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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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Opperman FLJ, Blaas LS, Pape M, Buijs N, Sterkenburg MV, Yuan JZ, Lameijer CM, Derksen RJ. Fibula allograft in complex three-part and four-part proximal humeral fractures in active patients, a matched case-control study. JSES Int 2024; 8:21-26. [PMID: 38312278 PMCID: PMC10837717 DOI: 10.1016/j.jseint.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background About 20% of proximal humerus fractures (PHFs) are unstable and/or markedly displaced and therefore require surgery. Locking plate fixation after anatomical reduction has become the current treatment of choice for these fractures in the active population. However, studies have shown complication rates up to 36%, such as loss of reduction and avascular necrosis. To date, data from literature are inconclusive on outcomes following the use of an intramedullary fibula allograft in PHFs, possibly due to the case mix. It is hypothesized that the use of a fibula allograft is beneficial to prevent secondary displacement of the fracture in cases where the medial hinge is markedly displaced and unstable, resulting in better clinical and patient reported outcomes. Methods In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without the allograft. The matches were made based on fracture characteristics, age, and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared. Results Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 years in the control group. Minimum follow-up was 12 months. Disability of the Arm Shoulder and Hand score, Constant Shoulder score, abduction, and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs. 26.1 ± 19.2, P = .048; 16.5 ± 11.5 vs. 19.8 ± 16.5 P = .040; mean 127° ± 38° vs. mean 92° ± 49° P = -.045; 50° ± 21° vs. mean 26° ± 23°, P = .004). There was no statistically significant difference in the Oxford Shoulder score between groups (P = .105). The Visual Analog Scale was not significantly different between groups (3.1 ± 1.8 vs. 1.6 ± 1.9, P = .439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (P = .317). The complication rate was twice as high in the control group (3 vs. 7). Conclusion Additional support of the medial hinge in unstable PHFs with a locking plate in combination with a fibula allograft appears to create a more stable construct without compromising the viability of the articular surface of the head. The use of a fibula allograft in selected complex cases could therefore result in better clinical outcomes with lower complication rates.
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Affiliation(s)
| | - Leanne S. Blaas
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Surgery, Zaandam Medical Center, Zaandam, The Netherlands
| | - Merel Pape
- Department of Surgery, Zaandam Medical Center, Zaandam, The Netherlands
| | - Nikki Buijs
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | | | - Jian Zhang Yuan
- Department of Surgery, Zaandam Medical Center, Zaandam, The Netherlands
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Shahien A, Likine EF, Soles G, Samborski S, Mehta SK, Ryan SP, Leroy TE, Mullis B, Spitler CA, Tornetta P. Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery. J Orthop Trauma 2023; 37:366-369. [PMID: 37074809 DOI: 10.1097/bot.0000000000002585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively. DESIGN Retrospective multicenter analysis. SETTING Five level-one trauma centers. PATIENTS/PARTICIPANTS Two hundred ten patients (152 F; 58 M), average age 64, with 112 left- and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C). INTERVENTION All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with ≥80% anterior humeral translation were compared with those with <80% anterior translation, including those with no or posterior translation. MAIN OUTCOMES The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion. RESULTS Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery ( P = 0.012). In addition, of those with anterior translation, having ≥80% anterior translation compared with <80% was also associated with surgery ( P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 ( P = 0.0001). CONCLUSIONS In a multicenter series of proximal humerus fractures, anterior translation of >80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amir Shahien
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA
| | - Elive F Likine
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Gillian Soles
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, MN
| | - Steven Samborski
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, MN
| | - Siddhant K Mehta
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and
| | - Scott Patrick Ryan
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, MA
| | - Taryn E Leroy
- Department of Orthopaedic Surgery, Tufts University Medical Center, Boston, MA
| | - Brian Mullis
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA
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Nie W, Wang Z, Gu F, Xu S, Yue Y, Shao A, Sun K. Effects of fibular strut augmentation for the open reduction and internal fixation of proximal humeral fractures: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:322. [PMID: 35729668 PMCID: PMC9210738 DOI: 10.1186/s13018-022-03211-4] [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: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still a lack of remarkable consensus regarding the clinical efficacy of the application of fibular strut augmentation (FSA) combined with a locking plate for proximal humeral fractures. A systematic review and meta-analysis to assess the effect of the use of FSAs in open reduction and internal fixation of proximal humeral fractures was conducted. METHODS A literature search was conducted in PubMed, Embase, Cochrane, Web of Science Core Collection, and ClinicalTrials.gov to identify trials that compared the clinical outcomes of proximal humeral fractures treated using a locking plate with or without FSA. The primary outcome measures were postoperative complications, radiographical findings, functional recovery scores, and postoperative range of motion (ROM). Data were pooled and analysed using a random-effects model based on the Der Simonian and Laird method. RESULTS Eight studies involving 596 participants were included for further analysis. Compared with using a locking plate independently, the additional application of FSA was associated with the likelihood of lower risk of overall complications (OR 0.37; 95% CI 0.22-0.65; I2 = 12.22%; 95% PI 0.14-0.98) and the rate of patients with orthopaedic complications (OR 0.48; 95% CI 0.25-0.92; I2 = 7.52%; 95% PI 0.16-1.45), less changes in postoperative humeral head height (MD - 2.40; 95% CI - 2.49 to - 2.31; I2 = 0.00%; 95% PI - 2.61 to - 2.20) and the neck-shaft angle (MD - 6.30; 95% CI - 7.23 to - 5.36; I2 = 79.32%; 95% PI - 10.06 to - 2.53), superior functional outcomes (Constant-Murley score: MD 5.07; 95% CI 3.40 to 6.74; I2 = 0.00%; 95% PI 2.361-7.78; American Shoulder and Elbow Surgeons Score: MD 5.08; 95% CI 3.67 to 6.49; I2 = 0.00%; 95% PI 1.98-8.18), and better postoperative ROM in terms of forward elevation and external rotation. However, the evidence regarding postoperative abduction was insufficient. CONCLUSION Meta-analytic pooling of current evidence showed a significant association between the application of FSAs and favourable clinical outcomes in terms of postoperative complications, radiographical findings, functional recovery, and postoperative elevation and external rotation.
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Affiliation(s)
- Wei Nie
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Zhaojun Wang
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Fei Gu
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Shizhuang Xu
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Yang Yue
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Anze Shao
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China
| | - Kefu Sun
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No. 41 Hailian East Road, Haizhou District, Lianyungang, 222000, Jiangsu, China.
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Dasari SP, Kerzner B, Fortier LM, Rea PM, Bodendorfer BM, Chahla J, Garrigues GE, Verma NN. Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:884-894. [PMID: 34906682 DOI: 10.1016/j.jse.2021.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, no meta-analysis has been performed on the efficacy of fibular allograft augmentation for the management of proximal humerus fractures. The purpose of this study was to evaluate the radiographic and clinical outcomes of proximal humerus fractures treated with a locking compression plate (LCP) with or without fibular allograft augmentation. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, and SCOPUS were queried in June of 2021 for literature comparing the radiographic and clinical outcomes for patients with proximal humerus fractures that were treated with an LCP only or an LCP augmented with a fibular allograft. Data describing study design, level of evidence, demographic information, final follow-up, radiographic changes in humeral head height (HHH), radiographic changes in neck shaft angle (NSA), final American Shoulder and Elbow Surgeons (ASES) scores, final Constant-Murley scores, and major complications were collected. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A meta-analysis was performed using pooled weighted mean differences (WMD) to compare changes in HHH, NSA, final ASES and final Constant-Murley scores between the 2 groups; a pooled odds ratio (OR) was used to compare complications between the groups. RESULTS Ten studies with a total of 802 patients were identified. There was a significant difference that favored patients augmented with a fibular allograft for change in HHH (WMD = -2.40; 95% confidence interval [CI], -2.49 to -2.31; P < .00001), change in NSA (WMD = -5.71; 95% CI, -6.69 to -4.72; P < .00001), final ASES scores (WMD = 5.08; 95% CI, 3.69-6.48; P < .00001), and OR for developing a major complication (OR = 0.37; 95% CI, 0.23-0.59; P < .0001). There was no significant difference in final Constant-Murley scores (WMD = 3.36; 95% CI, -0.21 to 6.93; P = .06) or revision surgery rate (P = .182) between the 2 groups. CONCLUSION The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. Limitations of this study include a relatively short average final follow-up time (<2 years) and a potential lack of standardization for radiographic outcomes among included studies.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Parker M Rea
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Blake M Bodendorfer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Cheng H, Yu J, Dong Z, Lin H, Liu Q, Zhang X, Wu J, Zeng X, Yu W, Xu B. Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely - A Retrospective Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211050155. [PMID: 34671509 PMCID: PMC8521760 DOI: 10.1177/21514593211050155] [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: 03/15/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION To date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely. MATERIALS AND METHODS One hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014-2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications. RESULTS Median follow-up was 24 (15.3-27.6) months. Significant improvements in the median Constant scores were observed (39 [26-58 points] prior to surgery vs 81 [67-95 points] at final follow-up). The median ASES scores improved from 43 (26-64 points) prior to surgery to 83 (65-96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain. CONCLUSION For elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.
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Affiliation(s)
- Huihui Cheng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiali Yu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhirui Dong
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Huanyi Lin
- Department of Urinary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qilong Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jianguo Wu
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Chang Z, Zhang W, Tang P, Chen H. [Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:375-380. [PMID: 33719248 DOI: 10.7507/1002-1892.202009127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures, and to provide reference for clinical treatment. Methods The literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed, as well as the biomechanical benefit and clinical advantage were analyzed thoroughly. Results Medial support augmentation of plate osteosynthesis for proximal humeral fractures is very important, especially in osteoporotic and/or comminuted fractures. Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support. It can also be divided into autogenous bone support and allogenic bone support according to the material and source, divided into medial column support, calcar support, and humeral head support according to the support site, and divided into fibular shaft support, femoral head support, anatomic fibula support according to the shape of the augmented fixation. At present, clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures. Conclusion As an important treatment strategy for the treatment of proximal humeral fractures, the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment. However, there are still widespread controversies among orthopedic surgeons regarding the support mode, site, implant shape, and material of medial column support for augmentation of proximal humeral fractures. More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration, are needed to provide better strategy treatment for the treatment of proximal humeral fractures.
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Affiliation(s)
- Zuhao Chang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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Kröger I, Nerz C, Schwickert L, Schölch S, Müßig JA, Studier-Fischer S, Nolte PC, Becker C, Augat P. Robot-assisted training after proximal humeral fracture: A randomised controlled multicentre intervention trial. Clin Rehabil 2020; 35:242-252. [PMID: 33016132 DOI: 10.1177/0269215520961654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether robotic-assisted training as a supplement to usual therapy is safe, acceptable and improves function and patient reported outcome after proximal humeral fractures (PHF). DESIGN Multicentre, assessor-blinded, randomised controlled prospective trial. SETTING Three different rehabilitation hospitals in Germany. SUBJECTS In total 928 PHF patients between 35 and 70 years were screened. Forty-eight participants were included in the study (intervention group n = 23; control group n = 25). INTERVENTION The control group received usual occupational and physiotherapy over three weeks, and the intervention group received additional 12 robot-assisted training sessions at the ARMEO®-Spring. MAIN MEASURES Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), the Wolf Motor Function Test-Orthopaedic, active range of motion and grip strength were determined before and after intervention period. The DASH was additionally obtained postal 6 and 13 months following surgery. RESULTS The mean age of participants was 55 ± 10 years and was similar in both groups (p > 0.05). The change in DASH as the primary endpoint in the intervention group after intervention was -15 (CI = 8-22), at follow-up six month -7 (CI = -2 to 16) at follow up 13 month -9 (CI = 1-16); in control group -14 (CI = 11-18), at follow-up six month -13 (CI = 7-19) at follow up 13 month -6 (CI = -3 to 14). No difference in the change was found between groups (p > 0.05). None of the follow-up time points demonstrated an additional benefit of the robotic therapy. CONCLUSION The additional robot-assisted therapy was safe, acceptable but showed no improvement in functional shoulder outcome compared to usual therapy only.
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Affiliation(s)
- Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lars Schwickert
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sabine Schölch
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janina Anna Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Studier-Fischer
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Philip-Christian Nolte
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
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Halvachizadeh S, Berk T, Rauer T, Hierholzer C, Pfeifer R, Pape HC, Allemann F. Treatment of proximal humerus fractures in geriatric patients - Can pathological DEXA results help to guide the indication for allograft augmentation? PLoS One 2020; 15:e0230789. [PMID: 32271792 PMCID: PMC7145012 DOI: 10.1371/journal.pone.0230789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/08/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Reconstruction of proximal humerus fracture continues to represent a challenge, especially in severe osteopenia. However, there still is a lack of consensus and clear indication on use of allograft augmentation. Therefore, this study aims to investigate outcome after osteosynthesis with and without allograft augmentation. It focuses on bone density results obtained by DEXA as potential examination that might help decision-making. METHODS This study included patients aged 65 years and older that were treated at one Level 1 trauma center between 2007 and 2018. Inclusion criteria: Proximal humerus fracture treated with or without allograft, conclusive data-sets. Exclusion criteria: prior surgical treatment of the proximal humerus, open fracture with bone loss, neurological damage. Patients were stratified according to the use of allograft augmentation in two groups: Group NA (no allograft augmented PHILOS) and Group A (PHILOS with allograft augmentation). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Fractures were graded according to the classification by Neer. Radiographic union was analyzed at 6 weeks, 12 weeks, and at year follow up. Complications include surgical site infection, implant failure, humeral head necrosis, or delayed union. Allograft was used in cases of 1inch/3cm3 bone-loss or an egg-shell situation, where the patient refused arthroplasty. RESULTS This study included 167 patients, with 143 (85%) in the Group NA, and 24 (15%) in the Group A. There were no significant differences in age, gender, injury distribution, and distribution of Neer classification or CCI. Patients in Group A had significantly lower T-scores preoperatively (-2.87 ± 1.08 versus -0.9 ± 2.12, p = 0.003). No difference occurred in any of the complications. At one-year follow-up, the range of motion was comparable in both groups. CONCLUSION In patients with allograft augmentation and severe osteopenia, similar clinical and radiological results were obtained when compared with patients with better preoperative bone density scores (T-scores, DEXA). In view of a lack of guidelines indicating the indication for the use of allograft, this difference may be worth further study.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Till Berk
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Thomas Rauer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Christian Hierholzer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Zurich, UniversitätsSpital Zürich, Zurich, Switzerland
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