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Ishii H, Shintaku T, Yoshizawa S, Sakamoto M, Kaneko T, Musha Y, Ikegami H. In vitro evaluation of the tension band suture method for proximal humerus fracture treatment. J Orthop Surg Res 2020; 15:345. [PMID: 32819382 PMCID: PMC7441671 DOI: 10.1186/s13018-020-01890-5] [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: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Proximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view. Methods The mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test. Results The most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly. Conclusions From a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.
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Affiliation(s)
- Hideaki Ishii
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.,Department of Orthopaedic Surgery (Ohashi), Toho University Graduate School of Medicine, 5-21-16 Omorinishi, Otaku, Tokyo, 143-8540, Japan
| | - Takanori Shintaku
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Shu Yoshizawa
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Misato Sakamoto
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Takao Kaneko
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Yoshiro Musha
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Hiroyasu Ikegami
- Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
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Noh YM, Kim DR, Kim CH, Lee SY. Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoidsplitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures. Clin Shoulder Elb 2018; 21:220-226. [PMID: 33330180 PMCID: PMC7726400 DOI: 10.5397/cise.2018.21.4.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022] Open
Abstract
Background This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures. Methods From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >5° loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated. Results In all cases, complete union was achieved. The ASES and VAS scores were improved to 85.4 ± 2.1 and 3.2 ± 1.3, respectively. Twelve patients (75.0%) had greater than a 5° change in NSA; the average NSA change was 3.8°. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a <100° active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit. Conclusions Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.
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Affiliation(s)
- Young-Min Noh
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
| | - Dong Ryul Kim
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
| | - Chul-Hong Kim
- Department of Shoulder Clinic, Mirae Hospital, Busan, Korea
| | - Seung Yup Lee
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
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Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation. Arch Phys Med Rehabil 2017; 98:1863-1892.e14. [DOI: 10.1016/j.apmr.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/04/2023]
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Cho CH, Kim DH, Kim BS. Radiographic and clinical results of tension suture fixation using two washers with PHILOS plate for proximal humeral fractures. Injury 2017; 48:464-468. [PMID: 27914660 DOI: 10.1016/j.injury.2016.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the radiographic and clinical results of tension suture fixation using two washers with PHILOS plate (Synthes, West Chester, PA, USA) for proximal humeral fractures. PATIENTS AND METHODS Consecutive 39 patients were included and divided into two groups of adequate and inadequate medial support (MS (+) group vs MS (-) group). The mean follow-up period was 45months (range: 26-69 months). The mean age at the time of surgery was 59 years (range: 17-86 years) and there were 12 men and 27 women. The clinical results were evaluated using the visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). The radiographic results were evaluated by serial radiographs and Paavolainen method, which measures the neck-shaft angle (NSA). We used the Paired T and Kruskal-Wallis test to compare radiographic and clinical results between the two groups. RESULTS Bony union was achieved in 37 cases (94.9%). The mean NSA was changed from 133.5° postoperatively to 131.0° at the final follow-up period, but this change was not statistically significant. Thirty-five cases (89.8%) had good radiographic results as determined by the Paavolainen method. The mean final VAS pain score, ASES score, and SSV were 1.3, 87.3, and 86.0%, respectively. There were no significant differences between the two groups with respect to radiographic and clinical outcomes. Eight cases (20.5%) had complications including 5 with shoulder stiffness, 1 experiencing nonunion by fixation failure, 1 malunion, and 1 migration of greater tuberosity. CONCLUSION Tension suture fixation using two washers with PHILOS plate for proximal humeral fractures yielded satisfactory radiographic and clinical results. It can be a treatment option that can reduce varus deformity and fixation loss.
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Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea.
| | - Du Han Kim
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Beom-Soo Kim
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
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Boudard G, Pomares G, Milin L, Lemonnier I, Coudane H, Mainard D, Delagoutte JP. Locking plate fixation versus antegrade nailing of 3- and 4-part proximal humerus fractures in patients without osteoporosis. Comparative retrospective study of 63 cases. Orthop Traumatol Surg Res 2014; 100:917-24. [PMID: 25453929 DOI: 10.1016/j.otsr.2014.09.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 06/29/2014] [Accepted: 09/11/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is no consensus on the treatment of proximal humeral fractures. The goal of the present retrospective observational study was to compare functional and radiological results and complications of internal fixation using locking plates versus antegrade nailing in the treatment of non-osteoporotic Neer classification 3- and 4-part fractures after a least 1 year of follow-up. MATERIAL AND METHODS Internal fixation was performed in 67 fractures (1 bilateral): 35 by locking plate (1 lost to follow-up, 1 deceased) and 32 by intramedullary nailing (2 lost to follow-up) between January 1st, 2004 and December 31st, 2010. Thus, the study included 33 plates (21 3-part and 12 4-part fractures) and 30 nails (21 3-part and nine 4-part fractures). Final functional assessment was based on the Oxford, Constant, Relative Constant and QuickDASH scores and percentage of handicap. Radiological follow-up included immediate postoperative, 6 weeks, 3 months and 1 year AP and Lamy lateral views. All complications were recorded prospectively. RESULTS Mean Oxford, Constant, Relative Constant and QuickDASH scores and percentage of disability for the plate and nail groups respectively were: 23.8 vs. 23.3, 59.7 vs. 60 6, 73.5 vs 79.3, 20.9 vs 21.0, 22.6 vs 22.6. Multivariate analysis did not show any significant difference in functional scores or quality of reduction: final unsatisfactory reduction on AP view, 30.3 vs. 36.7%; lateral view, 3.2 vs. 10.0%; greater tuberosity, 9.1 vs. 16.7%. Four-part fracture (P<0.05), frontal reduction defect at follow-up (P<0.05) or greater tuberosity defect (P>0.05) had negative impacts on functional scores. The complication rates corresponded to those in the literature and did not differ between the techniques (P=0.1901) except for three infections in the plate group. DISCUSSION-CONCLUSION Internal fixation is the treatment of choice for 3- and 4-part fractures in non-osteoporotic patients. Although no difference was found in the present study between locking plate and intramedullary nailing, the former seems to be less well adapted and more aggressive. TYPE OF STUDY Retrospective observational study. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- G Boudard
- Service de Chirurgie Arthroscopique Traumatologique Orthopédique de l'Appareil Locomoteur, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
| | - G Pomares
- Service de Chirurgie Arthroscopique Traumatologique Orthopédique de l'Appareil Locomoteur, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
| | - L Milin
- Service de Chirurgie Arthroscopique Traumatologique Orthopédique de l'Appareil Locomoteur, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
| | - I Lemonnier
- Service d'Épidémiologie et Évaluation Clinique, CHU de Nancy, Hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - H Coudane
- Service de Chirurgie Arthroscopique Traumatologique Orthopédique de l'Appareil Locomoteur, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
| | - D Mainard
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
| | - J-P Delagoutte
- Service de Chirurgie Arthroscopique Traumatologique Orthopédique de l'Appareil Locomoteur, CHU de Nancy, Hôpital Central, 29, avenue du Maréchal-Delattre-de-Tassigny, 54000 Nancy, France.
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The importance of inferomedial support in the hot air balloon technique for treatment of 3-part proximal humeral fractures. J Shoulder Elbow Surg 2012; 21:1152-9. [PMID: 22047786 DOI: 10.1016/j.jse.2011.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 07/11/2011] [Accepted: 07/24/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Inferomedial support may affect the results of the hot air balloon technique for the treatment of displaced, 3-part fractures of the proximal humerus. METHODS Forty-three patients with displaced, 3-part fractures of the proximal humerus treated with the hot air balloon technique between 1995 and 2007 were included in the study. All patients were classified into 4 subgroups based on the presence or absence of medial buttress restoration and inferomedial screw insertion (R+, restored with inferomedial screw; R-, restored without inferomedial screw; NR+, non-restored with inferomedial screw; and NR-, non-restored without inferomedial screw). Assessment of radiologic and clinical outcome among subgroups was based on evaluation of neck-shaft angle, American Shoulder and Elbow Surgeons score, and Neer score. RESULTS The mean follow-up duration was 65 ± 29.7 months. The change in the neck-shaft angle in the R+, R-, NR+, and NR- groups was 3°, 2°, 3°, and 11°, respectively. The mean American Shoulder and Elbow Surgeons scores in the R+, R-, NR+, and NR- groups were 91 ± 4.8, 86 ± 5.4, 85 ± 1.9, and 77 ± 5.8, respectively. The mean Neer scores in the R+, R-, NR+, and NR- groups were 92 ± 4.3, 88 ± 4.0, 87 ± 2.1, and 76 ± 8.2, respectively. CONCLUSIONS Medial buttress restoration and inferomedial screw insertion affect bone-nail construct stability and clinical outcomes.
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Abstract
The surgical treatment for proximal humeral fractures is challenging, especially in patients with osteoporosis. Locking plates and intramedullary nails have been widely used with satisfactory results, but previously reported complications have not been substantially reduced. Several authors have emphasized the importance of maintaining soft tissues around the proximal humerus with respect to limiting displacement and maintaining stability. To prevent postoperative complications, such as fixation failure and malunion, several supplementary suture techniques using nonabsorabable sutures that allow for the incorporation of the rotator cuff as a fixation point have been described.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 194 Dongsan-dong, Joong-gu, Daegu, Korea.
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Kim KC, Shin HD, Cha SM. Surgical treatment of displaced medial clavicle fractures using a small T-shaped plate and tension band sutures. Arch Orthop Trauma Surg 2011; 131:1673-6. [PMID: 21811810 DOI: 10.1007/s00402-011-1367-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Indexed: 11/29/2022]
Abstract
The surgical treatment of medial clavicle nonunion is associated with high complication and failure rates, particularly with regard to metal work migration. Therefore, we describe a simple surgical procedure for displaced medial clavicle fractures using a small T-shaped plate and multiple tension band sutures. After stabilizing the medial clavicle fracture using a small nonunion for the distal radius, our simple technique for preventing high complication and failure rates is performed easily and effectively, with sufficient tension band sutures.
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Affiliation(s)
- Kyung Cheon Kim
- Department of Orthopaedic Surgery, Chungnam National University College of Medicine, 640 Daesa-Dong, Jung-Gu, Daejeon 301-040, South Korea.
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Abstract
Recent innovations have greatly increased the range of proximal humeral fractures that are amenable to open reduction and plate fixation.The optimum technique for some of the more complex fracture patterns is not yet fully refined.This article aims to describe the recent advances in the treatment of complex proximal humeral fractures by open reduction and locking plate fixation, focusing particularly on the indications for surgery, the operative techniques, and the expected outcomes after treatment.
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Abstract
Surgical treatment of proximal humeral fractures continues to be a challenge especially in osteoporotic patients. Locking plates and intramedullary nails have been used with satisfactory results but the previous reported complications have not been substantially reduced. Most of the existing studies involve a small number of patients followed up for a rather short period of time. Since proximal humeral fractures constitute a heterogenous group of complex fractures in an even more heterogenous population, no single fixation method is a panacea. Choice of implant and method of fixation should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications. Based on the findings of the existing clinical studies the authors propose a treatment algorithm.
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Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. ACTA ACUST UNITED AC 2011; 93:1-11. [PMID: 21196536 DOI: 10.1302/0301-620x.93b1.25702] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated non-operatively. The management of the smaller number of more complex displaced fractures is more controversial and new fixation techniques have greatly increased the range of fractures that may benefit from surgery. This article explores current concepts in the classification and clinical aspects of these injuries, reviewing the indications, innovations and outcomes for the most common methods of treatment.
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Affiliation(s)
- I R Murray
- Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Zhu Y, Lu Y, Wang M, Jiang C. Treatment of proximal humeral fracture with a proximal humeral nail. J Shoulder Elbow Surg 2010; 19:297-302. [PMID: 19664939 DOI: 10.1016/j.jse.2009.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 05/22/2009] [Accepted: 05/26/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various treatment options are available for displaced proximal humeral fractures. This study monitored a series of patients treated with a locking proximal humeral nail (PHN). HYPOTHESIS Fixation with a PHN can be an effective method when treating patients with two part surgical neck fractures of proximal humerus. MATERIALS AND METHODS PHNs were used to surgically repair humeral neck fractures in 22 patients. Factors affecting the final function were analyzed by multiple linear regression. RESULTS Mean patient age at the time of surgery was 56.9 years. The mean follow-up was 25.4 months, and all fractures united within 8 weeks. The average active forward flexion was 147.3 degrees , the average external rotation was 44.1 degrees , and the average internal rotation was T10. All patients were satisfied with their results. Two factors associated with patient American Shoulder and Elbow Surgeon scores were patient age and the strength of the supraspinatus. DISCUSSION Details in patients choosing and surgical management were discussed. CONCLUSION Closed reduction and internal fixation with a PHN can be an effective method for the treatment of 2-part surgical neck fractures.
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Affiliation(s)
- Yiming Zhu
- Shoulder Service, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, People's Republic of China
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Young AA, Hughes JS. Locked intramedullary nailing for treatment of displaced proximal humerus fractures. Orthop Clin North Am 2008; 39:417-28, v-vi. [PMID: 18803972 DOI: 10.1016/j.ocl.2008.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Controversy surrounds the optimal technique for fixation of displaced fractures, although locked intramedullary nailing is emerging as a preferred technique in managing displaced proximal humerus fractures in appropriately selected patients. This technique provides stable fracture fixation allowing early postoperative mobilization critical in ensuring a pain-free shoulder with a functional range of motion. Additional advantages include the ability to insert by way of a minimally invasive approach with limited soft tissue dissection, achieve accurate anatomic reduction, provide a secure construct even in the situation of osteopenic bone or comminution, and manage fractures of the proximal humerus extending into the shaft.
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Affiliation(s)
- Allan A Young
- Department of Orthopaedic and Traumatic Surgery, Royal North Shore Hospital, Pacific Highway, St. Leonards, Sydney, NSW 2065, Australia
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Abstract
To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.
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Grossterlinden L, Ueblacker P, Rueger JM. Arthroscopical Findings after Antegrade Nailing of a Proximal Humeral Fracture : Case Report and Review of the Literature. Eur J Trauma Emerg Surg 2007; 33:383-7. [PMID: 26814731 DOI: 10.1007/s00068-007-7088-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 07/03/2007] [Indexed: 11/24/2022]
Abstract
Proximal humeral fractures represent up to five percent of all fractures in adults, commonly found in elderly patients. The final functional results after different operative procedures are among other factors dependent on whether or not a rotator cuff lesion is pre-existent, prior to the fracture, and how its surgical therapy is carried out. However, to what extent prior rotator cuff tears in this special patient group contribute to the functional outcome remains widely unclear. In our institution antegrade intramedullary nailing is the treatment of choice for proximal humeral fractures. One critical point of this technique is the unavoidable split of the rotator cuff on the approach to the proximal humerus and the insertion of the nail through the incised cuff. We report on a case of an impingement after antegrade intramedullary nailing of a proximal humeral fracture. Diagnostic glenohumeral arthroscopy revealed neither a residual lesion of the former rotator cuff incision nor a chondral lesion at the former insertion site of the nail. In the same session subacromial decompression and a nettoyage of adhesions were performed. We assume that splitting the rotator cuff for the insertion of an antegrade nail in a proximal humeral fracture is less relevant than previously assumed and described.
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Affiliation(s)
- Lars Grossterlinden
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Ueblacker
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes M Rueger
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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