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Oliveira CTBD, da Graça E, Fanelli VA. Posterior four-part fracture-dislocations of the proximal humerus: clinical and functional evaluation of osteosynthesis treatment. Rev Bras Ortop 2018; 53:350-356. [PMID: 29892588 PMCID: PMC5993887 DOI: 10.1016/j.rboe.2018.03.010] [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: 02/01/2017] [Accepted: 04/06/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate patients diagnosed with posterior four-part fracture-dislocations of the proximal humerus, that were surgically treated with osteosynthesis, regarding their clinical and functional outcomes. Methods A prospective observational study of eight patients from the same hospital institution in the interior of São Paulo State (Brazil), through individual interviews using the UCLA, DASH, and Constant international scores. The active movements included in the scores plus the range of motion of the affected and non-affected limb were measured. The affected shoulder's radiographs were requested to verify bone conditions and the fixation of the osteosynthesis. Results The rating of eight patients by the international scores indicated that seven of the eight patients presented good clinical and functional evolution of the affected limb; this represents 87.5% of the evaluated individuals. Conclusion Surgical treatment with osteosynthesis performed during the acute period (<four weeks) leads to good results in most cases.
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Fraturas‐luxações posteriores do úmero proximal em quatro partes: avaliação clínico‐funcional do tratamento por osteossíntese. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tenor Junior AC, Granja Cavalcanti AM, Albuquerque BM, Ribeiro FR, da Costa MP, Filho RB. Treatment of proximal humeral fractures using anatomical locking plate: correlation of functional and radiographic results. Rev Bras Ortop 2016; 51:261-7. [PMID: 27284546 PMCID: PMC4887510 DOI: 10.1016/j.rboe.2015.08.018] [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: 06/22/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To correlate the functional outcomes and radiographic indices of proximal humerus fractures treated using an anatomical locking plate for the proximal humerus. METHODS Thirty-nine patients with fractures of the proximal humerus who had been treated using an anatomical locking plate were assessed after a mean follow-up of 27 months. These patients were assessed using the University of California Los Angeles (UCLA) score and their range of motion was evaluated using the method of the American Academy of Orthopedic Surgeons on the operated shoulder and comparative radiographs on both shoulders. The correlation between radiographic measurements and functional outcomes was established. RESULTS We found that 64% of the results were good or excellent, according to the UCLA score, with the following means: elevation of 124°; lateral rotation of 44°; and medial rotation of thumb to T9. The type of fracture according to Neer's classification and the patient's age had significant correlations with the range of motion, such that the greater the number of parts in the fracture and the greater the patient's age were, the worse the results also were. Elevation and UCLA score were found to present associations with the anatomical neck-shaft angle in anteroposterior view; fractures fixed with varus deviations greater than 15° showed the worst results (p < 0.001). CONCLUSION The variation in the neck-shaft angle measurements in anteroposterior view showed a significant correlation with the range of motion; varus deviations greater than 15° were not well tolerated. This parameter may be one of the predictors of functional results from proximal humerus fractures treated using a locking plate.
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Affiliation(s)
- Antonio Carlos Tenor Junior
- Service of Orthopedic and Traumatology, Hospital do Servidor Público Estadual de São Paulo (SOT/HSPE), Sao Paulo, SP, Brazil
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Tenor Junior AC, Cavalcanti AMG, Albuquerque BM, Ribeiro FR, Costa MPD, Brasil Filho R. Tratamento das fraturas do úmero proximal com placa anatômica bloqueada: correlação dos resultados funcionais e radiográficos. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Miyazaki AN, Estelles JRD, Fregoneze M, Santos PD, da Silva LA, do Val Sella G, Ishioka FE, Rosa JP, Checchia SL. EVALUATION OF THE COMPLICATIONS OF SURGICAL TREATMENT OF FRACTURES OF THE PROXIMAL EXTREMITY OF THE HUMERUS USING A LOCKING PLATE. Rev Bras Ortop 2012; 47:568-74. [PMID: 27047867 PMCID: PMC4799444 DOI: 10.1016/s2255-4971(15)30005-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/08/2012] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate the complications from surgical treatment using a locking plate among patients with fractures of the proximal extremity of the humerus. Methods: Between July 2004 and December 2009, 56 patients with fractures of the proximal extremity of the humerus were treated using the PHILOS® plate. There were 19 male patients and 37 female patients, with a mean age of 62 years (range: 30 to 92 years). All the cases had a mean postoperative followup period of 12 months. Thirteen fractures were classified as presenting in two parts, 28 as three, eight as four and seven as epiphyseal fractures. Results: Among the patients operated, 26 were considered to have achieved excellent results, twelve good, ten fair and eight poor, according to the UCLA score. Thirty complications occurred in 20 patients (35.7%), among which the most frequent complication was inadequate reduction of the fracture, which occurred in eight cases. Subacromial impact, caused by the plate, occurred in seven cases, while inadequate fixation occurred in six cases. Other complications such as pseudarthrosis, adhesive capsulitis, avascular necrosis, loss of varus reduction and infection were also seen. Conclusion: The functional results from treating fractures of the proximal extremity of the humerus using a locking plate depended on correct anatomical reduction of the fracture and stable fixation of the implant. Complications still occur frequently, particularly because of intraoperative technical difficulty, fracture severity and possible inexperience of the surgeon.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Assistant Professor and Head of the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - José Renato Depari Estelles
- Resident in the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Fregoneze
- Assistant Professor and Attending Physician in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Pedro Doneux Santos
- Attending Physician in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Luciana Andrade da Silva
- Attending Physician in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Guilherme do Val Sella
- Attending Physician in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Fábio Eduardo Ishioka
- Trainee in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - João Polydoro Rosa
- Trainee in the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Sergio Luiz Checchia
- Adjunct Professor, Academic Consultant and Member of the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
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