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Kim M, Smolev E, Al-Humadi S, Tantone RP, Park HY, Ling K, Komatsu DE, Wang ED. Predictors of Extended Length of Stay Following Open Reduction and Internal Fixation for Proximal Humerus Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:195-199. [PMID: 38903841 PMCID: PMC11185893 DOI: 10.1016/j.jhsg.2023.11.013] [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] [Received: 07/31/2023] [Accepted: 11/18/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose An extended length of stay following open reduction and internal fixation (ORIF) for proximal humerus fractures (PHFs) is associated with increased patient morbidity and health care costs. The primary purpose of this study was to identify risk factors for an extended length of stay following ORIF for PHF. Methods All patients who underwent ORIF for PHF between 2015 and 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patient demographics, comorbid conditions, and postoperative complications within 30 days of procedure were collected. Extended length of stay (eLOS) was defined by ≥ 3 days from operation to discharge. Multivariate logistic regression was employed to identify predictors of eLOS following ORIF. Results Characteristics of patients significantly associated with eLOS included age ≥ 75 years (p < .001), male gender (p < 0.001), body mass index (BMI) < 18.5 (P = .001), American Society of Anesthesiologists (ASA) classification ≥ 3 (P < .001), dependent functional status (P < .001), noninsulin-dependent diabetes (P = .037), insulin-dependent diabetes (P < .001), chronic obstructive pulmonary disease (P < .001), congestive heart failure (CHF) (P < .001), hypertension (P < 0.001), dialysis (P < .013), disseminated cancer (P < 0.001), chronic steroid use (P = .004), and bleeding disorder (P < .001). Independent predictors of eLOS were age ≥ 75 years (OR = 2.69; P < .001), BMI < 18.5 (OR = 1.70; P = .016), ASA ≥ 3 (OR = 2.70; P < .001), dependent functional status (OR = 2.30; P < .001), CHF (OR = 3.57; P < .001), disseminated cancer (OR = 7.62; P < .001), and bleeding disorder (OR = 2.68; P < .001). Conclusion Age ≥ 75, BMI < 18.5, ASA ≥ 3, functional dependence, CHF, disseminated cancer, and bleeding disorder were independently associated with eLOS. Clinical Relevance Assessing specific patient factors prior to ORIF for PHF can assist in managing perioperative risks and decreasing expenses related to eLOS. Level of Evidence Prognosis III.
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Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Emma Smolev
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Samer Al-Humadi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY
| | - Ryan P. Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY
| | - Hee-Yon Park
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY
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Daf A, Patil DS. Impact of Virtual Rehabilitation in Adjunct to Conventional Physical Therapy on Proximal Humerus Fracture: A Randomized Controlled Trial. Cureus 2024; 16:e56022. [PMID: 38606214 PMCID: PMC11008555 DOI: 10.7759/cureus.56022] [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] [Received: 04/10/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Humerus fractures are fairly prevalent in the general population, and their incidence increases with age. The majority of minimally displaced fractures may be treated with prompt rehabilitation. An interdisciplinary team strategy involving experienced musculoskeletal specialists, geriatricians, and skilled physiotherapists should be employed for optimal therapy. Rehabilitation is essential in coping with the consequences of the fracture. The greatest current information for shoulder rehabilitation comprises the use of counseling, exercises, and mobility of restricted joints to regain upper limb function. Virtual reality (VR) based therapies are among the most effective since they may give visual, aural, and somatosensory cues to help patients. In fact, VR-based treatments have been shown to enhance motor function, neuropathic pain, balance, and aerobic performance in individuals with neurological disorders. However, there is limited evidence on the use of VR's therapeutic efficacy on individuals with musculoskeletal disorders. This study applied oculus-guided VR rehabilitation in addition to conventional physical therapy for the rehabilitation of patients with proximal humerus fractures. This study aims to assess the impact of virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture. Methods This study is a randomized controlled trial in which 50 patients were divided randomly into two groups: 25 patients in group A and 25 patients in group B. Group A was an experimental group that received VR plus conventional therapy. At the same time, group B was a control group that received only conventional therapy. Shoulder range of motion (ROM), manual muscle testing (MMT), numerical pain rating scale (NPRS), disabilities of arm, shoulder, and hand (DASH), and Shoulder pain and disability index (SPADI) were used as outcome measures of this study. Results There is an increase in flexion (t=7.58, P=0.0001), extension (t=6.90, P=0.0001), abduction (t = 9.57, P=0.0001), internal rotation (t=6.31, P=0.0001), and external rotation (t=3.41, P=0.001) in group A is statistically more significant than group B. The improvement in MMT scores in group B (t=1.71, P=0.10) is not significant, whereas improvements in group A are statistically significant (t=13.86, P=0.0001). The SPADI and DASH scores improved more significantly in group A (t=62.46, P=0.0001, and t=57.48, P=0.0001, respectively) than in group B (t=39.14, P=0.0001 and 46.58, P=0.0001, respectively). There is no significant difference in pain outcomes between the two groups. Conclusion The findings of this study reveal that virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture is more effective in improving shoulder ROM, muscle strength, and upper limb function than conventional therapy alone. However, no intervention can be considered superior to others in terms of the management of pain associated with proximal humerus fracture.
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Affiliation(s)
- Abhishek Daf
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zheng Y, Tang N, Zhang WJ, Shi W, Zhao WW, Yang K. Comparative efficacy and safety of medical treatments for proximal humerus fractures: a systematic review and network meta-analysis. BMC Musculoskelet Disord 2024; 25:17. [PMID: 38166758 PMCID: PMC10759392 DOI: 10.1186/s12891-023-07053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Various surgical techniques and conservative therapies are useful tools for treating proximal humerus fractures (PHFs), but it is important to understand how to properly utilize them. Therefore, we performed a systematic review and network meta-analysis to compare and rank the efficacy and safety of medical treatments for PHF. METHODS PubMed, Embase, the Cochrane Library, and the ClinicalTrials.gov databases were systematically searched for eligible randomized controlled trials (RCTs) from inception until June 2022. Conservative therapy-controlled or head-to-head RCTs of open reduction internal fixation (ORIF), intramedullary nailing (IMN), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (RTSA) used for the treatment of adult patients with PHF were included. The surface under the cumulative ranking (SUCRA) probabilities were applied to compare and rank the effects of medical treatments for PHF. RESULTS Eighteen RCTs involving 1,182 patients with PHF were selected for the final analysis. Mostly baseline characteristics among groups were well balanced, and the imbalanced factors only included age, injury type, medial comminution, blood loss, and cognitive function in single trial. The SUCRA probabilities found that RTSA provided the best effect on the Constant-Murley score (SUCRA: 100.0%), and the disabilities of the arm, shoulder and hand (DASH) score (SUCRA: 99.0%). Moreover, HA (SUCRA: 85.5%) and RTSA (SUCRA: 68.0%) had a relatively better effect on health-related quality of life than the other treatment modalities. Furthermore, conservative therapy (SUCRA: 84.3%) and RTSA (SUCRA: 80.7%) were associated with a lower risk of secondary surgery. Finally, the best effects on the risk of complications are varied, including infection was observed with conservative therapy (SUCRA: 94.2%); avascular necrosis was observed in HA (SUCRA: 78.1%), nonunion was observed in RTSA (SUCRA: 69.6%), and osteoarthritis was observed in HA (SUCRA: 93.9%). CONCLUSIONS This study found that RTSA was associated with better functional outcomes, while the comparative outcomes of secondary surgery and complications varied. Optimal treatment for PHF should consider patient-specific factors.
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Affiliation(s)
- Yun Zheng
- R & D Center, Beijing Naton Technology Group Co., Ltd, Peking, China
| | - Nan Tang
- Director of Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wen-Jie Zhang
- Comprehensive Business Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wei Shi
- Quality Management Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wen-Wen Zhao
- Registration and Regulatory Department, Beijing Naton Technology Group Co, Ltd, Building 1, Yard 9, Chengwan Street, Haidian District, Peking, 100094, China.
| | - Kun Yang
- Quality Management Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
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Reed LA, Hao KA, Patch DA, King JJ, Fedorka C, Ahn J, Strelzow JA, Hebert-Davies J, Little MTM, Krause PC, Johnson JP, Spitler CA. How do surgeons decide when to treat proximal humerus fractures with operative versus nonoperative management? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3683-3691. [PMID: 37300588 DOI: 10.1007/s00590-023-03610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The objective of this study was to determine the underlying factors that drive the decision for surgeons to pursue operative versus nonoperative management for proximal humerus fractures (PHF) and if fellowship training had an impact on these decisions. METHODS An electronic survey was distributed to members of the Orthopaedic Trauma Association and the American Shoulder and Elbow Surgeons Society to assess differences in patient selection for operative versus nonoperative management of PHF. Descriptive statistics were reported for all respondents. RESULTS A total of 250 fellowship trained Orthopaedic Surgeons responded to the online survey. A greater proportion of trauma surgeons preferred nonoperative management for displaced PHF fractures in patients over the age of 70. Operative management was preferred for older patients with fracture dislocations (98%), limited humeral head bone subchondral bone (78%), and intraarticular head split (79%). Similar proportions of trauma surgeons and shoulder surgeons cited that acquiring a CT was crucial to distinguish between operative and nonoperative management. CONCLUSION We found that surgeons base their decisions on when to operate primarily on patient's comorbidities, age, and the amount of fracture displacement when treating younger patients. Further, we found a greater proportion of trauma surgeons elected to proceed with nonoperative management in patients older than the age of 70 years old as compared to shoulder surgeons.
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Affiliation(s)
- Logan A Reed
- Department of Orthopaedic Surgery, University of Alabama, 510 20th St South, Faculty Office Tower, Birmingham, AL, 35294, USA.
| | - Kevin A Hao
- University of Florida College of Medicine, University of Florida, Gainesville, FL, USA
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama, 510 20th St South, Faculty Office Tower, Birmingham, AL, 35294, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine Fedorka
- Cooper Bone and Joint Institute, Cooper Medical School at Rowan University, Camden, NJ, USA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jason A Strelzow
- Department of Orthopaedic Surgery, The University of Chicago, Chicago, IL, USA
| | - Jonah Hebert-Davies
- Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Milton T M Little
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Peter C Krause
- Department of Orthopaedic Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Joseph P Johnson
- Department of Orthopaedic Surgery, University of Alabama, 510 20th St South, Faculty Office Tower, Birmingham, AL, 35294, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama, 510 20th St South, Faculty Office Tower, Birmingham, AL, 35294, USA
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Nah MFK, Pereira MJ, Hemaavathi M, Wong SW, Lim CJ, Tan BY. Study on proximal humerus evaluation of effective treatment (SPHEER) - what is the effect of rehabilitation compliance on clinical outcomes of proximal humerus fractures. BMC Musculoskelet Disord 2023; 24:778. [PMID: 37784126 PMCID: PMC10544385 DOI: 10.1186/s12891-023-06894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Proximal humeral fractures (PHFs) are 3rd commonest fragility fractures and cause significant functional impairment. This paper sought to determine impact of rehabilitation compliance on the clinical outcomes for non-surgically managed PHFs, while ascertaining reasons for non-compliance which can be addressed to improve compliance. METHODS Prospective cohort study of patients undergoing non-surgical treatment for PHFs from August 2017 to April 2020 in a tertiary trauma centre was performed. Data was collected via questionnaire: patient demographic data, PHF injury details, clinical outcome measures, therapist-reported (Sport Injury Rehabilitation Adherence Scale [SIRAS]) and patient-reported (subjective compliance, frequency of exercise) rehabilitation compliance measures. Data was analysed using multiple linear regression model to account for confounding variables. RESULTS 107 participants attended physical therapy follow-up for mean 137.8 days. 6-week SIRAS strongly predicted 3-month Constant score (p = 0.023; 95%CI = 0.265,3.423), OSS (p = 0.038; 95%CI = 0.049,1.634), flexion ROM (p < 0.001; 95%CI = 2.872,8.982), extension ROM (p = 0.035; 95%CI = 0.097,2.614), abduction ROM (p = 0.002;95%CI = 1.995,8.466) and achievement of functional active ROM at 3-months (p = 0.049; 95%CI = 1.001,1.638). Pain was the top reason impairing rehabilitation compliance from therapist (43.9% at 6-weeks and 20.6% at 3-months) and patient-perspective (33.6% at 6-weeks, 24.3% at 3-months). Author-developed patient-reported compliance measures had good correlation with validated SIRAS score (subjective compliance: p < 0.001 frequency of exercise: p = 0.001). CONCLUSION Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. Pain control should be optimised to maximise rehabilitation compliance and improve PHF outcomes. There is lack of consensus definition for rehabilitation compliance measures; patient-reported measures used have good correlation to existing validated measures and could serve as a steppingstone for further research. LEVEL OF EVIDENCE II, cohort study.
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Affiliation(s)
- Ming Foo Kenneth Nah
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | | | | | - Shiyun Winnie Wong
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chien Joo Lim
- Medical Statistician (Research), Woodlands Health, Singapore, Singapore
| | - Bryan Yijia Tan
- Department of Orthopedic Surgery, Woodlands Health, Singapore, Singapore
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Misir A, Oguzkaya S, Kizkapan TB, Eken G, Canbaz SB. Fracture line and comminution zone characteristics, and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humeral fractures: complex proximal humerus fracture map. Arch Orthop Trauma Surg 2023; 143:6219-6227. [PMID: 37378893 DOI: 10.1007/s00402-023-04962-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To identify fracture characteristics and zones of comminution as well as the relationship with anatomic landmarks and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humerus fractures. METHODS Computed tomography images of 201 OTA/AO 11C3 fractures were included. Fracture lines were superimposed to a 3D proximal humerus template, created from a healthy right humerus, after fracture fragment reduction on 3D reconstruction images. Rotator cuff tendon footprints were marked on the template. Lateral, anterior, posterior, medial, and superior views were captured for the interpretation of fracture line and comminution zone distribution as well as to define the relationship with anatomic landmarks and rotator cuff tendon footprints. RESULTS A total of 106 females and 95 males (mean age = 57.5 ± 17.7 [range 18-101] years) with 103 C3.1-, 45 C3.2-, and 53 C3.3-type fractures were included. On the lateral, medial, and superior humeral surfaces, fracture lines and comminution zones were distributed differently in 3 groups. Tuberculum minus and medial calcar region were significantly less severely affected in C3.1 and C3.2 fractures than C3.3 fractures. The supraspinatus footprint was the most severely affected rotator cuff footprint area. CONCLUSIONS Specifically defining the certain differences for repeatable fracture patterns and comminution zones in OTA/AO 11C3-type fractures and the relationship between the rotator cuff footprint and the joint capsule may contribute to the decision-making process of surgeons.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Private Safa Hospital, Zafer Mah. Ahmet Yesevi Cad. Gümüş Sk. No: 11A, Bahcelievler, 34194, Istanbul, Turkey.
| | - Sinan Oguzkaya
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
| | - Gökay Eken
- Department of Orthopaedics and Traumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sebati Baser Canbaz
- Department of Orthopaedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Fu H, Wu J, Wu X. Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar. Orthop Surg 2023; 15:2007-2015. [PMID: 36514186 PMCID: PMC10432444 DOI: 10.1111/os.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Restoration of the medial support is especially important for the treatment of proximal humeral fractures. The objective of this study was to investigate the radiographic and clinical outcomes of intramedullary nail fixation with a special focus on the presence of calcar comminution. METHODS In this retrospective study of patients with displaced proximal humeral fractures that were treated by intramedullary nail between January 2018 and July 2021, fracture morphology and the calcar integrity were noted on preoperative radiographs. Patients were divided into two groups according to calcar integrity. During follow-up, radiological assessment and functional outcome, including the deltoid tuberosity index (DTI), neck shaft angle (NSA), visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, active and passive range of motion, were performed. A Student t-test and univariate logistic regression analysis was used. RESULTS A total of 83 patients (54 female, 29 male) had complete follow-up (average, 12.8 months; range, 10 to 33 months) and functional assessment in our study. The average age was 58.6 years (range, 20 to 89 years). The mean loss of NSA was 4° (range, 0°-12°) and no significant difference was found between two groups (p = 0.27). DTI had an average of 1.50 ± 0.19 (range 1.13-2.04). Patients with intact calcar achieved greater range of forward elevation (129.06 ± 11.91 vs. 121.05 ± 11.97, p = 0.01), and higher SST scores (8.61 ± 1.85 vs. 7.37 ± 2.22, p = 0.02). Two groups showed similar outcomes in VAS, ASES score, and range of abduction. One patient demonstrated a proximal interlocking screw cutting through and osteonecrosis of the humeral head, who underwent a second surgery for screw removal. There were no cases of infection, malunion, nonunion, nerve injury, subacromial impingement, or rotator cuff tear during the study period. CONCLUSION Intramedullary nail can favorably be used to manage proximal humeral fractures with good early radiographic and functional outcomes, even for those with comminuted calcar.
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Affiliation(s)
- Huichao Fu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
| | - Jianhong Wu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
| | - Xiaoming Wu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
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Krasney LC, Rennie C, Brustein J, Naylor B. Rare finding of axillary artery dissection secondary to a proximal humerus fracture-dislocation: A case report. Trauma Case Rep 2023; 45:100828. [PMID: 37096136 PMCID: PMC10122036 DOI: 10.1016/j.tcr.2023.100828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
Case Proximal humerus fractures are a relatively common injury, making up approximately 5 % of all extremity fractures. Concurrent damage to the axillary artery, however, is not a commonly associated trauma. We present a unique case of a proximal humerus fracture-dislocation resulting in an axillary artery dissection and upper extremity ischemia, requiring emergent vascular intervention. Conclusion Axillary artery injury secondary to a proximal humerus fracture-dislocation is a rare, but possibly devastating complication. A thorough physical examination to identify any neurovascular deficits is critical in determining an optimal and timely resolution.
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Affiliation(s)
- Leighann C. Krasney
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA, United States of America
- Corresponding author at: 4300 Londonderry Road, Harrisburg, PA 17109, United States of America.
| | - Christopher Rennie
- Nova Southeastern University College of Osteopathic Medicine, Tampa, FL, United States of America
| | - Jason Brustein
- Resurgens Orthopaedics, Atlanta, GA, United States of America
| | - Brandon Naylor
- Northside Hospital, Atlanta, GA, United States of America
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Wu Z, Shen W. An updated systematic review and meta‑analysis comparing deltoid‑split approach with deltopectoral approach for proximal humerus fractures. Exp Ther Med 2023; 25:296. [PMID: 37229316 PMCID: PMC10203753 DOI: 10.3892/etm.2023.11995] [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] [Received: 11/23/2022] [Accepted: 03/15/2023] [Indexed: 05/27/2023] Open
Abstract
The present review and meta-analysis aimed to summarize the currently available data and to compare the important clinical and functional outcomes in patients with proximal humerus fractures who were treated using deltoid split (DS) or deltopectoral (DP) surgical approaches. The PubMed, EMBASE, Scopus and Cochrane Central Register of Controlled Trials databases were systematically searched for randomized controlled trials or observational studies that reported functional outcome data of patients with fracture of proximal humerus who were surgically treated using DS and DP approaches. A total of 14 studies were included in the present meta-analysis. The duration of surgery [min; weighted mean difference (WMD), -16.44; 95% CI, -(25.25-7.63)], amount of blood loss [ml; WMD, -57.99; 95% CI, -(102.74-13.23)] and time to bone union [weeks WMD, -1.66; 95% CI, -(2.30-1.02)] was comparatively lower in patients that underwent DS. There were no statistically significant differences in the pain and quality of life scores, range of movement and risk of complications between the DS and the DP groups. Patients in the DS group had improved shoulder function and constant shoulder score (CSS) at 3 months post-surgery (WMD, 6.36; 95% CI, 1.06-11.65). No differences were observed between the two groups in terms of CSS and disabilities of the arm, shoulder and hand scores at 12 and 24 months post-operatively. The activity of daily living (ADL) score was significantly improved in the DS group at 3 (WMD, 1.23; 95% CI, 0.40-2.06), 6 (WMD, 0.99; 95% CI, 0.72-1.25) and 12 months (WMD, 0.83; 95% CI, 0.18-1.47) after the surgery. The present results suggested that DS and DP surgical approaches were associated with similar clinical outcomes. The DS approach was associated with certain perioperative benefits, as well as reduced time to bone union, improved shoulder function in the early postoperative period and improved ADL scores. These benefits may be considered while choosing between these two surgical approaches.
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Affiliation(s)
- Zhe Wu
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Wenting Shen
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang 313000, P.R. China
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Lanzetti RM, Gaj E, Berlinberg EJ, Patel HH, Spoliti M. Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years. Clin Orthop Relat Res 2023; 481:735-747. [PMID: 36383078 PMCID: PMC10013660 DOI: 10.1097/corr.0000000000002480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Proximal humeral fractures are traditionally treated with open reduction and internal fixation (ORIF), but reverse total shoulder arthroplasty (RTSA) has emerged as an increasingly popular treatment option. Although ORIF with angular locking plates is a common treatment for proximal humerus fractures, prior reports suggest high failure and complication rates. Although RTSA has become an increasingly popular option for complex proximal humeral head fractures given its low complication rates, there are concerns it may lead to limited postoperative ROM. Thus, the optimal treatment for patients older than 70 years from a functional and radiographic perspective remains unclear. QUESTIONS/PURPOSES (1) In patients older than 70 years with three-part and four-part proximal humerus fractures, does RTSA result in better functional outcome scores (Constant, American Shoulder and Elbow Surgeons [ASES], and DASH scores) than ORIF with a locking plate? (2) Does RTSA result in greater ROM than ORIF? (3) Does RTSA result in a lower risk of complications than ORIF? (4) In patients with either procedure, what are the rates of negative radiographic outcomes in those treated with ORIF (such as malunion, bone resorption, malalignment, or avascular necrosis) or those with RTSA (such as resorption, notching, and loosening)? (5) At a minimum of 2 years of follow-up, does ORIF result in a greater number of revision procedures than RTSA? METHODS Between January 1, 2013, and June 30, 2018, we treated 235 patients for a proximal humeral fracture. We considered only patients without previous ipsilateral fracture or surgery, other fractures, or radial nerve injuries; age older than 70 years; and patients without neurologic disease or cognitive dysfunction as potentially eligible. Sixty-nine percent (162 patients) of the patients were eligible; a further 31% (73 patients) were excluded because 18% (13 of 73 patients) did not meet the inclusion criteria, 62% (45 patients) underwent nonoperative treatment, and 21% (15 patients) declined to participate. Patients were nonrandomly allocated to receive RTSA if they had supraspinatus Goutallier/Fuchs Grade 3 or 4 atrophy or ORIF if they had supraspinatus Goutallier/Fuchs Grade 1 or 2 atrophy. This left 81 patients who were treated with RTSA and another 81 patients who were treated with ORIF. Among the 81 patients treated with RTSA, 11% (nine patients) were lost to the minimum study follow-up of 2 years or had incomplete datasets, leaving 89% (72 patients) for analysis. Among the 81 patients treated with ORIF, 19% (15 patients) were lost before the minimal study follow-up of 2 years or had incomplete datasets, leaving 82% (66 patients) for analysis. The median follow-up for both groups was 53 months (range 24 to 72 months). The mean age was 76 ± 2.9 years in the RTSA group and 73 ± 2.9 years in the ORIF group. In the RTSA group, 27 patients had a three-part fracture and 45 patients had a four-part fracture. In the ORIF group, 24 patients had three-part fractures and 42 patients had four-part fractures (p = 0.48). Shoulder function was assessed using functional outcome questionnaires (ASES, DASH, and Constant) and active ROM measurements. A surgical complication was defined as any instance of dislocations, fractures, adhesive capsulitis, nerve injuries, or surgical site infections. Radiographic outcomes after ORIF (malunion, tuberosity resorption, or avascular necrosis) and RTSA (notching and osteolysis) were assessed. In calculating the revision rate, we considered unplanned revision procedures only. RESULTS Compared with patients treated with ORIF, patients treated with RTSA had superior improvements in Constant (85.0 ± 7.0 versus 53.0 ± 5.0; mean difference 32 [95% CI 30 to 34]; p < 0.01), ASES (46.3 ± 3.7 versus 30.0 ± 3.5; mean difference 16 [95% CI 15 to 18]; p < 0.01), and DASH scores (40.5 ± 4.2 versus 30.5 ± 2.6; mean difference 10 [95% CI 9 to 11]; p < 0.01). The mean elevation was 135° ± 7° for patients with RTSA and 100° ± 6° for patients with ORIF (mean difference 35 o [95% CI 33 to 37]; p < 0.01). The mean abduction was 131° ± 7° for patients with RTSA and 104° ± 6° for those with ORIF (mean difference 27 o [95% CI 25° to 29°]; p < 0.01). The mean external rotation was 85° ± 5° for patients with RTSA and 64° ± 5° for those with ORIF (mean difference 21° [95% CI 19° to 23°]; p < 0.01). The mean internal rotation was 45° ± 6° for patients with RTSA and 40° ± 6° for those with ORIF (mean difference 5° [95% CI 3° to 7°]; p < 0.01). The risk of complications was not different between patients with ORIF and those with RTSA (5% [three of 66] versus 1% [one of 72]; relative risk 3.3 [95% CI 0.3 to 30.7]; p = 0.30). Among patients with ORIF, 8% had varus malunions (five of 66), 6% had resorption of the greater tuberosity (four of 66), and 2% had avascular necrosis of the humeral head (one of 66). In the RTSA group, 24% (17 of 72 patients) demonstrated reabsorption of periprosthetic bone and 79% of patients (57 of 72) exhibited no notching. The risk of revision was not different between the RTSA and ORIF groups (0% [0 of 72] versus 9% [six of 66]; relative risk 0.07 [95% CI 0.0 to 1.2]; p = 0.07). CONCLUSION In patients older than 70 years with three-part and four-part proximal humerus fractures, primary RTSA resulted in better patient-reported outcome scores and better ROM than ORIF with an angular stable locking plate. Our findings might help surgeons decide between internal fixation and arthroplasty to surgically treat these injuries in older patients. Although RTSA seems to be a preferable treatment modality in view of these findings, longer follow-up is required to evaluate its longevity compared with ORIF with an angular locking plate. Dissimilar to ORIF, which is generally stable once healed, arthroplasties are at a continued risk for loosening and infection even after healing is complete. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Riccardo Maria Lanzetti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, San Camillo-Forlanini Hospital, Rome, Italy
| | - Edoardo Gaj
- San Andrea Hospital, University of Rome “Sapienza,” Rome, Italy
- Ospedale Israelitico di Roma, Rome, Italy
| | - Elyse J. Berlinberg
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Harsh H. Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, San Camillo-Forlanini Hospital, Rome, Italy
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Ratajczak K, Szczęsny G, Tomaszewski W. Stabilization of Comminuted Fractures of the Proximal Humerus with Intramedullary Nails and Angularly Stable Locking Plates—Functional Results before and during the SARS-COVID-19 Pandemics. Medicina (B Aires) 2023; 59:medicina59030575. [PMID: 36984576 PMCID: PMC10054681 DOI: 10.3390/medicina59030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life—being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. Materials and Methods: Investigations were performed on 112 adult patients with Neer’s three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evidence of bone union, humeral neck–shaft angle (NSA) and implant placement. Limb function was assessed with the QuickDash and Constant–Murley scores. Data obtained from patients treated in the COVID-19 pandemic were compared with those obtained before the pandemic. Results: The healing of all fractures was satisfactory, but complications developed in six cases. Three patients required secondary interventions due to inadequate repositioning: one after IMN and two after ASP. Additionally, one ASP was complicated by the secondary destabilization of a primarily properly stabilized major tubercle, and in two cases by conflict of the protruding implant with the acromion. ASP was noted to provide better functional results during the COVID-19 pandemic according to the Constant–Murley score (p = 0.0048; Student’s t-test). No significant differences were observed in the pre-COVID-19 pandemic. Conclusions: Our results suggest that ASP is more beneficial for the stabilization of comminuted fractures of the proximal humerus during the COVID-19 pandemic.
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Affiliation(s)
- Karol Ratajczak
- Department of Orthopedic Surgery and Traumatology, Medical University, 02-005 Warsaw, Poland
| | - Grzegorz Szczęsny
- Department of Orthopedic Surgery and Traumatology, Medical University, 02-005 Warsaw, Poland
- Correspondence: ; Tel.: +48-501-167-475
| | - Wiesław Tomaszewski
- ARS MEDICA Foundation for Medical Education and Promotion of Health, Art and Culture, 04-036 Warsaw, Poland
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12
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Entessari M, Bar-Eli H, Bernal J. A Case of Proximal Humerus Fracture Dislocation Presenting With Failed Primary Open Reduction and Internal Fixation Followed by Salvage Reverse Total Shoulder Arthroplasty. Cureus 2022; 14:e29407. [DOI: 10.7759/cureus.29407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
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13
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Spek RWA, Hoogervorst LA, Elias MEC, Jaarsma RL, Veeger DHEJ, Doornberg JN, Jutte PC, van den Bekerom MPJ. Management of displaced humeral surgical neck fractures in daily clinical practice: hanging does not re-align the fracture. Arch Orthop Trauma Surg 2022; 143:3119-3128. [PMID: 35840714 DOI: 10.1007/s00402-022-04545-8] [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: 02/11/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION It is unclear if the collar and cuff treatment improve alignment in displaced surgical neck fractures of the proximal humerus. Therefore, this study evaluated if the neckshaft angle and extent of displacement would improve between trauma and onset of radiographically visible callus in non-operatively treated surgical neck fractures (Boileau type A, B, C). MATERIALS AND METHODS A consecutive series of patients (≥ 18 years old) were retrospectively evaluated from a level 1 trauma center in Australia (inclusion period: 2016-2020) and a level 2 trauma center in the Netherlands (inclusion period: 2004 to 2018). Patients were included if they sustained a Boileau-type fracture and underwent initial non-operative treatment. The first radiograph had to be obtained within 24 h after the initial injury and the follow-up radiograph(s) 1 week after trauma and before the start of radiographically visible callus. On each radiograph, the maximal medial gap (MMG), maximal lateral gap (MLG), and neck-shaft angle (NSA) were measured. Linear mixed modelling was performed to evaluate if these measurements would improve over time. RESULTS Sixty-seven patients were included: 25 type A, 11 type B, and 31 type C fractures. The mean age (range) was 68 years (24-93), and the mean number (range) of follow-up radiographs per patient was 1 (1-4). Linear mixed modelling on both MMG and MLG revealed no improvement during follow-up among the three groups. Mean NSA of type A fractures improved significantly from 161° at trauma to 152° at last follow-up (p-value = 0.004). CONCLUSIONS Apart from humeral head angulation improvement in type A, there is no increase nor reduction in displacement among the three fracture patterns. Therefore, it is advised that surgical decision-making should be performed immediately after trauma. LEVEL OF CLINICAL EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Reinier W A Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia. .,Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands. .,Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
| | - Lotje A Hoogervorst
- Department of Orthopaedic Surgery, Department of Biomedical Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Flinders Dr, Bedford Park, Adelaide, 5042, Australia
| | - DirkJan H E J Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Michel P J van den Bekerom
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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14
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Comparison of 30-day complications between reverse shoulder arthroplasty and open reduction internal fixation for the treatment of proximal humerus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1117-1124. [PMID: 35429276 DOI: 10.1007/s00590-022-03260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While the use of open reduction internal fixation (ORIF) has remained stable over the last decade, there has been a significant increase in the use of reverse total shoulder arthroplasty (RTSA) for proximal humerus fractures (PHFs). This study sought to compare the complication profiles of RTSA to ORIF in a large, validated, retrospective cohort. METHODS Patients who underwent surgical treatment for PHFs with RTSA or ORIF were identified in a national database (NSQIP) using CPT and ICD codes. Demographics and comorbidities were identified for each cohort of patients. Thirty-day complications were analyzed with univariate and multivariate analyses using Chi-square, Fischer's exact and analysis of variance testing. RESULTS The total number of patients included in this study was 2157.522 (24.2%) underwent RTSA and 1635 (75.8%) underwent ORIF. Patients undergoing RTSA were older with an average age of 73.52 years compared with 63.84 years in those undergoing ORIF (p < 0.001). Patients with RTSA were more likely to experience any complications (p < 0.001), pulmonary complications (p = 0.029), extended length of stay > 3 days (p < 0.001), and perioperative transfusion requirement (p < 0.001) after univariate analysis. After controlling for demographic differences, the only statistically significant complication was perioperative transfusion requirement (OR 1.383). CONCLUSION After controlling for demographic variables and comorbidities, RTSA placed patients at increased risk for perioperative blood transfusion. Patients undergoing RTSA should be counseled prior to surgery regarding the risk for transfusion and potentially optimized medically through multidisciplinary care if the surgeon elects to proceed with RTSA versus ORIF for the treatment of PHFs.
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15
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Ling K, Kashanchi KI, VanHelmond T, Nazemi A, Kim M, Komatsu DE, Wang ED. Readmission, Reoperation, and Non-home Discharge Rates in Patients Receiving Surgical Treatment for Proximal Humerus Fractures. JSES Int 2022; 6:573-580. [PMID: 35813141 PMCID: PMC9264000 DOI: 10.1016/j.jseint.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Proximal humerus fractures (PHFs) are generally surgically treated with open reduction internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA). Diverse fracture patterns and a high prevalence in the elderly population make it difficult to establish objective guidelines for the decision to undergo surgical treatment. The purpose of this study was to investigate risk factors associated with readmission, reoperation, and nonhome discharge following ORIF, HA, and TSA for PHFs. Methods Data on all patients who underwent ORIF, TSA, or HA for treatment of closed PHF between 2015 and 2017 were obtained by querying the American College of Surgeons National Surgical Quality Improvement database. Rates of postoperative readmission, nonhome discharge, and reoperation within 30 days were collected. Multivariate logistic regression was employed to identify predictors of readmission, nonhome discharge, and reoperation. Results A total of 2825 patients were included in this study: 1829 underwent ORIF, 707 underwent TSA, and 289 underwent HA. The significant predictors for readmission were having an American Society of Anesthesiologists class ≥ 3 (odds ratio [OR] 1.95, P = .003) and being of dependent functional status (OR 3.15, P < .001). The significant predictors for reoperation were male sex (OR 2.41, P < .001) and dependent functional status (OR 2.92, P = .006). The significant predictors for nonhome discharge were age 66-80 years (OR 7.00, P < .001), age ≥ 81 years (OR 16.31, P < .001), American Society of Anesthesiologists ≥3 (OR 2.34, P < .001), dependent functional status (OR 2.48, P < .001), and inpatient status (OR 3.32, P < .001). TSA showed slightly higher rates of nonhome discharge than HA and ORIF. Conclusion Significant risk factors for readmission, reoperation, and nonhome discharge within 30 days following surgical treatment for PHF were identified. Additionally, TSA was significantly associated with nonhome discharge compared with HA and ORIF.
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Affiliation(s)
- Kenny Ling
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kevin I. Kashanchi
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Taylor VanHelmond
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Alireza Nazemi
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
- Corresponding author: Edward D. Wang, MD, Department of Orthopaedics, Stony Brook University Hospital, HSC T-18, Room 080, Stony Brook, NY 11794-8181, USA.
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16
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Mohan K, Hintze JM, Morrissey D, Molony D. Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN.
61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity.
40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature.
In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.
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Shi X, Han M, Dai B. Medial cortical positive support: A key factor for the postoperative stability of proximal humerus fractures. Medicine (Baltimore) 2021; 100:e26073. [PMID: 34087852 PMCID: PMC8183722 DOI: 10.1097/md.0000000000026073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Treatments for proximal humerus fractures (PHFs) often fail to achieve anatomical reduction. The purpose of this study was to evaluate the role of positive medial cortical support (PMCS) in the nonanatomical reduction of PHFs.A retrospective analysis was performed of 78 patients with PHFs who underwent surgery from August 2014 to September 2017 and whose treatments did not achieve anatomical reduction. Based on the results of standard AP radiographs of the shoulders 3, 6, and 12 months after surgery, the patients were divided into PMCS or negative medial cortical support (NMCS) groups. The postsurgical change in head-shaft angle (HSA) between the 2 groups was compared. Shoulder joint function and visual analog scale (VAS) scores of the 2 groups were also compared at the same time.Of the 78 patients analyzed, 37 were in the PMCS group and, 41 in the NMCS group. There was no statistically significant difference in any of the characteristics of the 2 groups (P > .05), or in postsurgical HSA. However, the HSA of the 2 groups had become significantly different (P < .05) 3, 6, and 12 months following surgery. The changes in HSA of the 2 groups were different at various time points (P < .05). One year after surgery, the shoulder function score of the PMCS group was significantly better than that of the NMCS group, as was the VAS score (both P < .05).Patients whose surgery for PHF does not achieve anatomical reduction during surgery can undergo PMCS to achieve improved results, postoperatively. NMCS should be avoided as far as possible.
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Carlock KD, Konda SR, Bianco IR, Zuckerman JD, Egol KA. Repair of proximal humerus fracture nonunions using a standardized treatment algorithm: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1151-1159. [PMID: 33417051 DOI: 10.1007/s00590-020-02857-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonunion of fractures about the proximal humerus represents a rare and complex problem. The purpose of this study was to evaluate the clinical and functional outcomes following proximal humerus fracture (PHF) nonunion repair using a plate and screw construct with a direct comparison to those experienced following operative fixation of acute PHF using a plate and screw construct. METHODS Two separate patient cohorts were included in this study. The first consisted of 16 patients diagnosed with a non-united PHF who underwent operative nonunion repair treated with a standard algorithmic approach. The comparison group consisted of 173 patients who achieved union following initial open reduction and internal fixation of an acute PHF treated with a proximal humerus locking plate construct. All patients had at least 12 months of postoperative follow-up. Outcomes were assessed for both groups using American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale (VAS) pain scores, and postoperative shoulder range of motion (ROM). Statistical analyses were used to compare these outcome measures between the two cohorts. RESULTS The nonunion repair cohort consisted of eleven surgical neck nonunions and five nonunions of both the surgical neck and greater tuberosity. Ten patients had undergone surgical treatment for their original fracture, while six were initially treated non-operatively. All patients had Boileau type 3 sequelae of their proximal humerus fracture. Union was achieved in all patients at a mean of 5.4 months following nonunion repair. Complications included hardware failure requiring revision in two patients (12.5%) and avascular necrosis requiring conversion to anatomic total shoulder arthroplasty following union in one patient (6.3%). The nonunion repair and acute fracture cohorts did not differ with respect to mean ASES scores, VAS pain scores, or active shoulder ROM at any postoperative time point. CONCLUSION Surgical repair of PHF nonunion is a viable treatment strategy that can lead to consistent bony healing with outcomes comparable to those of patients who achieve fracture union following initial surgical repair of an acute proximal humerus fracture. Surgeons should be cognizant of mechanical considerations that may lead to early failure.
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Affiliation(s)
- Kurtis D Carlock
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, USA
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Isabella R Bianco
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, USA
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA.
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Althoff AD, Ignozzi AJ, Bell JE, Werner BC. Pre-operative Hypoalbuminemia Is Associated with Complications Following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients. HSS J 2020; 16:436-442. [PMID: 33380978 PMCID: PMC7749917 DOI: 10.1007/s11420-020-09804-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proximal humerus fractures are among the most common presenting fractures to orthopedic surgeons in the USA. Hypoalbuminemia is accepted as a nutrition marker associated with post-operative complications following common orthopedic interventions. QUESTIONS/PURPOSES Thus, the authors sought to (1) describe the national demographic trends of patients undergoing surgical fixation for proximal humerus fracture and (2) investigate the association between pre-operative hypoalbuminemia, a malnutrition marker, and post-operative complications within 1 year of surgical intervention. METHODS The PearlDiver Humana Claims Database was queried to identify a nationally representative cohort of patients who underwent surgical intervention for proximal humerus fractures from 2008 to 2015. Demographic and comorbid characteristics were collected. Pearson's χ-squared analysis was used to compare rates of 90-day and 1-year outcomes between hypoalbuminemia (albumin ≤ 3.5 mg/dL) and control groups. Multivariate logistic regression was then used to determine the isolated effect that hypoalbuminemia had on post-operative outcomes. RESULTS Of the 3337 patients identified, 919 (27.5%) had available serum albumin data. Seventy (7.6%) patients had hypoalbuminemia. Hypoalbuminemia was more likely to be associated with post-operative sepsis (7.1% vs. 1.5%, respectively) and pneumonia (15.7% vs. 4.6) compared with controls. Additionally, hypoalbuminemia was associated with increased 90-day rates of discharge to extended care (4.3% vs. 0.8), emergency room visits (38.6% vs. 21.7), and total cost ($24,051.96 ± 24,972.74 vs. $15,429.74 ± 24,492.30). CONCLUSION Our study suggests hypoalbuminemia is associated with an increased risk of complications, specifically pneumonia and sepsis, and total health care costs in patients undergoing surgery for proximal humerus fractures. These findings provide insight for individualized patient care that will aid in evaluating the potential risk of surgical complications in an effort to improve outcomes and reduce costs.
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Affiliation(s)
- Alyssa D. Althoff
- grid.27755.320000 0000 9136 933XDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA USA
| | - Anthony J. Ignozzi
- grid.27755.320000 0000 9136 933XDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA USA
| | - Joshua E. Bell
- grid.27755.320000 0000 9136 933XDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA USA
| | - Brian C. Werner
- grid.27755.320000 0000 9136 933XDepartment of Orthopaedic Surgery, University of Virginia, Charlottesville, VA USA
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Sun Q, Wu X, Wang L, Cai M. The plate fixation strategy of complex proximal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1785-1795. [PMID: 32535700 DOI: 10.1007/s00264-020-04544-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate fixation is still a preference and the proper selection of its strategy for each individual seems to be essential. METHOD The available classification system of the fracture, determination of surgical intervention, the common complications and related causes, and the latest critical surgical strategies with locking plate fixation were discussed in this review. RESULTS The frequent complications with complex proximal humeral fractures after operative treatment present a great challenge to orthopedic surgeons. In order to maintain the stability of locking plate fixation, several options including calcar screw, bone graft, bone cement augmentation, dual plate fixation, and fracture impaction were available for restoration of medial support. CONCLUSION Restoration of medial support seems of importance to provide solid stability and reduced complication for the complex fractures with fixation of locking plates.
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Affiliation(s)
- Qi Sun
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Xiaoming Wu
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Lei Wang
- Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Ming Cai
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, 200072, China.
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21
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Pogliacomi F, Malagutti G, Menozzi M, Colacicco A, Ceccarelli F, Vaienti E, Calderazzi F. Antegrade intramedullary nailing in proximal humeral fractures: results of 23 cases. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:209-216. [PMID: 32555099 PMCID: PMC7944828 DOI: 10.23750/abm.v91i4-s.9650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 11/23/2022]
Abstract
Introduction: the metaepiphyseal fractures of the proximal humerus represent 5% of all fractures and mainly affect elderly patients. The type of treatment remains controversial. This retrospective study aimed to evaluate the clinic and radiographic results of 23 patients affected by two or three fragments fractures of the proximal humerus with or without metaphyseal extension treated with antegrade intramedullary nailing. Materials and Methods: all patients were clinically evaluated using the “Constant score” (CS) and individual satisfaction was assessed with a visual scale (VS). Moreover, the fracture’s healing process and the neck shaft angle (NSA) were assessed radiographically. Results: the mean follow-up was 72 months (24-120). Clinical evaluation and individual satisfaction were positive in most cases (mean CS 79,39 and VS 3,17). Worse results were observed in patients over 65 years. Discussion: among the different surgical options intramedullary nailing ensures good fracture stability and high consolidation rate. The entry point through the rotator cuff is of main importance as well as proximal nail positioning and choice of the locking screws length. In this study the functional results of the shoulder were worse in the elderly, who were supposed to have already a degenerated rotator cuff. Conclusions: antegrade intramedullary nailing should be considered a valid therapeutic option in this type of fractures. The surgical technique may influence functional results, as consequence of iatrogenic damage of the rotator cuff. (www.actabiomedica.it)
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Affiliation(s)
- Francesco Pogliacomi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Giovanni Malagutti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Margherita Menozzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Alessandra Colacicco
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Francesco Ceccarelli
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
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22
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Malik AT, Barlow JD, Jain N, Khan SN. Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures. Shoulder Elbow 2019; 11:430-439. [PMID: 32269603 PMCID: PMC7094066 DOI: 10.1177/1758573218809505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. METHODS The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. RESULTS Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. CONCLUSION The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.
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Affiliation(s)
| | | | | | - Safdar N Khan
- Safdar N Khan, Department of Orthopaedic
Surgery, Wexner Medical Center at The Ohio State University Columbus, Ohio, USA.
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23
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Maugendre E, Gadisseux B, Chantelot C, Clavert P, Ramdane N, Werthel JD, Boileau P. Epidemiology and mortality in older patients treated by reverse shoulder arthroplasty for displaced proximal humerus fractures. Orthop Traumatol Surg Res 2019; 105:1509-1513. [PMID: 31732395 DOI: 10.1016/j.otsr.2019.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is rapidly becoming the preferred treatment for displaced proximal humerus fractures in older patients. However, few studies have analyzed the target population and the effect of RSA on survival, although the socioeconomic impact of this type of surgery is considerable. PATIENTS AND METHODS This was a retrospective epidemiological study of all patients with a displaced proximal humeral fracture treated by RSA in 14 public and private hospitals throughout France between 1995 and 2016. The French hospital discharge database (PMSI) was analyzed to isolate an 898-patient cohort who underwent RSA within 6 weeks of the fracture event. In 87% of cases, this was a 3- or 4-fragment fracture. We analyzed the epidemiological characteristics of the patients at the time of fracture, their survival (Kaplan-Meier estimate) and factors that may impact survival. RESULTS The mean age at the time of fracture and surgery was 79 years (46-98 years). Eighty percent of the cohort was female (sex ratio: 0.18 [p=0.0042], with 21% obesity rate [BMI>30]) and 60% of patients were ASA 1-2. The most common comorbidities were cardiovascular and neurological. The survival rate after RSA was 94% at 1 year and 73% at 5years. At the latest follow-up of 19 years, 42% of patients were still alive. In 18% of cases, the patient died within the first 15 days. The presence of comorbidities (ASA score>3-4) (p<0.004) and/or cognitive disorders (p<0.0001) were risk factors for early mortality. The time to surgery, type of fracture, associated fractures and discharge destination (return home, transfer to nursing home) had no effect on postoperative mortality in our cohort. CONCLUSION Despite being older (79 years) at the time of proximal humerus fracture, patients who underwent RSA treatment had a high survival rate (94% at 1 year, 73% at 5years), which is better than the survivorship reported after surgical treatment of femoral neck fractures (81-87% at 1 year, 38% at 5years). The presence of comorbidities (ASA>3-4) and/or cognitive disorders are risk factors for early mortality and should be taken into account to prevent early death. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Emmanuel Maugendre
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Benjamin Gadisseux
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Christophe Chantelot
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Philippe Clavert
- Service d'orthopédie-traumatologie, centre de chirurgie orthopédique et de la main, service de chirurgie orthopédique, avenue Baumann, 67400 Illkirch, France
| | - Nassima Ramdane
- EA 2694 - santé publique: épidémiologie et qualité des soins, université de Lille, CHU de Lille, 59000 Lille, France
| | - Jean-David Werthel
- Hôpital Ambroise-Paré Paris, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Pascal Boileau
- iULS - Institut universitaire locomoteur and sport, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
| | -
- Société française de chirurgie orthopédique et traumatologique, 56, rue Boissonade, 75014 Paris, France
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Zhao L, Qi YM, Yang L, Wang GR, Zheng SN, Wang Q, Liang B, Jiang CZ. Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three- or Four-part Proximal Humerus Fractures in the Elderly. Orthop Surg 2019; 11:1003-1012. [PMID: 31762222 PMCID: PMC6904636 DOI: 10.1111/os.12564] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 01/28/2023] Open
Abstract
Objective To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three‐ and four‐part proximal humerus fractures (PHF) in the elderly. Methods From January 2014 to January 2018, a total of 42 elderly patients with Neer three‐ or four‐part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant‐Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm‐Shoulder‐Hand (DASH) score. Radiological results were evaluated using the neck‐shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group. Results There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow‐up time was 12 months. At the last follow‐up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups. Conclusions For Neer three‐ or four‐part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short‐term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.
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Affiliation(s)
- Lei Zhao
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-Min Qi
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Yang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Gang-Rui Wang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Sheng-Nai Zheng
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qiang Wang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Bin Liang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chun-Zhi Jiang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Grünewald D, Langenmair E, Hirschmüller A, Maier D, Südkamp NP, Konstantinidis L. Biomechanical in vitro evaluation of a ready-to-use calcium phosphate cement implanted to augment intramedullary nail fixation of a three-part humeral head fracture model. Proc Inst Mech Eng H 2019; 233:706-711. [PMID: 31064313 DOI: 10.1177/0954411919848625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was the dynamic biomechanical evaluation of a ready-to-use oil-based calcium phosphate cement paste implanted to augment intramedullary nail fixation of a three-part humeral head fracture model. Fractures in the osteoporotic bone are often fractures of the proximal humerus. Secondary fracture displacements due to cut-out in osteoporotic bone have been observed in up to 13% of cases. Procedures have been developed to augment fracture fixation with polymethylmethacrylate to increase stability, but there are still unsolved challenges relating to its material-specific properties. Calcium phosphate cement could be a biological alternative in the augmentation of osteoporotic fractures because of its more favourable material properties. Fracture fixation was performed on eight pairs of human cadaveric bones to stabilize a standardized three-part humeral head fracture model by implantation of the Targon® PH (Braun-Aesculap AG, Tuttlingen, Germany) intramedullary nail and insertion of three head screws and two bicortical shaft screws. The procedure was randomized, and one bone of each pair received calcium phosphate cement augmentation. Custom-made cannulated screws with an open lateral slot facilitated augmentation, making it possible to cement the threaded portion of the screw (1-mL calcium phosphate cement/screw). After the calcium phosphate cement had hardened, the humeri were subjected to dynamic axial loading. Load was progressively increased, monitored by ultrasound-based motion analysis, and total deformation was recorded. Load testing continued until implant failure. The augmented group withstood significantly more cycles before implant failure. The average initial stiffness showed a significant difference between the two study groups. Ultrasonic sensor technology was used to measure angular displacement during testing and a significant difference was found. Calcium phosphate cement offers a potential alternative to implant augmentation in the treatment of osteoporotic humeral head fractures. Future studies are required to confirm these observations clinically in vivo.
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Affiliation(s)
- Dag Grünewald
- 1 Department of Orthopaedics and Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Elia Langenmair
- 2 Department of Orthopaedics and Trauma Surgery, Loretto-Krankenhaus Freiburg, Freiburg im Breisgau, Germany
| | - Anja Hirschmüller
- 3 Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Dirk Maier
- 3 Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Norbert P Südkamp
- 3 Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Lukas Konstantinidis
- 3 Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
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The Augment of the Stability in Locking Compression Plate with Intramedullary Fibular Allograft for Proximal Humerus Fractures in Elderly People. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3130625. [PMID: 30306087 PMCID: PMC6165610 DOI: 10.1155/2018/3130625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/12/2018] [Indexed: 11/17/2022]
Abstract
Objective The objective of this study was to compare the clinical outcomes and complications between the locking compression plate (LCP) and LCP with fibular allograft in the treatment of patients with displaced proximal humerus fracture (PHF) in elderly people. Material and Methods Between January 2010 and December 2013, a total of 97 elderly patients with displaced PHF were treated by LCP or LCP with fibular allograft, and finally 89 patients were included in our study. All the patients were divided into Group I (patients treated by LCP) and Group II (patients treated by LCP with fibular allograft). Function results were assessed by the disability of the arm, shoulder, and hand (DASH) score and Constant-Murley score (CMS), and complications were also recorded in each group. Results The average follow-up was 35.2 months (range, 24-48 months) in Group I and 33.5 months (range, 24-48 months) in Group II. DASH in patients of Group I was significantly higher than that in patients in Group II and patients of Group I had CMS scores significantly lower than patients in Group II (P<0.05). The rates of varus malunion, screw perforation, and loss of reduction>5mm were significantly higher in Group I than in Group II (P<0.05). Conclusions The present results showed that that patients treated by LCP with fibular allograft had a better functional outcome and a lower complication rate compared to patients treated by LCP alone. Suitable void filler in the proximal humerus for supporting the head fragment, medial cortical bone, and greater tuberosity might play a key role in reducing the incidence of the complications in elderly patients, especially with osteoporosis.
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27
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Zeng LQ, Zeng LL, Jiang YW, Wei HF, Zhang W, Chen YF. Influence of Medial Support Screws on the Maintenance of Fracture Reduction after Locked Plating of Proximal Humerus Fractures. Chin Med J (Engl) 2018; 131:1827-1833. [PMID: 30058580 PMCID: PMC6071468 DOI: 10.4103/0366-6999.237396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows: 75 patients in the medial cortical support (MCS) group, 26 patients in the medial multiscrew support (MMSS) group, 29 patients in the medial single screw support (MSSS) group, and 51 patients in the no medial support (NMS) group. Clinical and radiographic evaluations included the Constant-Murley score (CM), visual analogue scale (VAS), complications, and revision surgeries. The neck-shaft angle (NSA) was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or Kruskal-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher's exact test was used for categorical data. Results The mean postoperative NSAs were 133.46° ± 6.01°, 132.39° ± 7.77°, 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found (F = 1.02, P = 0.387). In the final follow-up, the NSAs were 132.79° ± 6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 4.40, P = 0.008). There were marked differences in the NSA at the final follow-up between the MCS and NMS groups (P = 0.004). The median (interquartile range [IQR]) NSA losses were 0.0° (0.0-1.0)°, 1.3° (0.0-3.1)°, 1.5° (1.0-5.2)°, and 4.0° (1.2-7.1)° in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 60.66, P < 0.001). There were marked differences in NSA loss between the MCS and the other three groups (MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P < 0.001; and MCS vs. NMS, Z = 7.34, P < 0.001). There was also significantly less NSA loss observed in the MMSS group compared to the NMS group (Z = -3.16, P = 0.002). However, there were no significant differences between the MMSS and MSSS groups (Z = -1.65, P = 0.225) or the MSSS and NMS groups (Z = -1.21, P = 0.099). The average CM scores were 81.35 ± 9.79, 78.04 ± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively (F = 18.68, P < 0.001). The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively (χ2 = 29.25, P < 0.001). The median (IQR) VAS scores were 1 (0-2), 1 (0-2), 2 (1-3), and 3 (1-5) points in the MCS, MMSS, MSSS, and NMS groups, respectively (H = 27.80, P < 0.001). Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups (for CM scores: MCS vs. MSSS, P < 0.001; MCS vs. NMS, P < 0.001; MMSS vs. MSSS, P = 0.031; and MMSS vs. NMS, P < 0.001 and for VAS values: MCS vs. MSSS, Z = 3.31, P = 0.001; MCS vs. NMS, Z = 4.64, P < 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037; and MMSS vs. NMS, Z = -3.16, P = 0.003). Conclusions Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.
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Affiliation(s)
- Lang-Qing Zeng
- Department of Orthopaedics, Zhuhai City People's Hospital, Jinan University Affiliated Zhuhai Hospital, Jinan University, Zhuhai, Guangdong 519000, China
| | - Lu-Lu Zeng
- Department of Anesthesiology, Zhuhai City People's Hospital, Jinan University Affiliated Zhuhai Hospital, Jinan University, Zhuhai, Guangdong 519000, China
| | - Yu-Wen Jiang
- Department of Orthopaedics, Zhuhai City People's Hospital, Jinan University Affiliated Zhuhai Hospital, Jinan University, Zhuhai, Guangdong 519000, China
| | - Hai-Feng Wei
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wen Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yun-Feng Chen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Abstract
STUDY DESIGN Clinical commentary. INTRODUCTION Proximal humeral fractures (PHF) are the third most common fracture in the elderly with an increased incidence expected in the coming years with the aging population, causing an important burden to the healthcare system. The management of PHF is challenging due to its complexity and the wide variety of fractures and treatment options. PURPOSE The objective of this clinical commentary is to update the available evidence on clinical presentation, classification, imaging, medical treatment, and rehabilitation of acute PHF. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The first step to a successful management of PHF is the clinical and radiographic examination of the shoulder, which enables the physician to classify the fracture and choose the appropriate treatment option. The Neer and OA classifications are commonly used and are based on the identification of the fractured parts of the humerus, as well as the displacement of the fragments. In case of non-displaced or minimally displaced fractures, a conservative treatment, consisting of initial immobilization and a rehabilitation program will be chosen. Displaced or unstable fractures will be managed operatively. Different surgical options exist and will vary according to the fracture type, patient's age, and functional needs, followed by rehabilitation. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Véronique Lowry
- Department of Research, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Radiology Department, University of Montreal, Montreal, Quebec, Canada; Department of Research, Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Department of Research, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada; Department of Rehabilitation, School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
| | - Dominique M Rouleau
- Department of Surgery, Hôpital du Sacré-Cœur de Montréal, Montréal PQ, Canada; Department of Surgery, Université de Montréal, Montréal PQ, Canada.
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Kumar S, Sonar U, Singh I. Fragility fractures in the upper limb: proximal and distal humerus. Br J Hosp Med (Lond) 2018. [PMID: 29528748 DOI: 10.12968/hmed.2018.79.3.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of fragility fractures of the humerus is increasing worldwide. Although clinicians are aware of fractures of hips and wrists, fractures of the shoulder and elbow do not receive much attention. A considerable proportion of the elderly population (estimated at 10-24%) is dependent on walking aids. A well-functioning and pain-free shoulder and elbow is essential for use of these aids. The impact of loss of mobility in the elderly is well known, hence the overall impact of these fractures on the individual can be considerable. This article increases the awareness of these fractures among non-orthopaedic colleagues and provides a brief outline of their management. In the elderly population using walking aids, the shoulder and elbow are effectively weight-bearing joints. Fractures of the shoulder or elbow in the elderly require extra attention to maintain their mobility during this period by physiotherapy to the lower limbs and chest. In patients who mobilize using a frame, the use of a stick on the opposite side of the injury may have to be considered while recovery is in progress.
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Affiliation(s)
- Shyam Kumar
- Consultant in Trauma and Orthopaedics, Department of Orthopaedics, Royal Lancaster Infirmary, University Hospitals Morecambe Bay NHS Foundation Trust, Lancaster LA1 4RP
| | - Ulhas Sonar
- MCh Fellow in Upper Limb Surgery, Department of Orthopaedics, Royal Lancaster Infirmary, University Hospitals Morecambe Bay NHS Foundation Trust, Lancaster
| | - Iqbal Singh
- Consultant Physician in Medicine for Older People, Department of Medicine, East Lancashire Hospitals NHS Trust, Blackburn
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30
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Hao TD, Huat AWT. Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design. J Orthop Surg (Hong Kong) 2018. [PMID: 28625096 DOI: 10.1177/2309499017713934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite being a common orthopedic injury, the optimal management of proximal humeral fractures remains a topic of debate. Although intramedullary nails have been used to treat these fractures, several complications have been reported with older nail devices. We describe our surgical technique and aim to evaluate the early functional and radiological outcomes of displaced Neer's two- to four-part proximal humeral fractures undergoing fixation with a contemporary straight intramedullary nail. METHODS A prospective cohort study of 22 consecutive patients (mean age 55.7 ± 18.0) with acute displaced proximal humeral fractures underwent intramedullary nailing (Depuy Synthes MultiLoc Humeral Nail) by a single surgeon in a single institution. According to Neer's classification, 11 had two-part fractures, 9 had three-part fractures, and 2 had four-part fractures. Functional and radiological outcomes, as well as occurrence of complications, were assessed at 12 months postoperatively. RESULTS The mean Constant-Murley score and American Shoulder and Elbow Surgeons score at 12 months were 75.5 ± 12.1 and 81.7 ± 6.2, respectively. Mean range of motion was forward flexion 144.3 ± 28.4, abduction 141.3 ± 30.5, external rotation 58.0 ± 13.9, and internal rotation 62.0 ± 15.2. Mean visual analog scale score was 1.7 ± 0.8. Radiographic fracture union was achieved at a mean of 3 months post-op. One patient underwent a second surgery for screw removal due to a proximal screw backing out. No other complications were found in our cohort. Notably, no patients had clinical signs and symptoms of subacromial impingement and/or rotator cuff tear. CONCLUSION Our study demonstrated that intramedullary nailing using the contemporary straight nail design is well suited for Neer's two- and three-part proximal humeral fractures, with good early outcomes and low rates of complications. Results for four-part fractures were, however, inferior in our cohort, suggesting that further studies with larger patient numbers are needed to determine the role of intramedullary nailing for four-part fractures.
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Affiliation(s)
- Toon Dong Hao
- 1 Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
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Rollo G, Rotini R, Pichierri P, Giaracuni M, Stasi A, Macchiarola L, Bisaccia M, Meccariello L. Grafting and fixation of proximal humeral aseptic non union: a prospective case series. ACTA ACUST UNITED AC 2017; 14:298-304. [PMID: 29354157 DOI: 10.11138/ccmbm/2017.14.3.298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Fractures of the proximal part of the humerus represent almost 4-5% of all fractures. The rate of non union is estimated to be 1.1 to 10%. Non union, displacement, and fixation failure can be hazardous complications for these injuries. The purpose of our study was to evaluate the outcomes of plate and bone strut allograft with bone chips grafting augmentation in the management of proximal humeral aseptic non union. Methods We treated 16 aseptic non union proximal humeral fractures by the medial humeral shaft bone strut allograft and lateral plate and screws with bone chips grafting. The patients' ages were between 55 and 70 years. The chosen criteria to evaluate the group during the clinical and radiological follow-up were the quality of life measured by The Short Form (12) Health Survey (SF-12), shoulder function and related quality of life measured by the Constant Shoulder Score (CSS) compared with healthy side, bone healing measured by X-rays, and postoperative complications. The follow-up was perfor med with clinical and radiographic controls at 1, 3, 6 and 12 months. Surgical time and international units of red blood cells transfused were also calculated. The evaluation endpoint was set at 12 months. Results The X-rays bone healing occurred in our group on average of 126.4 days after surgery. The surgical time and blood loss were consistent with standard surgical procedures. The quality of life and functional recovery were excellent after plate and bone strut allograft. Conclusions Surgical techniques that increase mechanical stability, while incorporating bone biology, are effective aids for treating problematic fractural patterns.
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Affiliation(s)
- Giuseppe Rollo
- UOC Orthopedics and Traumatology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, "Rizzoli" Orthopedic Institute, Bologna, Italy
| | - Paolo Pichierri
- UOC Orthopedics and Traumatology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Marco Giaracuni
- UOC Orthopedics and Traumatology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Alessandro Stasi
- UOC Orthopedics and Traumatology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Luca Macchiarola
- Shoulder and Elbow Unit, "Rizzoli" Orthopedic Institute, Bologna, Italy
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Luigi Meccariello
- UOC Orthopedics and Traumatology, "Vito Fazzi" Hospital, Lecce, Italy
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The Applications of Finite Element Analysis in Proximal Humeral Fractures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:4879836. [PMID: 29081829 PMCID: PMC5610852 DOI: 10.1155/2017/4879836] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/06/2017] [Indexed: 12/18/2022]
Abstract
Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.
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Fixation of a Proximal Humeral Fracture Using a Novel Intramedullary Cage Construct following a Failed Conservative Treatment. Case Rep Orthop 2017; 2017:4347161. [PMID: 28255485 PMCID: PMC5309419 DOI: 10.1155/2017/4347161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/10/2017] [Indexed: 11/20/2022] Open
Abstract
A majority of proximal humeral fractures are preferably treated conservatively. However, surgical management may be beneficial in proximal humeral fractures with significant displacement or angulation. Unfortunately, the complication rates associated with current surgical procedures for fracture fixation, ORIF and IM devices, can be unacceptably high. A new technology, termed the PH Cage, addresses the technical limitations associated with current technologies available for fixation of proximal humeral fractures. It allows for intramedullary fixation of a PH fracture and provides direct load bearing support to the articular surface and buttresses the medial column during healing. We are presenting our first experience with the PH Cage for the fixation of a PH fracture, which had previously failed conservative management.
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D'Ambrosi R, Palumbo F, Barbato A, Facchini RM. A prospective study for the treatment of proximal humeral fractures with the Galaxy Fixation System. Musculoskelet Surg 2016; 101:11-17. [PMID: 27822870 DOI: 10.1007/s12306-016-0434-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fractures of the proximal humerus represent a common problem in clinical practice; in particular for three- or four-part fractures, there is no consensus regarding which is the best treatment. The aim of our study was to report clinical and radiological outcomes in patients treated with the Galaxy Fixation System™ for a proximal humerus fracture. MATERIALS AND METHODS Thirty-two patients of which 18 (56.25%) women, and 14 (43.75%) men suffering from proximal humerus fractures were treated using the Galaxy Fixation System™. Fractures were classified according to Neer and only patients with a three- or four-part fracture with two-thirds of the methaphysis intact were included. Clinical examination included the Constant-Murley score, UCLA score and Quick DASH evaluated at 6, 12 and 24 months after surgery. In addition, at the final follow-up, patients were asked to complete the SF-12 questionnaire. The humeral head-shaft angle was evaluated by radiographs the day after surgery, as well as after 12 and 24 months. RESULTS All 32 patients were available for the 6th, 12th and 24th month follow-up examination. The mean interval between trauma and surgery was 2.7 days (range 0-6 days). The period of hospital stay ranged from 2 to 8 days with an average of three days. The time of healing ranged from 4 to 10 weeks with an average of 7 weeks. The mean Constant score increased from 72.9 after 6 months to a mean of 82.8 at 12 months (p < 0.05) to 88.9 at 24 months (p < 0.05). UCLA score ranged from 27.5 at 6 months to 29.5 at 12 months (p < 0.05) and finally improved to 32.3 at final follow-up (p < 0.05). Quick DASH varied from 7.2 at 6 months after surgery to 5.2 at 12 months after surgery (p > 0.05) and reached the value of 3.1 after 24 months (p > 0.05). Mean Mental Component (MCS) resulted in a value of 48.1, while the Physical Component (PCS) was 52.7. The mean head-shaft angulation was 137.6° the day after surgery compared with 137.5° (p > 0.05) measured 12 months later, and 137.2° measured 24 months later (p > 0.05). CONCLUSIONS Galaxy Fixation System™ is a safe and efficient procedure for the treatment of three- or four-part proximal humerus fractures, providing an excellent outcome. LEVEL OF EVIDENCE Prospective case series, Level IV.
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Affiliation(s)
- R D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy. .,Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy.
| | - F Palumbo
- Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
| | - A Barbato
- Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
| | - R M Facchini
- Centro Traumatologico Ortopedico, U.O. Clinica Ortopedica e Traumatologica, Milan, Italy
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Blonna D, Barbasetti di Prun N, Bellato E, Manino L, Rossi R, Banche G, Allizond V, Cuffini AM, Castoldi F. Effect of surgical delay on bacterial colonization in proximal humeral fractures. J Orthop Res 2016; 34:942-8. [PMID: 26580139 DOI: 10.1002/jor.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/16/2015] [Indexed: 02/04/2023]
Abstract
Postoperative infection is a severe complication after proximal humeral fracture surgical treatment. The aim of this study was to determine if the surgical delay could modify the number and type of bacteria on the surgical site. A two stages study was set up. In the first stage the effect of delay was simulated in 20 patients affected by proximal humeral fracture treated conservatively. In a second stage, the effect of delay was measured in 20 patients that underwent surgery. In stage 1, three skin culture swabs were taken in correspondence of the deltopectoral approach, the day of the fracture (day 0), the day after (day 1), and five days after fracture (day 5). In stage 2, skin swab cultures were taken the day of trauma and immediately before surgery and cultured on various media suitable for aerobic and anaerobic bacteria. The number of bacteria increased over the course of the study, from day 0 to day 5, both considering the total number of colony-forming units and individual species of pathogen bacteria. The second stage of the study confirmed these data. An increasing number of bacteria was observed in patients that underwent surgery later than 2 days from trauma. The delay of surgery increased bacterial colonization of the skin in the deltopectoral approach area including common pathogenic bacteria such as Staphylococcus aureus, coagulase-negative staphylococci and Propionibacterium acnes. This might justify the correlation between delay to surgery and risk of infection. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:942-948, 2016.
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Affiliation(s)
- Davide Blonna
- Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy
| | - Nicola Barbasetti di Prun
- Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy
| | - Enrico Bellato
- Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy
| | - Laura Manino
- Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy
| | - Giuliana Banche
- Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Valeria Allizond
- Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Anna Maria Cuffini
- Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Filippo Castoldi
- Department of Orthopaedic and Traumatology, Città della Salute e della Scienza, CTO-Maria Adelaide Hospital, University of Turin Medical School, Turin, Italy
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Abstract
Shoulder replacement surgery is a common elective surgical procedure for those with progressive osteoarthritis and rheumatoid arthritis. This review explores the history of shoulder replacements, the different types of replacements and their advantages or disadvantages.
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Affiliation(s)
- Ahmed Mehmood
- 5th year Medical Student, UCL Medical School, University College London, London WC1E 6BT
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Chen H, Ji X, Zhang Q, Liang X, Tang P. Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures. J Orthop Surg Res 2015. [PMID: 26195025 PMCID: PMC4509847 DOI: 10.1186/s13018-015-0258-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study is to explore the clinical outcomes of anatomical allograft or fibula shaft augmentation with locking compression plates (LCPs) in elderly patients with four-part proximal humeral fracture (PHF). Methods A total of 22 elderly patients with four-part PHF underwent allograft augmentation with LCPs for treatment. Among them, 7 cases received anatomical allograft and 15 patients received fibula shaft. Constant-Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, and subjective ratings, radiographic imaging, range of motion (ROM), and complications were recorded as postoperative evaluations. Results Although the ROM and strength were considerably limited compared with the normal side, there were no significant differences in pain and daily activity between the unaffected and affected sides at the last follow-up according to the CMS. Additionally, no significant differences were found in the subjective ratings and CMS and DASH scores between the patients augmented with fibular shaft and anatomical allograft. Among the 15 patients who received fibular shaft, one case developed avascular necrosis (AVN) and screw cutout, but satisfactory outcomes were obtained after removal of implant. Besides, varus displacement occurred in one case, the patient acquired good function without revision. There were no infection, bone nonunion, and hardware-related complications occurred in any case. Conclusions Both anatomical allograft and fibula shaft with LCPs showed relatively good clinical outcomes for elderly patients with four-part PHF.
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Affiliation(s)
- Hua Chen
- The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
| | - Xinran Ji
- The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
| | - Qun Zhang
- The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
| | - Xiangdang Liang
- The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
| | - Peifu Tang
- The Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
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