1
|
Agrawal U, K VB, Rao HK, R PK, Narayandas DK. Assessment of Functional Outcome and Postoperative Complications in Proximal Humerus Fracture Patients Managed With Proximal Humerus Internal Locking System (PHILOS) Plating. Cureus 2024; 16:e63250. [PMID: 39070483 PMCID: PMC11281970 DOI: 10.7759/cureus.63250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Proximal humerus fractures are primarily common in the old age group. The appropriate approach to managing such displaced and comminuted fracture patterns is often questionable. Hence, this study was conducted to assess the functional outcome of proximal humerus fractures following treatment with a proximal humerus locking plate and to assess the frequency of complications in such patients. METHODOLOGY In this robust study, 33 cases of proximal humerus fractures underwent surgical management at a prestigious teaching hospital from February 2021 to August 2022 utilizing a proximal humerus internal locking system (PHILOS) plate. The NEER classification was employed to categorize the fractures, and the NEER score was used for functional assessment. It's crucial to note that individuals with pathological fractures, associated injuries in the ipsilateral limb, nerve injuries, and cases of open fracture were rigorously excluded from the study. RESULTS The mean age was 47 ± 5.2 years. Based on NEER's classification, the distribution of fractures was as follows: two-part fractures accounted for 18.18% (n = 6) of cases, three-part fractures for 54.54% (n = 18) of cases, and four-part fractures for 27.27% (n = 9) of cases. A history of road traffic accidents and falls was reported in 54.54% (n = 18) and 45.45% (n = 15) of cases, respectively. Functional outcome assessment utilizing NEER's score revealed a minimum score of 48 and a maximum of 96, with an average score of 82.96 ± 12.73. Notably, 39% of patients demonstrated excellent results, 27% exhibited satisfactorily, 21% manifested unsatisfactorily, and 12.12% presented failure outcomes. Of the 33 operated cases, 81.8% (n = 27) exhibited no complications during follow-up. The predominant complication observed was shoulder stiffness (9.09%, n = 3), followed by Varus mal-union (6.06%, n = 2), and superficial surgical site infection (3.03%, n = 1), managed with debridement and antibiotics leading to subsequent resolution. CONCLUSIONS Managing proximal humerus fractures has consistently posed a formidable challenge. Our study indicates that using the PHILOS plate represents a reliable option for addressing such fractures. This plate provides sturdy fixation, facilitates early mobilization, and culminates in exceptional functional outcomes. The insights gained from this study can inform clinical decision-making and guide orthopedic surgeons in selecting the appropriate treatment strategy for proximal humerus fracture patients.
Collapse
Affiliation(s)
- Udit Agrawal
- Pediatric Orthopedics, King George's Medical University, Lucknow, IND
| | - Vaibhav B K
- Pediatric Orthopedics, King George's Medical University, Lucknow, IND
| | - Harsh Kirthi Rao
- Orthopedics and Traumatology, Srinivas Institute of Medical Sciences and Research Center, Mangalore, IND
| | - Praseeth K R
- Pediatric Orthopedics, King George's Medical University, Lucknow, IND
| | | |
Collapse
|
2
|
Traumatic brain injuries are ignored or discriminated in prospective clinical trials on shoulder fractures: a systematic review. INTERNATIONAL ORTHOPAEDICS 2023; 47:17-50. [PMID: 36435944 DOI: 10.1007/s00264-022-05642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Current literature suggests a significant epidemiological association between traumatic brain injury (TBI) and proximal upper limb fractures in addition to major clinical consequences. A systematic review was conducted to assess how TBI is taken into consideration in interventional studies on shoulder fractures. METHODS The following data sources were used: MEDLINE, EMBASE, EBM Reviews, CINAHL, and OpenGrey databases. Study selection included interventional randomized clinical trials and prospective cohort studies on shoulder fractures published in English or French between 2008 and 2020. Studies on pathologic fractures, chronic fracture complications, nonhuman subjects, and biomechanics were excluded. Articles were reviewed by two independent authors according to the PRISMA guidelines. Baseline characteristics, exclusion criteria, and input relevant to TBI were recorded. Methodological quality was assessed with the Cochrane risk of bias tool for randomized clinical trials and the Newcastle-Ottawa Scale for cohort studies. RESULTS One-hundred-thirteen studies met the inclusion criteria. None discussed the possible impact of TBI on their results. Only three (2.7%) studies considered TBI relevant and included these patients in their cohort. Furthermore, 43/113 (38.1%) excluded patients with injuries or mechanisms strongly related to traumatic brain injuries: head injuries (4); moderate and/or severe TBI (7); high energy traumas (3); Polytrauma subjects (33). CONCLUSION TBI are ignored or discriminated in prospective clinical trials on shoulder fractures. The exclusion of these cases impacts generalizability as their prevalence is significant. Considering the major impact of TBI on important outcomes, its presence should always be assessed to ensure high quality evidence. LEVEL OF EVIDENCE Systematic Review, Therapeutic Level II.
Collapse
|
3
|
van Hasselt AJ, Hooghof JT, Huizinga MR, van Raay JJAM. Intrathoracic migration of a K-wire after percutaneous fixation of a proximal humerus fracture. Trauma Case Rep 2021; 32:100425. [PMID: 33665318 PMCID: PMC7907529 DOI: 10.1016/j.tcr.2021.100425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Proximal humerus fractures are common in elderly patients. Not all patient are fit for major surgery. Percutaneous fixation can be a suitable option though surgeons should be aware of the risks and complications. This case is about a 90-year-old woman with a proximal humerus fracture. After closed anatomical reduction we performed percutaneous K-wire fixation of the humerus fracture with a single K-wire. Five days postoperatively the patient experienced increased pain and dyspnea due to a pneumothorax caused by intrathoracic migration of the K-wire. Percutaneous fixation can be a suitable treatment for low-maintenance and fragile patients but surgeons should act with caution. Multiple threaded K-wires with a bend-free end should be used to reduce the risk for loss of repositioning or migration of the K-wire.
Collapse
Affiliation(s)
- A J van Hasselt
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - J Th Hooghof
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - M R Huizinga
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - J J A M van Raay
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| |
Collapse
|
4
|
Simionato IF, Brunelli JPF, Ferreira MT, Matsumoto FY, Britto AG, Mothes FC. Radiographic Evaluation of the Consolidation of Humerus Surgical Neck Fractures Treated With Percutaneous Fixation. Rev Bras Ortop 2020; 55:347-352. [PMID: 32616981 PMCID: PMC7316538 DOI: 10.1055/s-0039-3402463] [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: 01/13/2018] [Accepted: 05/02/2019] [Indexed: 12/03/2022] Open
Abstract
Objective
To evaluate radiographically the postoperative results of patients with fracture of the proximal humerus in two parts of the surgical neck treated with threaded percutaneous fixation.
Methods
We evaluated the radiographic results of percutaneous fixation with threaded pins on the treatment of proximal humerus fractures in our service. Preoperative and postoperative images of 42 patients were evaluated, evaluating radiographs until 8 weeks postoperatively. We considered on evaluation the fracture deviation on preoperative images, the loss of reduction and no consolidation.
Results
Our consolidation rate was 90.4%, with loss of reduction in 16.6% of the cases and no consolidation rates in just 4 operated cases. We observed a predominance of a specific fracture pattern in the cases with loss of reduction.
Conclusion
The present study allows us to consider the percutaneous fixation technique with threaded pins as an alternative in our therapeutic arsenal for the proximal humerus fracture of the surgical neck. Contraindications are considered for low fracture trait on the metaphysis and with medial/lateral cortical impairment.
Collapse
Affiliation(s)
| | | | - Marco Tonding Ferreira
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
| | | | - Almiro Gerszon Britto
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
| | - Fernando Carlos Mothes
- Grupo de Cirurgia do Ombro e Cotovelo, Santa Casa de Misericórdia de Porto Alegre, RS, Brasil
| |
Collapse
|
5
|
Nowak LL, Davis AM, Mamdani M, Beaton D, Schemitsch EH. A concept analysis and overview of outcome measures used for evaluating patients with proximal humerus fractures. Disabil Rehabil 2019; 43:1450-1462. [PMID: 31479302 DOI: 10.1080/09638288.2019.1649728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE It is unclear to which degree existing studies evaluate the primary goal of treatment for patients with proximal humerus fractures (restoration of daily activities). Our purpose was to systematically review and analyze the concepts reflected by outcome measures used in studies of patients with proximal humerus fractures. METHODS We reviewed three databases from 2000 to 2018. Two reviewers categorized outcomes in each study into concepts of the International Classification of Functioning, Disability and Health framework. RESULTS The most commonly represented concept across 35 studies was "Body Function/Structure Impairment", followed by aggregate measures that reflect multiple concepts to varying degrees. All patient-reported aggregate measures such as the Disabilities of the Arm, Shoulder, and Hand, American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores better reflected "Activity Limitations", however, these measures were only reported in 34% of studies. CONCLUSION There may be misalignment between what studies measure, and the primary goal of treatment for patients with proximal humerus fractures. The Disabilities of the Arm, Shoulder and Hand, American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores reflect concepts that more adequately address the restoration of daily activities following these injuries, and future studies should include at least one of these measures.Implications for rehabilitationWe have shown that there is a misalignment between what existing studies are measuring (primarily objective measures of impairment) and the primary goal of treatment and rehabilitation (restoring activities of daily living).This suggests that existing studies evaluating different treatment types for proximal humerus fracture patients are providing inadequate information to make evidence-based treatment and rehabilitation decisions following theses injuries.Our results tentatively suggest that the Disabilities of the Arm, Shoulder and Hand, the American Shoulder and Elbow Surgeon's, and Oxford Shoulder scores may better reflect limitations in daily activities following these injuries and should be used in future studies and by clinicians.
Collapse
Affiliation(s)
- Lauren L Nowak
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Clinical Orthopaedic Research, St. Michael's Hospital, Toronto, Canada
| | - Aileen M Davis
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Canada
| | - Dorcas Beaton
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Musculoskeletal Health & Outcomes Research, Institute for Work Health, Toronto, Canada
| | - Emil H Schemitsch
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Clinical Orthopaedic Research, St. Michael's Hospital, Toronto, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, London, Canada
| |
Collapse
|
6
|
Doshi C, Sharma GM, Naik LG, Badgire KS, Qureshi F. Treatment of Proximal Humerus Fractures using PHILOS Plate. J Clin Diagn Res 2017; 11:RC10-RC13. [PMID: 28892988 DOI: 10.7860/jcdr/2017/26782.10304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Treatment of proximal humerus fractures always holds a dilemma for the treating surgeon. AIM To assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. MATERIAL AND METHODS Fifty three consecutive patients were treated with PHILOS plating between August 2013 and August 2014. The inclusion criteria were skeletally matured patients with closed fracture proximal humerus with displacement >1 cm and varus angulation of >450. Severely comminuted fractures, open fractures and valgus impacted fractures were excluded from the study. The outcome was assessed using Neer's scoring system. RESULTS The average age was 54.3±5.8 years. As per the Neers classification system, there were 6 (11.32%) 1-part, 19 (35.85%) 2-part, 17 (32.085) and 11 (20.75%) 3 and 4-part fracture respectively. Average surgical duration was 94±10.2 minutes. Radiological union was seen at 12±4.6 weeks. There were 2 (3.77%) cases of varus collapse. Three (5.66%) cases had screw back out, which was later revised and had a favourable outcome. As per the Neer's scoring system, 7 (13.21%) cases had excellent results, 37 (69.81%) had satisfactory, 6 (11.32%) had unsatisfactory while 3 (05.66%) cases had poor outcomes. CONCLUSION PHILOS plating has a good functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.
Collapse
Affiliation(s)
- Chintan Doshi
- Junior Consultant, Department of Orthopaedics, Sancheti Institute for orthopaedics and rehabilitation, Pune, Maharashtra, India
| | - Gaurav Mahesh Sharma
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Lokesh Gudda Naik
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Krishna Sudhakar Badgire
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Faisal Qureshi
- Clinical Associate, Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Biazzo A, Cardile C, Brunelli L, Ragni P, Clementi D. Early results for treatment of two- and three-part fractures of the proximal humerus using Contours PHP (proximal humeral plate). ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:65-73. [PMID: 28467336 PMCID: PMC6166187 DOI: 10.23750/abm.v88i1.5193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: The management of displaced 2- and 3-part fractures of the proximal humerus is controversial, both in younger and in elderly patients. The purpose of this paper is to evaluate the functional results of the Contours Proximal Humerus Plate (OrthofixR, Bussolengo,Verona, Italy), for the treatment of displaced 2- and 3-part fractures of the proximal humerus. Methods: We retrospectively reviewed 55 patients with proximal humerus fractures, who underwent osteosynthesis with Contours Proximal Humerus Plate from December 2011 to March 2015. We had 21 patients with 2-part fractures and with an average age of 67.1 years and 34 patients with 3-part fractures, with average age of 63.6 years. Results: The average union time was 3 months. The mean Constant score was 67 for 2-part fracture group and 64.9 for 3-part fracture group. The difference was not statistically significant (p = 0.18). The overall complication rate was 14.5 %. Six patients underwent additional surgery (10.9%). Conclusions: The most frequent major complication was secondary loss of reduction following varus collapse of the fracture (2 cases). In these patients, there was loss of medial hinge integrity due to impaction and osteoporosis. The placement of the main locking screw in the calcar area to provide inferomedial support is the rational of the Contours Proximal Humerus Plate. Osteosynthesis with Contours Proximal Humerus Plate is a safe system for treating displaced 2- and 3-part fractures of the proximal humerus, with good functional results and complication rates comparable to those reported in the literature. (www.actabiomedica.it)
Collapse
|