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Ou Z, Feng Q, Peng L, Zhou M, Rai S, Tang X. Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:31-40. [PMID: 37566131 DOI: 10.1007/s00402-023-05020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH. METHODS Literature was retrieved from PubMed, Cochrane Library, Embase, Web of Science, and Scopus for eligible studies published up to January 2023. The pooled odds ratios (ORs) were calculated with their corresponding 95% confidence intervals (CIs) to evaluate. STATA 15.1 software was applied for data synthesis, sensitivity synthesis, and publication bias. RESULTS 45 articles were published between 2000 and 2022, and 2482 patients were finally included. All articles were observational research, with 7 case-control studies and 38 cohort studies, and the Newcastle Ottawa Scale (NOS) score ranged from 7 to 9. The pooled results suggested that age (OR 0.32, 95% CI 0.14-0.74, P = 0.01), reduction quality (OR 0.08, 95% CI 0.01-0.44, P = 0.00), fracture type (OR 0.44, 95% CI 0.25-0.78, P = 0.01), surgical approach (OR: 4.06, 95% CI 1.21-13.61, P = 0.02) and fixation implant (OR = 0.68, 95% CI = 0.34-1.33, P = 0.02) were risk factors for ONHH after IFPHF. According to sensitivity analysis, Begg (P = 0.42) and Egger (P = 0.68) tests, the results were stable and exhibited no publication bias. CONCLUSIONS The study showed that age, reduction quality, fracture type, surgical approach and fixation implant were risk factors for ONHH after IFPHF, while gender, varus or valgus, timely operation, injured side, and the existence of medial support have little influence on ONHH, as they could not be considered risk factors and still need further investigations.
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Affiliation(s)
- ZiXuan Ou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - QiYuan Feng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - LianQi Peng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - MinQi Zhou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Orthopaedics, Al Ahalia Hospital, Abu Dhabi, United Arab Emirates
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Hohmann E, Keough N, Glatt V, Tetsworth K. Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03436-3. [PMID: 36454289 DOI: 10.1007/s00590-022-03436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing surgical interventions for proximal humerus fractures. METHODS Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1-3 studies from 2000 to 2022 comparing surgical treatment with ORIF, IM nailing, hemiarthroplasty, total and reverse shoulder arthroplasty (RTS) was conducted. Clinical outcome scores, range of motion (ROM), and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Thirty-five studies were included in the analysis. Twenty-five studies had a high risk of bias and were of low and very low quality. Comparisons between ORIF and hemiarthroplasty favored ORIF for clinical outcomes (p = 0.0001), abduction (p = 0.002), flexion (p = 0.001), and external rotation (p = 0.007). Comparisons between ORIF and IM nailing were not significant for clinical outcomes (p = 0.0001) or ROM. Comparisons between ORIF and RTS were not significant for clinical outcomes (p = 0.0001) but favored RTS for flexion (p = 0.02) and external rotation (p = 0.02). Comparisons between hemiarthroplasty and RTS favored RTS for clinical outcomes (p = 0.0001), abduction (p = 0.0001), and flexion (p = 0.0001). Complication rates between groups were not significant for all comparisons. CONCLUSIONS This meta-analysis for surgical treatment of proximal humerus fractures demonstrated that ORIF is superior to hemiarthroplasty, ORIF is comparable to IM nailing, reverse shoulder arthroplasty is superior to hemiarthroplasty but comparable to ORIF with similar clinical outcomes, ROM, and complication rates. However, the study validity is compromised by high risk of bias and low level of certainty. The results should therefore be interpreted with caution. Ultimately, shared decision making should reflect the fracture characteristics, bone quality, individual surgeon's experience, the patient's functional demands, and patient expectations. LEVEL OF EVIDENCE Level III; systematic review and meta-analysis.
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Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, Medical School, University of Pretoria, Pretoria, South Africa.
- Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Natalie Keough
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA
- Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Kevin Tetsworth
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia
- Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia
- Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia
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Abbot S, Proudman S, Ravichandran B, Williams N. Predictors of outcomes of proximal humerus fractures in children and adolescents: A systematic review. J Child Orthop 2022; 16:347-354. [PMID: 36238150 PMCID: PMC9550992 DOI: 10.1177/18632521221117445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Minimally displaced pediatric proximal humerus fractures can be reliably managed non-operatively; however, there is considerable debate regarding the appropriate management of severely displaced proximal humerus fractures, particularly in older children and adolescents with limited remodeling potential. The purpose of this study was to perform a systematic review to answer the questions: "What are the functional and quality-of-life outcomes of pediatric proximal humerus fractures?" and "What factors have been associated with a poorer outcome?" METHODS A review of Medline and Embase was performed on 4 July 2021 using search terms relevant to proximal humerus fractures, surgery, non-operative management, pediatrics, and outcomes. Studies including ≥10 pediatric patients with proximal humerus fractures, which assessed clinical outcomes by use of an established outcome measure, were selected. The following clinical information was collected: participant characteristics, treatment, complications, and outcomes. RESULTS Twelve articles were selected, including four prospective cohort studies and eight retrospective cohort studies. Favorable outcome scores were found for patients with minimally displaced fractures, and for children aged less than 10 years, irrespective of treatment methodology or grade of fracture displacement. Older age at injury and higher grade of fracture displacement were reported as risk factors for a poorer patient-reported outcome score. CONCLUSION An excellent functional outcome can be expected following non-operative management for minimally displaced pediatric proximal humerus fractures. Prospective trials are required to establish a guideline for the management of severely displaced proximal humerus fractures in children and adolescents according to fracture displacement and the degree of skeletal maturity. LEVEL OF EVIDENCE level V.
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Affiliation(s)
- Samuel Abbot
- Women’s and Children’s Hospital, North
Adelaide, SA, Australia,Royal Adelaide Hospital Orthopaedic and
Trauma Service, Adelaide, SA, Australia,The Queen Elizabeth Hospital, Woodville
South, SA, Australia,Centre for Orthopaedic and Trauma
Research, University of Adelaide, Adelaide, SA, Australia,Samuel Abbot, Women’s and Children’s
Hospital, North Adelaide, SA 5006, Australia.
| | - Susanna Proudman
- Discipline of Medicine, University of
Adelaide, Adelaide, SA, Australia,Rheumatology Unit, Royal Adelaide
Hospital, Adelaide, SA, Australia
| | - Bhuvanesh Ravichandran
- Women’s and Children’s Hospital, North
Adelaide, SA, Australia,Royal Adelaide Hospital Orthopaedic and
Trauma Service, Adelaide, SA, Australia
| | - Nicole Williams
- Women’s and Children’s Hospital, North
Adelaide, SA, Australia,Centre for Orthopaedic and Trauma
Research, University of Adelaide, Adelaide, SA, Australia
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Adeyemo A, Bertha N, Perry KJ, Updegrove G. Implant Selection for Proximal Humerus Fractures. Orthop Clin North Am 2021; 52:167-175. [PMID: 33752838 DOI: 10.1016/j.ocl.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Proximal humerus fractures (PHF) are a common orthopedic injury; however, their treatment remains largely controversial with evidence supporting a wide array of treatments. Although many injuries can be treated nonoperatively, there has been much debate about surgical management of PHF. A detailed review of the literature was performed relative to operative management options specifically related to implant choices. Although no definitive answers are available regarding best practice, there is literature to guide operative decision-making and implant selection based on both patient- and surgeon-specific factors.
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Affiliation(s)
- Adeshina Adeyemo
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Nicholas Bertha
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Kevin J Perry
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Gary Updegrove
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA.
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Simionato IF, Brunelli JPF, Ferreira MT, Matsumoto FY, Britto AG, Mothes FC. Radiographic Evaluation of the Consolidation of Humerus Surgical Neck Fractures Treated With Percutaneous Fixation. Rev Bras Ortop 2020; 55:347-352. [PMID: 32616981 PMCID: PMC7316538 DOI: 10.1055/s-0039-3402463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/02/2019] [Indexed: 12/03/2022] Open
Abstract
Objective
To evaluate radiographically the postoperative results of patients with fracture of the proximal humerus in two parts of the surgical neck treated with threaded percutaneous fixation.
Methods
We evaluated the radiographic results of percutaneous fixation with threaded pins on the treatment of proximal humerus fractures in our service. Preoperative and postoperative images of 42 patients were evaluated, evaluating radiographs until 8 weeks postoperatively. We considered on evaluation the fracture deviation on preoperative images, the loss of reduction and no consolidation.
Results
Our consolidation rate was 90.4%, with loss of reduction in 16.6% of the cases and no consolidation rates in just 4 operated cases. We observed a predominance of a specific fracture pattern in the cases with loss of reduction.
Conclusion
The present study allows us to consider the percutaneous fixation technique with threaded pins as an alternative in our therapeutic arsenal for the proximal humerus fracture of the surgical neck. Contraindications are considered for low fracture trait on the metaphysis and with medial/lateral cortical impairment.
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Affiliation(s)
| | | | - Marco Tonding Ferreira
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
| | | | - Almiro Gerszon Britto
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
| | - Fernando Carlos Mothes
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
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Shi X, Liu H, Xing R, Mei W, Zhang L, Ding L, Huang Z, Wang P. Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis. J Orthop Surg Res 2019; 14:285. [PMID: 31470878 PMCID: PMC6717341 DOI: 10.1186/s13018-019-1345-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture (PHF). METHODS China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang database, Chinese Biomedicine Database (CBM), PubMed, EMBASE, Web of Science, and Cochrane Library were searched until July 2018. The eligible references all show that the control group uses locking plates to treat PHF, while the experimental group uses intramedullary nails to do that. Two reviewers independently retrieved and extracted the data. Reviewer Manager 5.3 was used for statistical analysis. RESULTS Thirty-eight retrospective studies were referred in this study which involves 2699 patients. Meta-analysis results show that the intramedullary nails in the treatment of proximal humeral fractures are superior to locking plates in terms of intraoperative blood loss, operative time, fracture healing time, postoperative complications, and postoperative infection. But there is no significance in constant, neck angle, VAS, external rotation, antexion, intorsion pronation, abduction, NEER, osteonecrosis, additional surgery, impingement syndrome, delayed union, screw penetration, and screw back-out. CONCLUSIONS The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of PHF. Due to the limitations in this meta-analysis, more large-scale, multicenter, and rigorous designed RCTs should be conducted to confirm our findings. TRIAL REGISTRATION PROSPERO CRD42019120508.
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Affiliation(s)
- Xiaoqing Shi
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Hao Liu
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Runlin Xing
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Wei Mei
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Li Zhang
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Liang Ding
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Zhengquan Huang
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China
| | - Peimin Wang
- Department of Orthopedic Trauma, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, PO Box 210029, Nanjing, China.
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7
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Huang H. Treatment of the surgical neck fracture of the humerus with a novel external fixator in the elderly with osteoporosis: biomechanical analysis. BMC Musculoskelet Disord 2019; 20:218. [PMID: 31092231 PMCID: PMC6521449 DOI: 10.1186/s12891-019-2599-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/30/2019] [Indexed: 11/16/2022] Open
Abstract
Background No consensus exists on the treatment of proximal humerus fractures, especially in the elderly patients with osteoporosis. This study was aimed to evaluate the biomechanical characteristics of a novel external fixator in treating two-part surgical neck fracture of the proximal humerus in the elderly patients with osteoporosis. Methods Sixteen female elderly humeral shaft specimens with osteoporosis were randomized into 2 groups. Models with the surgical neck two-part fracture of the proximal humerus were built, in which a novel external fixator (test group) and a clover plate (control group) were applied separately. In the test group, the fracture was firstly fixed with intersection pinning using 3 Schanz pins (3.5 mm), followed by the novel external fixation frame. In the control group, a clover plate and 6 cortical bone screws were applied. Biomechanical testing of the specimens was performed to assess the resistance to load bearing and torsional stress. The parameters of the two groups were compared using independent t-test. Results Ultimate bearing capacity and load bearing at different parts with the humerus rotation were higher (P < 0.05) in the external fixator group (145.16 ± 17.42 N and 140 N respectively) than those in the plate group (120.21 ± 13.15 N and 69.63 ± 25.16–90.78 ± 17.18 N respectively). As for resistance to torsional stress, plate’s torque fluctuated between 1 Nm and 5 Nm, while the external fixator’s torque values were more evenly (P < 0.01) distributed with the fluctuation within 1 Nm. Conclusions In the fixation of two-part humeral fracture in elderly patients with osteoporosis, the new external fixator seemed to be superior to plate fixation in load bearing and resistance to torsional stress.
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Affiliation(s)
- Haijing Huang
- Department of trauma Orthopedic, Tianjin Hospital, No. 406, Jiefang south Road, Hexi District, Tianjin, 300021, China.
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Plath JE, Kerschbaum C, Seebauer T, Holz R, Henderson DJH, Förch S, Mayr E. Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial. BMC Musculoskelet Disord 2019; 20:20. [PMID: 30630465 PMCID: PMC6329164 DOI: 10.1186/s12891-019-2399-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background Proximal humeral fractures (PHFs) are the third most common fracture in older patients. The purpose of the study was to prospectively evaluate the outcomes of PHF fixation with a locking blade nail (LBN) or locking plate (PHILOS) osteosynthesis in a homogeneous elderly patient population. Methods Inclusion criteria were an age > 60 years and the capacity to give informed consent. Patients with isolated tuberosity fractures, previous trauma or surgery, advanced osteoarthritis, fracture dislocation, pathological fractures, open fractures, neurological disorders, full-thickness rotator cuff tears, fracture line at the nail entry point or severely reduced bone quality intra-operatively were excluded. Eighty one patients with PHFs were randomised to treatment using LBN or PHILOS. Outcome measures comprised Constant score, age and gender adjusted Constant score, DASH score, VAS for pain, subjective overall condition of the shoulder (1–6) and active shoulder range-of-motion in flexion and abduction. Plain radiographs were obtained in two planes. All data were collected by an independent observer at 3, 6 and 12 months postoperatively. Results Thirteen patients were excluded intra-operatively due to rotator cuff tears, fracture morphology or poor bone-quality. Of the remaining 68 patients, 27 in the LBN and 28 in the PHILOS group completed the full follow-up. Mean age at surgery was 75.6 years and the majority of PHFs were three-part fractures (49 patients). Baseline demographics between groups were comparable. All outcome measures improved between assessments (p < 0.001). The LBN group showed improved DASH scores as compared to PHILOS at 12 months (p = 0.042) with fewer incidences of secondary loss of reduction and screw cut-out (p = 0.039). A total of 29 complications (in 23 patients) were recorded, 13 complications (in 12 patients) in the LBN group and 16 complications (in 11 patients) in the PHILOS group (p = 0.941). No significant inter-group difference was observed for any other outcome measures, nor was fracture morphology seen to be associated with clinical outcome or complication rate. Conclusions At short-term follow-up, LBN osteosynthesis yielded similar outcomes and complication rates to PHILOS plate fracture fixation in an elderly patient population, though with a significantly lower rate of secondary loss of reduction and screw cut-out. Registration trial No. DRKS00015245 at Deutsches Register Klinischer Studien, registered: 22.08.2018, retrospectively registered.
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Affiliation(s)
- Johannes E Plath
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Christian Kerschbaum
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Tobias Seebauer
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Rainer Holz
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | | | - Stefan Förch
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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Li M, Wang Y, Zhang Y, Yang M, Zhang P, Jiang B. Intramedullary nail versus locking plate for treatment of proximal humeral fractures: A meta-analysis based on 1384 individuals. J Int Med Res 2018; 46:4363-4376. [PMID: 30270807 PMCID: PMC6259395 DOI: 10.1177/0300060518781666] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The optimal surgical intervention on the treatment for proximal humeral
fractures (PHFs) remains uncertain. The aim of this study was to evaluate
clinical outcomes following fixation of PHFs by intramedullary nails or
locking plates Methods The Cochrane Library, PubMed, EMBASE, China Knowledge Resource Integrated
(CNKI), Chongqing VIP and Wanfang databases were systematically searched for
studies published between January 01, 1996 and December 31, 2016 that
investigated intramedullary nail vs. locking plate in the
surgical treatment of PHFs. A meta-analysis examined incision length, blood
loss, operation time, fracture healing time, Constant scores and
post-operative complications. The methodological and evidence quality were
also assessed by MINORS and GRADE system. Results From the original 1024 references, 20 studies involving 1384 patients met the
eligibility criteria. Analyses showed that intramedullary nails were
superior to locking plates in incision length, peri-operative bleeding time,
operation time and fracture healing time. However, there were no differences
between treatments in Constant score or post-operative complications. Conclusion Although the evidence quality was poor, the results suggest that compared
with locking plates, intramedullary nails may be a better choice for the
repair of PHFs.
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Affiliation(s)
- Ming Li
- 1 Department of Trauma Rescue and Treatment Centre, Peking University People's Hospital, Beijing, China.,2 Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Yanhua Wang
- 2 Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Yupeng Zhang
- 3 Department of Orthopaedics and Spinal Surgery, Binzhou Centre hospital, Binzhou, China
| | - Ming Yang
- 2 Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Peixun Zhang
- 2 Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Baoguo Jiang
- 1 Department of Trauma Rescue and Treatment Centre, Peking University People's Hospital, Beijing, China.,2 Department of Orthopaedics and Trauma, Peking University People's Hospital, Beijing, China
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Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review. Biomed Eng Online 2018; 17:47. [PMID: 29703261 PMCID: PMC5923007 DOI: 10.1186/s12938-018-0479-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 04/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates' mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible. METHODS AND RESULTS Web of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load-displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement. CONCLUSIONS Overall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs' mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.
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Sun Q, Ge W, Li G, Wu J, Lu G, Cai M, Li S. Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 42:641-650. [PMID: 29119298 DOI: 10.1007/s00264-017-3683-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/27/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare the clinical outcome and complications of locking plates versus intramedullary nails in patients with displaced proximal humeral fractures. Our hypothesis was that there would be no difference between these two implants with regard to clinical outcome and complications. METHODS We performed a systemic review of PubMed, EMBASE, Clinical Trials Registry, Cochrane Central Register of Controlled Trials and Google Scholar to identify all relevant randomized controlled trials, prospective and retrospective comparative studies on April 26, 2017. The studies of locking plates compared to intramedullary nails in patients with displaced proximal humeral fractures were included. We conducted a meta-analysis of shoulder functional scores, range of motion, pain scores, and complications. RESULTS This meta-analysis included 13 comparative studies with 958 patients (529 in the locking plate group and 429 in the intramedullary nail group). A significantly greater external rotation (MD = 9.67; 95% CI, 4.22-15.12; P = 0.0005) and a significantly higher penetration rate (RR = 1.75; 95% CI, 1.11-2.77; P = 0.02) were observed in the locking plate group compared with the intramedullary nail group. Constant-Murley scores, DASH scores and total complication rate were comparable between the two groups. Moreover, there were no significant differences in forward elevation, VAS scores, and other complications. CONCLUSIONS Current evidence indicates that locking plates and intramedullary nails have similar performance in terms of the functional scores and total complication rate. No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures.
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Affiliation(s)
- Qi Sun
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Wei Ge
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Gen Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Jiezhou Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Guanghua Lu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Ming Cai
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Shaohua Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China.
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Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis and Open Reduction Internal Fixation on Proximal Humeral Fracture in Elder Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3431609. [PMID: 28698871 PMCID: PMC5494086 DOI: 10.1155/2017/3431609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022]
Abstract
Objective The study aims to compare minimally invasive percutaneous plate osteosynthesis (MIPO) and open reduction internal fixation (ORIF) in the treatment of proximal humeral fracture in elder patients. Method PubMed, Medline, EMbase, Ovid, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wangfang, and VIP Database for Chinese Technical Periodicals were searched to identify all relevant studies from inception to October 2016. Data were analyzed with Cochrane Collaboration's Review Manage 5.2. Results A total of 630 patients from 8 publications were included in the systematic review and meta-analysis. The pooled results showed that MIPO was superior to ORIF in the treatment of proximal humeral fracture in elder patients. It was reflected in reducing blood loss, operation time, postoperative pain, or fracture healing time of the surgery and in improving recovery of muscle strength. Concerning complications, no significant difference was seen between MIPO and ORIF. Conclusion The MIPO was more suitable than ORIF for treating proximal humeral fracture in elder patients.
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Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review. PLoS One 2016; 11:e0166801. [PMID: 27861604 PMCID: PMC5115806 DOI: 10.1371/journal.pone.0166801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/03/2016] [Indexed: 02/05/2023] Open
Abstract
Purpose Network meta-analysis (NMA) is a comparatively new evidence-based technique in medical disciplines which compares the relative benefits associated with multiple interventions and obtains hierarchies of these interventions for various treatment options. We evaluated the effectiveness and safety of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), intramedullary nailing (IN) and non-operative treatment (NOT) of displaced proximal humeral fractures in adults using Bayesian NMA of data from clinical trials. Method PUBMED, EMBASE and CENTRAL in July 2016 were searched and clinical trials that evaluated interventions for treating adults with displaced proximal humeral fractures were identified. Methodological qualities of studies were assessed by the Newcastle—Ottawa Scale and risk of bias using the Cochrane Collaboration tool. Result Thirty-four trials involving 2165 participants were included in the study. RSA had significantly the highest Constant score and lower total incidence of complications than ORIF, HA and IN. Moreover, RSA resulted in a lower incidence of additional surgery than ORIF and IN. The rank of treatments in terms high Constant score was: RSA, ORIF, IN, NOT and HA. The rank for reduction in total incidence of complications was: RSA, NOT, HA, IN and ORIF. For lowering the risk of additional surgery, the rank was: RSA, NOT, HA, IN and ORIF. Conclusion RSA had the highest probability for improving functional outcome and reduction in the total incidence of complications and requiring additional surgery among the five interventions for treating adults with displaced proximal humeral fracture.
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Tamimi I, Montesa G, Collado F, González D, Carnero P, Rojas F, Nagib M, Pérez V, Álvarez M, Tamimi F. Displaced proximal humeral fractures: when is surgery necessary? Injury 2015; 46:1921-9. [PMID: 26120018 DOI: 10.1016/j.injury.2015.05.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/12/2015] [Accepted: 05/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several therapeutic methods have been traditionally used in the treatment of displaced proximal humeral fractures; however, the indication of these treatments is still controversial. The purpose of this study was to compare the medium-term functional results of four methods commonly used in the treatment of proximal humeral fractures [conservative treatment, proximal humeral nails (PHN), percutaneous K-wiring (PKW), and locking-plates (LP)] taking into consideration the type of fracture and the age of the patients. METHODS We conducted a retrospective cohort study on patients with proximal humeral fractures treated with one of the following methods: conservative treatment, PHN, PKW, or LP. Functional results were assessed using the absolute Constant score and the disabilities of the arm shoulder and hand score (DASH). The functional outcome was analysed according to age (≥65 years and <65 years) and fracture type (displaced 2-fragment and 3-4-fragment fractures). RESULTS A total of 113 patients were included in the study, with a mean age of 65.3 SD 15.2 years and average follow-up time of 26.2 SD 12.6 months. Patients under 65 years had higher Constant scores when treated with PHN and PKW than those treated conservatively (77.2 vs. 54.7, p=0.01 and 74.0 vs. 54.7, p=0.03, respectively). Patients above 65 years had higher Constant scores when treated with PKW compared to PHN and conservative treatment (68.7 vs. 51.9, p=0.02 and 68.7 vs. 55.9, p=0.029, respectively). In 2-fragment fractures, PKW resulted in higher Constant scores than conservative treatment (70.4 vs. 53.9, p=0.048). No differences were found in the final outcome between patients treated with LP and those treated conservatively regardless of age, and fracture type. There were also no differences between any of the evaluated methods in the treatment of 3-4-fragment fractures. CONCLUSION The use of PKW was associated with better functional results than conservative treatment in individuals of all ages, especially in patients with 2-fragment fractures; PKW also achieved better functional results than PHN in elderly patients. PHN was superior to conservative treatment in young individuals. No significant differences were found between LP and conservative treatment in any of the analysed categories.
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Affiliation(s)
| | - Guillermo Montesa
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Francisco Collado
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - David González
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Pablo Carnero
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Facundo Rojas
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Mohamed Nagib
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Verónica Pérez
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Miguel Álvarez
- Traumatology and Orthopedic Surgery Department HRU Carlos Haya, Malaga, Spain
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Canada
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Wang G, Mao Z, Zhang L, Zhang L, Zhao Y, Yin P, Gao L, Tang P, Kang H. Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. J Orthop Surg Res 2015; 10:122. [PMID: 26370230 PMCID: PMC4570456 DOI: 10.1186/s13018-015-0242-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/24/2015] [Indexed: 01/12/2023] Open
Abstract
Purpose This meta-analysis compared the clinical outcomes of locking plate with intramedullary nail in the treatment of displaced proximal humeral fractures. Methods We searched PubMed, Embase, and the Cochrane databases for studies comparing locking plate and intramedullary nail treatment of displaced two-, three-, or four-part proximal humeral fractures. The quality of the studies was assessed, and meta-analysis was performed using the Cochrane Collaboration’s REVMAN 5.1 software. Results A total of 615 patients from eight studies were included in this meta-analysis (348 fractures treated with locking plate and 267 with intramedullary nail). Similar Constant scores were observed between the locking plate and intramedullary nail both in randomized controlled trials (RCTs) (mean difference (MD) = 2.12, 95 % confidence interval (CI), −2.54 to 6.79, P = 0.37) and observational studies (MD = −1.93, 95 % CI, −4.95 to 1.09, P = 0.21). Only one RCT provided American Shoulder and Elbow Surgeons Standardized scores indicating that the locking plate was better than the intramedullary nail (MD = 7.20, 95 % CI, 1.29–13.11, P = 0.02). The total complication rate did not specifically favor the locking plate or intramedullary nail both in the RCTs (risk ratio (RR), 2.44; 95 % CI, 0.35–16.78; P = 0.37) and observational studies (RR, 1.01; 95 % CI, 0.72–1.43; P = 0.94). Conclusions In the existing literature, limited evidence suggests that the locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures. Because of the observed heterogeneity and variance between the subgroups, more RCT are needed to be able to definitively recommend a locking plate or intramedullary nail for specific fracture patterns.
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Affiliation(s)
- Guoqi Wang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.,Department of Critical Care Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Zhi Mao
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yanpeng Zhao
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Peng Yin
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.,Medical College, Nankai University, No. 94 Weijin Road, Tianjin, 300071, People's Republic of China
| | - Ling Gao
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Hongjun Kang
- Department of Critical Care Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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Lin T, Xiao B, Ma X, Fu D, Yang S. Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures. BMC Musculoskelet Disord 2014; 15:206. [PMID: 24934152 PMCID: PMC4065576 DOI: 10.1186/1471-2474-15-206] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 06/12/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or open reduction and internal fixation (ORIF) in patients with proximal humerus fractures. METHODS A matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score. RESULTS The MIPO technique required less surgery time and caused less blood loss compared to ORIF (p < 0.01). In addition, MIPO required a smaller incision, resulted in less scarring, and was cosmetically more appealing and acceptable to female patients than ORIF. Following MIPO, patients had better functional results at 3 and 6 months, with better outcomes, less pain, higher satisfaction in activities of daily living, and a higher range of motion when compared to ORIF (p < 0.05). Fracture configuration, according to the AO/ASIF(Association for the Study of Internal Fixation) fracture classification, did not significantly influence the functional results. The complication rate was comparable between both groups. CONCLUSION The use of MIPO with a locking compression plate in the management of proximal humerus fractures is a safe and superior option compared to ORIF.
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Affiliation(s)
- Tao Lin
- Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Baojun Xiao
- Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiucai Ma
- Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Dehao Fu
- Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shuhua Yang
- Department of Orthopedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Yoon RS, Dziadosz D, Porter DA, Frank MA, Smith WR, Liporace FA. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury 2014; 45:510-4. [PMID: 24168862 DOI: 10.1016/j.injury.2013.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/29/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent advancements in implant technology offer updated options for surgical management that have been rapidly adopted into clinical practice. The objective of this study is to biomechanically test and compare the current fixation options available for surgical fixation of two-part proximal humerus fractures and establish load to failure and stiffness values. METHODS Sixteen match-paired (32 total) fresh-frozen, cadaveric specimens were randomized to receive 1 of 4 fixation constructs following creation of an AO/OTA Type 11A3 (two-part) proximal humerus fractures. Fixation constructs tested consisted of 3.5 mm fixed angle plate (3.5-FAP), 4.5 mm fixed angle plate (4.5-FAP), humeral intramedullary nail (IMN), and a humeral intramedullary nail with a fixed angle blade (IMN-FAB). Specimen bone density was measured to ensure no adequate, non-osteoporotic bone. Constructs were tested for stiffness and ultimate load to failure and compared via one-way ANOVA analysis with subsequent post hoc Tukey HSD multiple group comparison statistical analysis. RESULTS The IMN-FAB construct was significantly stiffer than the 3.5-FAP construct (123.8 vs. 23.9, p<0.0001), the 4.5-FAP construct (123.8 vs. 33.3, p<0.0001) and the IMN construct (123.8 vs. 60.1, p=0.005). The IMN-FAB construct reported a significantly higher load to failure than the 3.5-FAB construct (4667.3 N vs. 1756.9 N, p<0.0001), and the 4.5-FAP construct (4667.3 N vs. 2829.4 N, p=0.019, Table 2). The IMN construct had a significantly higher load to failure than the 3.5-FAP construct (3946.8 vs. 1756.9, p=0.001, Table 2). CONCLUSION Biomechanical testing of modern fixation options for two-part proximal humerus fracture exhibited that the stiffest and highest load to failure construct was the IMN-FAB followed by the IMN, 3.5-FAP and then the 4.5-FAP constructs. However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures.
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Affiliation(s)
- Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA
| | - Daniel Dziadosz
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, INOVA Fairfax Hospital, Faiefax, VA 22003, USA
| | - David A Porter
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, INOVA Fairfax Hospital, Faiefax, VA 22003, USA
| | - Matthew A Frank
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, INOVA Fairfax Hospital, Faiefax, VA 22003, USA
| | - Wade R Smith
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Swedish Medical Center, Denver, CO 80204, USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10003, USA.
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Lu Y, Jiang C, Zhu Y, Wang M, Bowles RJ, Mauffrey C. Delayed ORIF of proximal humerus fractures at a minimum of 3 weeks from injury: a functional outcome study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:715-21. [DOI: 10.1007/s00590-013-1255-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/29/2013] [Indexed: 11/29/2022]
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Elidrissi M, Bensaad S, Shimi M, Elibrahimi A, Elmrini A. Le traitement chirurgical des fractures de l’extrémité supérieure de l’humérus : plaque anatomique versus embrochage en palmier, à propos de 26 cas. ACTA ACUST UNITED AC 2013; 32:25-9. [DOI: 10.1016/j.main.2012.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 07/30/2012] [Accepted: 12/16/2012] [Indexed: 11/26/2022]
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Management of displaced surgical neck fractures of the humerus: health related quality of life, functional and radiographic results. Injury 2012; 43 Suppl 2:S12-9. [PMID: 23622986 DOI: 10.1016/s0020-1383(13)70174-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no controversy about the need for surgical treatment of the displaced surgical neck fractures of the humerus, but there are few studies comparing the results of the three preferred types of surgical treatment. To expand the knowledge needed in decision making, a patient series is reviewed using health related quality of life (HRQoL), functional and radiographic data from patients treated with percutaneous pinning, locking plates or intramedullary nails. MATERIALS AND METHODS Retrospective observational cohort study of patients who underwent internal fixation of fractures of the surgical neck of the humerus between 2004 and 2009 (mean follow-up 40.67 ± 17.93 months). Fifty patients fulfilled the inclusion criteria (mean age 70.04 ± 13.15 years). Nine had been treated by percutaneous pinning, fifteen with locking plates and twenty-six with intramedullary nails. We compared the results between the three groups of the HRQoL with the EuroQol5D questionnaire; the functional capacity of the operated and non-operated shoulder with the Constant score; and the radiographic result with plain X-rays. RESULTS Forty-eight patients had achieved fracture healing. The plating and nailing groups had a better fracture reduction compared with the pinning group (p <0.05). The EuroQol-5D did not discriminate between groups (mean 0.65 ± 0.26; p >0.05). The mean Constant score of the K-wire group (47.67 ± 22.42) was lower than those of the plating (82.45 ± 17.69) and nailing groups (72.72 ± 15.96) (p = 0.001), with no differences between plates and nails. There was positive correlation between the EuroQol-5D result and the Constant score (r = 0.490; p <0.005). The fractured shoulder was worse in each item of the Constant score than the non-operated one in patients treated with pins and nails. Patients treated with plates achieved similar results between operated and non-operated shoulder in three items: arm positioning, internal and external rotation. Seventeen patients (six re-operated) had some kind of complication during follow-up. CONCLUSION Patients treated with pinning achieved a worse radiographic and Constant score than patients treated with plates or nails. Although we did not find differences between the plating and nailing groups, patients treated with plates got a Constant score more similar to the non-operated shoulder.
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Retrograde nailing versus locking plate osteosynthesis of proximal humeral fractures: a biomechanical study. J Shoulder Elbow Surg 2012; 21:618-24. [PMID: 21803607 DOI: 10.1016/j.jse.2011.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 03/21/2011] [Accepted: 04/07/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND In locking plate osteosynthesis of proximal humeral fractures, secondary varus malalignment is a specific complication. Retron nails (Tantum AG, Neumunster, Germany), among others, have been designed to improve medial support of the calcar humeri. The aim of our biomechanical study was to examine whether Retron nails provide increased stiffness for axial loads and adequate stiffness for torsional loads when compared with Philos plates (Synthes AG, Umkirch, Germany). MATERIALS AND METHODS Twenty-two fresh-frozen paired humeri were collected. After potting the specimens, intact bones were exposed to sinusoidal axial (10-120 N) and torsional (±2.5 Nm) loading for 8 cycles to calculate the initial stiffness and exclude pairs with differences. Afterward, an unstable proximal humeral fracture (AO 11-A3) was created by means of an oscillating saw, and the respective osteosynthesis devices were implanted. After another 4 cycles, initial changes in stiffness were measured. Subsequently, all specimens were tested for 1,000 cycles of loading before final stiffness was assessed. RESULTS We found no statistically significant differences between Retron and Philos specimens after 4 or 1,000 cycles of loading. CONCLUSION Our study suggests that retrograde nailing provides sufficient stability for axial and torsional loading in 2-part fractures of proximal humeri.
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Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures. Clin Orthop Relat Res 2012; 470:602-9. [PMID: 21879402 PMCID: PMC3254759 DOI: 10.1007/s11999-011-2056-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 08/16/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures. QUESTIONS/PURPOSES The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures. PATIENTS AND METHODS Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts. RESULTS Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure. CONCLUSIONS The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant. LEVEL OF EVIDENCE Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
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