The use of intramedullary helix wire for the treatment of proximal humerus fractures

A Comprehensive Review of Proximal Humerus Fractures: From Epidemiology to Treatment Strategies

This comprehensive review delves into the intricate landscape of proximal humerus fractures (PHFs), exploring their epidemiology, historical evolution, contemporary classification systems, treatment strategies, and outcome measures. PHFs present a complex orthopedic challenge, necessitating a nuanced understanding of their multifaceted dimensions. Despite their clinical significance, PHFs remain relatively understudied in population-based epidemiology. This review critically examines existing literature to uncover the incidence, prevalence, and demographic patterns associated with these fractures. A foundational understanding of the epidemiological landscape is crucial for effective preventive strategies and optimized fracture management. Tracing back to historical records, the review explores the evolution of diagnostic and therapeutic approaches for PHFs. From ancient treatment modalities documented on the Edwin Smith papyrus to contemporary X-ray-based classifications such as Neer and AO/OTA, a historical context is provided to understand the journey of managing these fractures. Navigating through a spectrum of treatment strategies, the review contrasts nonoperative approaches with various surgical interventions. The challenges and outcomes associated with conservative management are juxtaposed against methods like open reduction internal fixation and tension band osteosynthesis. Evidence synthesis guides clinicians in making informed decisions based on patient characteristics and fracture complexities. Central to assessing PHF management are patient-reported outcome measures. The review explores the significance of instruments such as the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Constant-Murley score in evaluating treatment success. The shift toward subjective measures is discussed, considering their correlation with patient experiences and the concept of minimal clinically important difference. The impact of demographic factors, including age and gender, on PHFs is scrutinized. The association between these fractures and osteoporosis is highlighted, emphasizing the crucial role of bone health in fracture prevention and management. Through this comprehensive exploration, the review provides a robust foundation for understanding, evaluating, and advancing the management strategies for PHFs. The synthesis of historical perspectives, contemporary classifications, and treatment modalities serves as a valuable resource for the orthopedic community, fostering improved clinical decision-making and patient outcomes.

Employee Involvement and Socialization as an Example of Sustainable Marketing Strategy and Organization’s Citizenship Behavior: Empirical Evidence from Beirut Hotel Sector

In recent years, environmental consideration and notion of sustainability has gained extensive attention on global scale from political aspect to businesses and social means. It has been the core concept of development for organizations in different industries in an increasing manner. As tourists tend to be more aware regarding environment and impact of human activity on nature, it becomes more important to include sustainable measures so that firms can remain competitive in the market and attract new customers. The current research examines the relationship between sustainable marketing orientation deployed by organizations operating in tourism sector (i.e., hotels) and employees’ extra-role behavior in form of organizational citizenship behavior. Furthermore, indirect effects of employees’ socialization and involvement are examined to provide a better understanding on related factors. Gathering data from hotels of Beirut, 218 employees participated in the research and PLS-SEM yielded significant results, stating that the variables are vital for positive behavioral outcomes within the hotel industry. The results can be beneficial for scholars and practitioners in tourism sector alike.

Assessment of Entrepreneurial Traits and Small-Firm Performance with Entrepreneurial Orientation as a Mediating Factor

Entrepreneurship is considered to be one of the most critical factors contributing to the successful performance of business, innovations, and growth of the economy. Entrepreneurship is the main driver of innovation and sustainable business. The purpose of this research is to assess the main traits that are deemed essential for the successful performance of a firm. A model is developed to assess how entrepreneurs’ creativity, self-efficacy, and achievement motivation influence the performance of small firms through the role of entrepreneurial orientation (EO) as a mediating variable. The hypotheses are tested by using Smart PLS (partial least squares path modeling) on a sample of 353 business owners to seek the insight of entrepreneurial traits on small-firm performance. The findings of the research show that self-efficacy and EO have a significant and positive association with the performance of a firm, while creativity and internal locus of control are fully mediated by EO. The subjective measures are used to examine the performance of a firm in terms of growth, sustainability, and financial performance, but the same can also be assessed by objective measures. The practical implication of this research provides entrepreneurs with a different perspective of the entrepreneurial traits that contribute to successful firm performance. The originality of the research lies in the attempt to explore the entrepreneurial traits that significantly influence the effectiveness of the performance of firms in the Pakistani context.

Weight-bearing-induced displacement and migration over time of fracture fragments following split depression fractures of the lateral tibial plateau: a case series with radiostereometric analysis

We investigated the stability of seven Schatzker type II fractures of the lateral tibial plateau treated by subchondral screws and a buttress plate followed by immediate partial weight-bearing. In order to assess the stability of the fracture, weight-bearing inducible displacements of the fracture fragments and their migration over a one-year period were measured by differentially loaded radiostereometric analysis and standard radiostereometric analysis, respectively. The mean inducible craniocaudal fracture fragment displacements measured -0.30 mm (-0.73 to 0.02) at two weeks and 0.00 mm (-0.12 to 0.15) at 52 weeks. All inducible displacements were elastic in nature under all loads at each examination during follow-up. At one year, the mean craniocaudal migration of the fracture fragments was -0.34 mm (-1.64 to 1.51). Using radiostereometric methods, this case series has shown that in the Schatzker type II fractures investigated, internal fixation with subchondral screws and a buttress plate provided adequate stability to allow immediate post-operative partial weight-bearing, without harmful consequences.

New trends in fixation of proximal humeral fractures: a review

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.

The "Helix Wire": our experience in the treatment of humeral neck fractures

The management of proximal humeral fractures is still controversial and no single treatment has been unanimously accepted. This paper focuses on displaced two-part fractures to describe the minimally invasive fixation device known as Helix Wire and to propose precise indications for its use, partly on the basis of our previous study of its mechanical properties. Thirty patients with nondisplaced and displaced humeral neck fractures were treated with implantation of a Helix Wire between January 2005 and September 2005. Clinical and radiographic follow-up was carried out at 1, 2, 6 and 12 months. Clinical and functional assessment was performed using the Constant-Murley score. The results at 1 year after surgery were excellent in 7 cases (23.3%), good in 14 cases (46.6%), fair in 8 cases (26.6%) and poor in 1 case (3.3%). On the basis of our precise indications, elderly patients with nondisplaced or displaced two-part fractures of the proximal humerus may achieve good results with minimally invasive implantation of the Helix Wire.