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Lim JH, Ahn YS, Kim S, Kim MS. Novel Use of a Fibular Strut Allograft with Fibular Head in an Elderly Patient with Proximal Humeral Fracture and Severe Metaphyseal Comminution: An Alternative to Shoulder Arthroplasty. J Clin Med 2024; 13:2200. [PMID: 38673473 PMCID: PMC11050512 DOI: 10.3390/jcm13082200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Treatment of a comminuted proximal humerus fracture (PHF) in elderly patients with severe osteoporosis is challenging, often leading to arthroplasty (such as hemiarthroplasty or reverse shoulder arthroplasty) as the treatment of choice. However, arthroplasty does not always guarantee favorable outcomes. In contrast, the use of intramedullary fibular strut allografts provides additional reduction stability during locking plate fixation; however, to our knowledge, there is limited literature on the use of fibular strut allografts, including the fibular head. Here we aim to report the advantages of using a fibular strut containing the fibular head in severe osteoporotic PHFs. We present the case of an 88-year-old female patient with severe osteoporosis diagnosed with a left PHF accompanied by severe metaphyseal comminution following a fall from a chair. Rather than shoulder arthroplasty, we performed osteosynthesis using a fibular strut allograft containing the fibular head. At the one-year follow-up after surgery, we observed excellent bony union and a favorable functional outcome without major complications, such as reduction loss. The novel use of a fibular strut allograft containing the fibular head could be promising for PHFs with severe metaphyseal comminution, potentially avoiding the need for arthroplasty.
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Affiliation(s)
- Jun-Hyuk Lim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
| | - Yeong-Seub Ahn
- Department of Orthopedic Surgery, Good Morning General Hospital, Pyeongtaek 17874, Republic of Korea;
| | - Sungmin Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
| | - Myung-Sun Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
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Porcellini G, Montanari M, Giorgini A, Micheloni GM, Bonfatti R, Tarallo L. Great tuberosity fixation does not affect healing and clinical outcomes in RSA performed in proximal humeral fractures in elderly patients. Musculoskelet Surg 2024; 108:107-114. [PMID: 38175393 DOI: 10.1007/s12306-023-00807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Aims of our study were to define whether the great tuberosity (GT) positioning fixation in reverse shoulder arthroplasty (RSA) after proximal humeral fracture (PHF) could predict tuberosity healing and its impact on clinical outcomes. METHODS We enrolled 59 patients treated with cementless reverse shoulder arthroplasty after PHF in our institute between 2012 and 2018. The mean follow-up was 57 months (± 23.4). We divided patients into two groups according to GT positioning after fixation: Group 1 GT in contact and Group 2 GT detached at least 1 mm from humeral diaphysis. Clinical and radiographic evaluations were conducted at last follow-up. RESULTS Overall GT healing rate was 64.4%, (Group 1 70.7%-Group 2 50%). A statistically significant difference (P = 0.047) was found in cortical thickness narrowing at one-third of stem length. We found a correlation between lateral cortical narrowing and GT fixation in non-anatomical position, but we observed no statistically significant differences about GT healing according to GT anatomical or non-anatomical fixation. No differences were found in shoulder function in patients whose tuberosity was healed or failed to heal. CONCLUSION GT reduction is not a predictive factor for GT healing; external stress shielding, instead, seems to be decreased in patients with postoperative anatomically reduced GT. In our study, GT healing did not affect clinical outcomes or patient's satisfaction in elderly low-demanding patients.
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Affiliation(s)
- Giuseppe Porcellini
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Marta Montanari
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy.
| | - Andrea Giorgini
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Gian Mario Micheloni
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Rocco Bonfatti
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
| | - Luigi Tarallo
- Orthopaedics and Traumatology Department, University of Modena and Reggio Emilia - Policlinico di Modena, Modena, Italy
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Huang Z, Dong H, Ye C, Zou Z, Wan W. A network meta-analysis of multiple modalities for the treatment of complex proximal humeral fractures in older adults. Injury 2023; 54:110958. [PMID: 37573842 DOI: 10.1016/j.injury.2023.110958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Four principal treatment modalities are applied to treat complex proximal humeral fractures in older adults: conservative treatment, open reduction internal fixation, hemiarthroplasty, and reverse shoulder arthroplasty. However, among these, the optimal treatment modality has yet to be determined. Therefore, a network meta-analysis was carried out to compare treatment modalities and assess their effectiveness. METHODS The databases PUBMED, EM-BASE, the Cochrane Central Register of Controlled Trials, Web of Science, and CNKI were searched for randomised controlled trials on complex proximal humeral fractures in older people, ranging from inception of each database to May 2023. RESULTS This meta-analysis included 14 randomised controlled trials, containing 791 patients aged over 60 years who were treated for complex proximal humeral fractures. Reverse shoulder arthroplasty and hemiarthroplasty yielded the highest Constant shoulder scores, whilst conservative treatment performed poorly. Hemiarthroplasty and open reduction internal fixation yielded the best performances on the visual analogue pain scale, whilst conservative treatment performed poorly. Reverse shoulder arthroplasty and open reduction internal fixation allowed for maximum forward flexion and outreach of range of motion, whilst hemiarthroplasty allowed for the least. Open reduction internal fixation and reverse shoulder arthroplasty allowed for maximum internal rotation of the range of motion, whilst conservative treatment allowed for the least. Hemiarthroplasty and conservative treatment allowed for maximum external rotation of the range of motion, whilst open reduction internal fixation allowed for the least. CONCLUSION Compared with open reduction internal fixation, reverse shoulder arthroplasty yields better Constant shoulder scores and allows for greater forward flexion and outreach of range of motion of the shoulder joint in complex proximal humerus fractures in older patients. Meanwhile, hemiarthroplasty yields the best visual analogue scale scores and allows for maximum external rotation of the range of motion. However, open reduction with internal fixation remains the preferred clinical treatment for complex proximal humeral fractures in older patients.
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Affiliation(s)
- Zuqi Huang
- Hezhou People's Hospital of Guangxi Zhuang Autonomous Region, China
| | - Huazhang Dong
- Hezhou People's Hospital of Guangxi Zhuang Autonomous Region, China
| | - Changping Ye
- Hezhou People's Hospital of Guangxi Zhuang Autonomous Region, China
| | - Zhuan Zou
- Hezhou People's Hospital of Guangxi Zhuang Autonomous Region, China
| | - Weiliang Wan
- Hezhou People's Hospital of Guangxi Zhuang Autonomous Region, China.
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Rasmussen JV, Amundsen A, Petersen JK, Issa Z, Olsen BS. Stemmed hemiarthroplasty with a suture collar and a common platform system for acute proximal humeral fractures. JSES Int 2023; 7:607-613. [PMID: 37426938 PMCID: PMC10328766 DOI: 10.1016/j.jseint.2023.03.003] [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] [Indexed: 07/11/2023] Open
Abstract
Background Hemiarthroplasty for acute proximal humeral fractures gives disappointing results, often due to rotator cuff insufficiency. Better tuberosity fixation might improve results. Therefore, the aim of this study was to: 1) report the outcome of a stemmed hemiarthroplasty with a common platform system and a modular suture collar; 2) compare the outcome with that of a standard stemmed hemiarthroplasty; 3) report the feasibility of revision arthroplasty with retention of the stem; and 4) to evaluate the association between tuberosity healing and functional outcome. Methods Forty-four fractures that were deemed not suitable for nonsurgical treatment or open reduction and internal fixation were treated with the Global Unite fracture system between January 2017 and July 2019. The functional and radiographic results at 2 years were compared with the results of 44 Global Fx arthroplasties. The results of patients who had adequate healing of the greater tuberosity were compared with the results of patients who had severe malunion or nonunion (resorption). Results Mean Oxford Shoulder Score, Constant-Murley Score, and Western Ontario Osteoarthritis of the Shoulder index was 33 (range: 10 to 48), 40 (range: 10 to 98), and 68 (range: 18 to 98) at 2 years. There were no differences in functional outcome scores or in the risk of inadequate healing of the greater tuberosity between the Global Unite and the Global Fx systems. Five (11%) patients underwent revision surgery with retention of the stem. Inadequate tuberosity healing was associated with an inferior Constant-Murley Score (mean difference: 6; 95% confidence interval: 1 to 10, P = .01) and an inferior Oxford Shoulder Score (mean difference: 9; 95% confidence interval: 1 to 16, P = .03). Conclusion The use of stemmed hemiarthroplasty with a suture collar did not improve the healing of the greater tuberosity or the functional outcome. Five arthroplasties were revised with retention of the stem. This possibility could be arguments for using the Global Unite system when a stemmed hemiarthroplasty is used for acute proximal humeral fractures.
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Affiliation(s)
- Jeppe V. Rasmussen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Amundsen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - John K. Petersen
- Department of Orthopedic Surgery, Zealand University Hospital, Koge, Denmark
| | - Zaid Issa
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Zealand University Hospital, Koge, Denmark
| | - Bo S. Olsen
- Department of Orthopedic Surgery, Herlev-Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Troiano E, Peri G, Calò I, Colasanti GB, Mondanelli N, Giannotti S. A novel "7 sutures and 8 knots" surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results. J Orthop Traumatol 2023; 24:18. [PMID: 37155113 PMCID: PMC10167075 DOI: 10.1186/s10195-023-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Complex proximal humeral fractures (cPHFs) represent an important public health concern, and reverse shoulder arthroplasty (RSA) has emerged as a feasible treatment option in the elderly with high functional demands. Recent studies have shown that tuberosity healing leads to better clinical outcomes and an improved range of motion. However, the best surgical technique for the management of the tuberosities is still a topic of debate. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients who underwent RSA for cPHFs using a novel "7 sutures and 8 knots" technique. MATERIALS AND METHODS A consecutive series of 32 patients (33 shoulders) were treated with this technique by a single surgeon from January 2017 to September 2021. Results at a minimum follow-up of 12 months and a mean ± SD follow-up of 35.9 ± 16.2 (range 12-64) months are reported. RESULTS The tuberosity union rate was 87.9% (29 out of 33 shoulders), the mean Constant score was 66.7 ± 20.5 (range 29-100) points, and the mean DASH score was 33.4 ± 22.6 (range 2-85) points. CONCLUSIONS The "7 sutures and 8 knots" technique, which relies on three sutures around the implant and five bridging sutures between the tuberosities, is a relatively simple procedure which provides a reliable means for anatomic restoration of the tuberosities and allows functional recovery of the shoulder in elderly patients with cPHFs treated with RSA. LEVEL OF EVIDENCE IV; retrospective atudy. TRIAL REGISTRATION At our institution, no institutional review board nor ethical committee approval is necessary for retrospective studies.
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Affiliation(s)
- Elisa Troiano
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Giacomo Peri
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Irene Calò
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy.
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy.
| | - Stefano Giannotti
- Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Policlinico Santa Maria Alle Scotte, Viale Mario Bracci 16, 53100, Siena, Italy
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Bagga R, Cay P, Ricketts D, Roper T, Phadnis J. Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study. Shoulder Elbow 2021; 13:642-648. [PMID: 34804213 PMCID: PMC8600671 DOI: 10.1177/1758573220950235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to assess the accuracy of quotations of the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study in the published literature. METHODS A literature search was performed from March 2015 to November 2019 to identify all papers that reference ProFHER since its publication. Full text articles were reviewed by two independent reviewers using a validated framework of assessing quotation errors. A kappa co-efficient was calculated to assess interobserver reliability of the reviewers. RESULTS There were 260 individual ProFHER quoted references within the 138 included articles. We identified 35/260 quotation errors (13%). Of these, 10/35 (29%) were major quotation errors and 25/35 (71%) minor quotation errors. There was substantial interobserver agreement when errors were classified. Of the 10 major errors, six quotations were not substantiated by the results of ProFHER and three were unrelated to ProFHER. One paper contained a quotation error that contradicted the results of ProFHER. Of the 25 minor errors, 19 oversimplified or generalised the conclusions of ProFHER and six contained numerical or grammatical errors. CONCLUSION The current study demonstrated substantial inaccuracies in quotations of the Proximal Fracture of the Humerus Evaluation by Randomization study. Vigilance is recommended when quoting the literature and reviewing submitted papers in order to prevent the perpetuation of misquoted data.
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Affiliation(s)
- Rahul Bagga
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK,Rahul Bagga, Royal Sussex County Hospital,
Eastern Rd, Brighton BN2 5BE, UK.
| | - Peter Cay
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK
| | - David Ricketts
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK
| | - Tom Roper
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK
| | - Joideep Phadnis
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK,Brighton and Sussex Medical School,
Brighton, UK
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Amundsen A, Brorson S, Olsen BS, Rasmussen JV. Ten-year follow-up of stemmed hemiarthroplasty for acute proximal humeral fractures. Bone Joint J 2021; 103-B:1063-1069. [PMID: 34058878 DOI: 10.1302/0301-620x.103b6.bjj-2020-1753.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome. METHODS We obtained data on 1,371 hemiarthroplasties for acute proximal humeral fractures from the Danish Shoulder Arthroplasty Registry between 2006 and 2010. Of these, 549 patients (40%) were alive and available for follow-up. The Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire was sent to all patients at nine to 14 years after primary surgery. Revision rates were calculated using the Kaplan-Meier method. Risk factors for an inferior WOOS score were analyzed using the linear regression model. RESULTS Mean age at surgery was 67 years (24 to 90) and 445 (81%) patients were female. A complete questionnaire was returned by 364 (66%) patients at a mean follow-up of 10.6 years (8.8 to 13.8). Mean WOOS score was 64 (4.3 to 100.0). There was no correlation between WOOS scores and age, sex, arthroplasty brand, or year of surgery. The 14-year cumulative revision rate was 5.7% (confidence interval 4.1 to 7.2). Patients aged younger than 55 years and patients aged between 55 to 74 years had 5.6-times (2.0 to 9.3) and 4.3-times (1.9 to 16.7) higher risk of revision than patients aged older than 75 years, respectively. CONCLUSION This is the largest long-term follow-up study of acute proximal humeral fractures treated with hemiarthroplasty. We found a low revision rate and an acceptable ten-year patient-reported outcome. The patient-reported outcome should be interpreted with caution as we have no information about the patients who died or did not return a complete WOOS score. The long-term outcome and revision rate suggest that hemiarthroplasty offers a valid alternative when non-surgical treatment is not possible. Cite this article: Bone Joint J 2021;103-B(6):1063-1069.
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Affiliation(s)
- Alexander Amundsen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Bo S Olsen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Gentofte University Hospital, Hellerup, Denmark
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