevated by 158.11° ± 13.09° (range: 140°-180°), rotated externally by 38.38° ± 7.55° (range: 20°-45°), and internally rotated to T4-L4 level. The VAS score was 0.46 ± 0.87 (range: 0-3), the ASES was 86.58 ± 8.79 (range: 56.7-100), and the Constant-Murley score was 88.76 ± 8.25 (range: 60-100). Thirty-three cases were excellent, and four cases were good. No obvious complications occurred.

CONCLUSION

The combination of anterior plate and lateral PHILOS plate in the treatment of proximal humeral fractures with calcar comminution can achieve stable fixation, and the postoperative clinical and imaging outcome was satisfactory. Firstly, the anterior plate can provide temporary stability when the Kirschner wires are removed, which can provide space for lateral plate placement during fracture reduction and fixation. Secondly, additional support by the anterior plate can provide higher stability in complex fractures with calcar comminution.

Revision Arthroscopic Greater Tuberosity Fracture Fixation and Implant Removal: An Open to Arthroscopic Approach

Failure of a greater tuberosity fracture fixation with screws can lead to stiffness, pain, and weakness of the rotator cuff. Management of a previously performed open greater tuberosity fracture fixation with screws involves implant removal and refixation of the fragment. Doing this arthroscopically in a previously performed open surgery has its own challenges but distinct advantages. Describe herein is a technique for performing this revision surgery arthroscopically.

Outcomes of surgical fixation of greater tuberosity fractures: A systematic review

BACKGROUND

Isolated greater tuberosity fractures account for up to a fifth of all proximal humeral fractures. There have been several retrospective cohort studies and case series reporting outcomes after treatment of this pathology. This study aims to report on the clinical outcomes of surgically treated isolated greater tuberosity fractures, as well as diagnostic workup and complications associated with fracture fixation.

METHODS

A systematic review was performed under PRISMA guidelines to identify studies that reported the results or clinical outcomes of isolated greater tuberosity fracture. The searches were performed using MEDLINE through PubMed, the Elsevier Embase database, and the Cochrane Database of Systematic Reviews.

RESULTS

Sixteen studies met inclusion criteria comprising 345 patients and 345 shoulders. The mean age was 52.9 years and mean follow-up was 3.4 months. The mean postoperative American Shoulder and Elbow Surgeon Score, the most frequently utilized patient reported outcome measure across studies, was 90.1% of ideal maximum. All studies used standard shoulder radiographs in their initial workup and most commonly referred to a minimum of 5mm displacement as an indication for surgery. Fifty five percent of patients were treated using open fixation and 35.9 with arthroscopic fixation. Ninety three percent of patients were able to return to work. A total of fifty-two (15.1%) complications were reported in the included studies.

CONCLUSIONS

The current literature describes overall satisfactory functional outcomes and minimal occupational morbidity following either open or arthroscopic fixation of isolated greater tuberosity fractures despite a notable rate of complications.

LEVEL OF EVIDENCE

IV, systematic review.