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Aiba H, Atherley O'Meally AO, Aso A, Tsukamoto S, Kimura H, Murakami H, Saito S, Sakai T, Bordini B, Cosentino M, Zuccheri F, Manfrini M, Donati DM, Errani C. Malawer type I/V proximal humerus reconstruction after tumor resection: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(24)00263-5. [PMID: 38642876 DOI: 10.1016/j.jse.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Several reconstruction methods exist for Malawer type I/V proximal humerus reconstruction after bone tumor resection; however, no consensus has been reached regarding the preferred methods. METHODS We conducted a literature search on various types of proximal humerus oncologic reconstruction methods. We collected data on postoperative functional outcomes assessed based on Musculoskeletal Tumor Society (MSTS) scores, 5-year reconstruction survival rates, and complications. We calculated each reconstruction's weighted mean based on the sample size and standard errors. Complications were categorized based on the Henderson classification. Based on these integrated data, our primary objective is to propose an optimal strategy for proximal humerus reconstruction after bone tumor resection. RESULTS We examined various reconstruction techniques, including modular prosthesis (752 patients in 21 articles), osteoarticular allograft (142 patients in six articles), allograft prosthesis composites (236 patients in 12 articles), reverse shoulder total arthroplasty (141 patients in 10 articles), composite reverse shoulder total arthroplasty (33 patients in four articles), claviculo-pro-humero technique (51 patients in six articles), and cement spacer (207 patients in four articles). Weighted mean MSTS scores were: modular prosthesis (73.8%), osteoarticular allograft (74.4%), allograft prosthesis composites (79.2%), reverse shoulder total arthroplasty (77.0%), composite reverse shoulder total arthroplasty (76.1%), claviculo-pro-humero technique (75.1%), and cement spacer (69.1%). Weighted 5-year reconstruction survival rates were modular prosthesis (85.4%), osteoarticular allograft (67.6%), allograft prosthesis composites (85.2%), reverse shoulder total arthroplasty (84.1%), and cement spacer (88.0%). Reconstruction survival data was unavailable for composite reverse shoulder total arthroplasty and claviculo-pro-humero technique. Major complications included shoulder joint instability: modular prosthesis (26.2%), osteoarticular allograft (41.5%), allograft prosthesis composites (33.9%), reverse shoulder total arthroplasty (17%), composite reverse shoulder total arthroplasty (6.1%), claviculo-pro-humero technique (2.0%), and cement spacer (8.7%). Aseptic loosening of the prosthesis occurred: modular prosthesis (3.9%) and reverse shoulder total arthroplasty (5.7%). Allograft fracture was observed in 54.9% of patients with osteoarticular allograft. CONCLUSION The complication profiles differed among reconstruction methods. Weighted mean MSTS scores exceeded 70% in all methods except cement spacer, and the 5-year reconstruction survival rate surpassed 80% for all methods except osteoarticular allograft. Proximal humerus reconstruction after bone tumor resection should consider potential complications and patients' individual factors.
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Affiliation(s)
- Hisaki Aiba
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan.
| | - Ahmed Orland Atherley O'Meally
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Orthopaedic Surgery, Complejo Hospitalario Metropolitano CSS, Panama, Panama
| | - Ayano Aso
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Shiro Saito
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Takao Sakai
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Japan
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Zuccheri
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Sadek WMS, Elshamly IKF, Salem MSM, AbouSenna WG, Ebeid E, Ebeid WA. Functional and oncological outcomes of patients with proximal humerus osteosarcoma managed by limb salvage. J Orthop Traumatol 2024; 25:18. [PMID: 38637478 PMCID: PMC11026314 DOI: 10.1186/s10195-024-00756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/24/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Osteosarcoma is the most common primary bone malignancy in skeletally immature patients. The proximal humerus is the third most common site of osteosarcoma. The literature shows a paucity of published data concerning the outcome of proximal humerus osteosarcoma managed by limb salvage. The purpose of this study was to answer the following questions: (1) do patients with proximal humerus osteosarcoma managed by limb salvage and neoadjuvant chemotherapy show good functional and oncological outcomes, and (2) are there any prognostic factors that are associated with better oncological and functional outcomes? MATERIALS AND METHODS The study was a retrospective case series study assessing the overall outcome of 34 patients with proximal humerus osteosarcoma. Eighteen patients were males (53%) while 16 were females. Biological reconstruction was done in 15 patients (44%), while nonbiological reconstruction was done in 19 patients. Resections were mainly intraarticular (82%). Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score, while oncological outcome was assessed based on local recurrence and development of chest metastasis. Comparisons between quantitative variables were done using the nonparametric Mann-Whitney test. To compare categorical data, the chi-square (χ2) test was performed. The exact test was used instead when the expected frequency was less than 5. Correlations between quantitative variables were examined using the Spearman correlation coefficient. RESULTS The mean MSTS score was 25.5 (range 23-29). A younger age was statistically correlated with a poorer MSTS score (P = 0.0016). Six patients out of 34 (17.6%) had local recurrence and four of them (67%) were treated by forequarter amputation. 41% of patients developed chest metastasis, and the majority of them were treated by chemotherapy (71%). In comparison with patients with osteosarcoma at other sites who were also managed in our institution, proximal humerus osteosarcoma patients showed higher incidence rates of local recurrence and chest metastasis along with lower 5-year patient and limb survivorships compared to distal femur, proximal tibia and proximal femur osteosarcoma patients. CONCLUSION Treatment of osteosarcoma of the proximal humerus by limb salvage and chemotherapy yields a good functional outcome. The method of reconstruction does not impact the resultant function. The 5-year survivorship of these patients is 65%. Younger patients have a better oncological outcome and an inferior functional outcome. LEVEL OF EVIDENCE Level IV therapeutic study.
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Affiliation(s)
| | | | | | | | - Emad Ebeid
- Department of Paediatric Oncology and Haematology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Walid Atef Ebeid
- Department of Orthopedics and Traumatology, Cairo University, Cairo, Egypt
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Ke S, Zhang B, He Y, Zhou Y, Hu X, Fan Y, Wang M, Zhang Y, Wang C. Reconstruction Strategy for Upper Extremity Defects After Bone Tumor Resection Based on 3D Customized Bone Cement Mold. Surg Innov 2024:15533506241244493. [PMID: 38606504 DOI: 10.1177/15533506241244493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Reconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection. METHODS Computer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. RESULTS The mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) (P < .001). CONCLUSION Customized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.
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Affiliation(s)
- Song Ke
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bokai Zhang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yongqin He
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yuanyuan Zhou
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xu Hu
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Min Wang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yuan Zhang
- Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chao Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
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Makaram NS, Robinson CM. A new clinical sign to detect radiologically occult greater tuberosity fractures. J Shoulder Elbow Surg 2024; 33:932-939. [PMID: 37689105 DOI: 10.1016/j.jse.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/29/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Up to 59% of undisplaced greater tuberosity (GT) fractures are missed on initial evaluation. Timely diagnosis of these injuries can avoid undue morbidity, but a clinical sign to accurately identify them has not previously been described. Magnetic resonance imaging (MRI) remains the gold standard for their assessment but may not be routinely available, or difficult to organize urgently. We aimed to evaluate the diagnostic efficacy of a new clinical sign (the anterior bruise sign [ABS]), in diagnosing radiologically occult GT fractures. METHODS Over a 4-year period, 59 patients who sustained a traumatic shoulder injury with no fracture on initial radiographs were referred to a specialist shoulder clinic within a week of their injury and enrolled in a prospective observational cohort study. At initial presentation, the presence of anterior arm bruising extending to the mid-diaphysis was recorded as a positive ABS. MRI assessment of the injured shoulder was performed in all patients at first follow-up. Presenting radiographs, 2-week radiographs, and MRI scans were reviewed by a musculoskeletal radiologist. The diagnostic value of a positive ABS was compared with 2-week radiographs, and other clinical tests. RESULTS The mean age of the cohort was 58.5 (range 30-79) years, and 27 (45.8%) were female. The mean time from injury to first follow-up was 6.9 (standard deviation 2.4) days. MRI revealed that 25 of 59 patients (42.4%) had an undisplaced GT fracture. The overall accuracy of the ABS in identifying occult GT fractures was 98% (sensitivity = 100%, specificity = 97%, positive predictive value = 96%, negative predictive value = 100%, P < .001). In contrast, radiographs taken at 2 weeks postinjury were less accurate (71.2%) (P < .001), and other clinical assessments of cuff function had much lower accuracy. CONCLUSION In patients presenting with a traumatic shoulder injury with normal radiographs, the ABS is a highly sensitive and specific clinical aid to identify patients with an occult GT fracture.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom.
| | - C Michael Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Lee E, Jeong HJ, Lee YS, Oh JH. The application of a dual-lead locking screw could enhance the reduction and fixation stability of the proximal humerus fractures: a biomechanical evaluation. Front Surg 2024; 11:1333670. [PMID: 38586241 PMCID: PMC10995320 DOI: 10.3389/fsurg.2024.1333670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Bicortical screw fixation, which penetrates and fixes the near and far cortex of bone, has been conventionally used to achieve compressive fixation for fracture using screws. Open reduction and internal fixation using the locking plate are widely used for treating proximal humerus fractures. However, minimal contact between the bone and the locking plate can lead to an insufficient reduction. Theoretically, a dual-lead locking screw with different leads for the screw head and body could enhance the reduction and fixation stability of fragments in proximal humeral fractures without bicortical fixation, and achieve additional compression at the bone-plate-screw interface. This study assessed the insertion mechanics of the lead ratio of the dual-lead locking screw and its effect on the fixation stability of the proximal humerus fracture. Methods A Multi-Fix® locking plating system composed of ∅ 3.5 mm locking screws and a locking plate was used to make a locked plating for Sawbone bone blocks and fourth-generation composite humeri. Two different types of Sawbone bone blocks were used to simulate the osteoporotic (10 PCF) and normal cancellous (20 PCF) bones. The lead of the screw head thread (L head ) was 0.8 mm, and that of the screw body (L body ) was 0.8, 1.25, 1.6, 2.0, and 2.4 mm, whose lead ratios (R lead = L body / L head ) were 1.0, 1.56, 2.0, 2.5, and 3.0, respectively. Results The dual-lead locking screw elevated the compression between the locking plate and the bone. The elevation in the compression due to the dual-lead thread became weaker for the cancellous bone when the lead of the screw body was more than twice that of the screw head. The plate/humerus compression with strong bone quality withstood higher dual-lead-driven compression. Discussion A dual-lead locking screw of L body = 1.25 mm (R lead = 1.56 ) is recommended for maximum rotational stability for the locked humerus plating. The screws with over L body = 1.6 mm (R lead = 2 ) have no advantage in terms of the failure torque and maximum torsional deformation. Any locking dual-lead screw with a body thread lead of <1.6 mm (R lead = 2 ) can be used without the risk of bone crush when surgeons require additional compression to the locked cancellous bone plating.
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Affiliation(s)
- Eunju Lee
- Department of BioMedical Engineering, School of BioMed Science, Daegu Catholic University, Gyoungbuk, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yeon Soo Lee
- Department of BioMedical Engineering, School of BioMed Science, Daegu Catholic University, Gyoungbuk, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Karslioglu B, Dedeoglu SS, Imren Y, Yerli M, Guler Y, Keskin A. Pectoralis major pedicle bone grafting vs. tricortical iliac grafting for Neer 4-part proximal humerus fractures: a randomized controlled trial. J Shoulder Elbow Surg 2024; 33:14-22. [PMID: 37625692 DOI: 10.1016/j.jse.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We evaluated the results of patients who underwent plate osteosynthesis with a vascularized pectoralis major graft compared with tricortical iliac grafting to treat 4-part proximal humerus fractures. MATERIAL AND METHODS Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis. RESULTS Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems. CONCLUSION Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.
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Affiliation(s)
- Bulent Karslioglu
- Department of Orthopedics and Traumatology, Prof. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Suleyman Semih Dedeoglu
- Department of Orthopedics and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Yunus Imren
- Department of Orthopedics and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedics and Traumatology, Prof. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasin Guler
- Department of Orthopedics and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Keskin
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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Bianco Prevot L, Fozzato S, Cannavò L, Accetta R, Amadei F, Basile M, Leigheb M, Basile G. Pathological Fracture of the Proximal Humerus Occurred on Metastases of Probable Kidney Origin in the Absence of Primary Lesions: A Case Report. Healthcare (Basel) 2023; 11:3108. [PMID: 38131998 PMCID: PMC10742696 DOI: 10.3390/healthcare11243108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Cancer of unknown primary (CUP) origin represents a diagnostic and therapeutic challenge. These tumours spread to different parts of the body even if the site of origin has not been identified. When renal metastases are observed without an obvious primary lesion, it is important to exclude the possibility of a primary kidney tumour that may be unknown or too small to be detected. The diagnosis of CUP is established after a careful clinical evaluation and diagnostic tests, including blood chemistry and laboratory tests, instrumental exams (CT, MRI, PET, bone scan), biopsy, and molecular and cytogenetic analysis. Once the diagnosis of CUP with kidney metastases is confirmed, treatment depends on the location of the metastases, the patient's health status, and available treatment options. The latter includes surgery to remove metastases, radiation therapy, or systemic treatment such as chemotherapy or immunotherapy. It is important that patients with CUP are evaluated by a multidisciplinary team of specialists, who can contribute to planning the most appropriate treatment. In this article, we report the clinical case of a patient with a pathological fracture of the proximal humerus which occurred on metastases of probable renal origin in the absence of primary lesions.
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Affiliation(s)
- Luca Bianco Prevot
- IRCCS Orthopaedic Institute Galeazzi, 20161 Milan, Italy; (L.B.P.); (G.B.)
| | - Stefania Fozzato
- IRCCS Orthopaedic Institute Galeazzi, 20161 Milan, Italy; (L.B.P.); (G.B.)
| | - Luca Cannavò
- Orthopaedic Department, Esine Hospital, 25040 Brescia, Italy
| | - Riccardo Accetta
- IRCCS Orthopaedic Institute Galeazzi, 20161 Milan, Italy; (L.B.P.); (G.B.)
| | - Federico Amadei
- Hand and Peripheral Nerve Centre, COF Lanzo Hospital, 22020 Alta Valle Intelvi, Italy
| | - Michela Basile
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, “Maggiore Della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Giuseppe Basile
- IRCCS Orthopaedic Institute Galeazzi, 20161 Milan, Italy; (L.B.P.); (G.B.)
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Alqahtani SM, Aljamaan Y, Abusultan A, Alzahrani MM. Dual plate fixation of proximal humerus fractures: Retrospective review and surgical technique. Shoulder Elbow 2023; 15:641-646. [PMID: 37981973 PMCID: PMC10656976 DOI: 10.1177/17585732231158798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/13/2023] [Accepted: 02/01/2023] [Indexed: 11/21/2023]
Abstract
Introduction Recent interest has been directed towards dual plate fixation for comminuted proximal humerus fractures, with an aim to improve construct stability and thus improve patient outcomes while decreasing the risk of fracture-associated complications. We present our experience with this technique in a case series of patients with proximal humerus fractures and describe our surgical technique. Methodology This was a single-center retrospective case series of patients presenting with an acute (<6 weeks) proximal humerus fracture who underwent ORIF with dual plating fixation. Patient, fracture, and surgical data were collected. All patient outcomes were evaluated using Constant-Murley shoulder score and Single Assessment Numeric Evaluation. Results Our series included nine patients with a mean age of 46.2 years (range: 27-70 years old). All fractures healed within 4 months and no complications were encountered. At 1 year follow-up, the mean SANE score was 69.4% and the mean Constant Murley shoulder score was 78.9 (range: 70-96). Conclusion Our current series shows that applying the dual plating technique in severely comminuted proximal humerus fractures provides adequate fixation and thus good patient outcomes. Further research is required before this technique can be strongly recommended for management of these complex fractures. Level of Evidence Level 5.
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Affiliation(s)
- Saad M Alqahtani
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yousef Aljamaan
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ammar Abusultan
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad M Alzahrani
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Rachbauer AM, Schneider KN, Gosheger G, Deventer N. Endoprosthetic Reconstruction of the Proximal Humerus with an Inverse Tumor Prosthesis. Cancers (Basel) 2023; 15:5330. [PMID: 38001590 PMCID: PMC10670134 DOI: 10.3390/cancers15225330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Reconstructing the proximal humerus after tumor removal is challenging due to muscle and bone loss. The current methods often result in poor shoulder function. This study assessed the long-term functional and oncological outcomes of using an inverse proximal humerus prosthesis in 46 patients with bone tumors. The results showed a mean range of motion of 62° in anteversion, 28° in retroversion, and 55° in abduction. Notably, 23 patients achieved over 90° of shoulder abduction, with an average of 140°. The median Musculoskeletal Tumor Society Score was 25. Complications included infection in two radiotherapy patients and single dislocations in seven patients. One patient with recurrent dislocations needed revision surgery. In conclusion, the use of the inverse proximal humerus prosthesis in bone tumor treatment yields excellent shoulder function and high patient satisfaction. This approach is especially beneficial for those with metastatic disease.
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Affiliation(s)
- Anna Maria Rachbauer
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, Germany (N.D.)
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Knapp G, Pawelke J, Heiss C, Elmas S, Vinayahalingam V, ElKhassawna T. Traumatic Fracture Treatment: Calcium Phosphate Bone Substitute Case-Control Study in Humerus, Radius, Tibia Fractures-Assessing Efficacy and Recovery Outcomes. Biomedicines 2023; 11:2862. [PMID: 37893234 PMCID: PMC10604612 DOI: 10.3390/biomedicines11102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
To date, insufficient investigation has been carried out on the biocompatibility of synthetic bioactive bone substitute materials after traumatically induced bone fractures in clinical conditions. This study encompasses the safety, resorption, healing process, and complications of surgical treatment. Our current hypothesis posits that calcium phosphate-based bone substitutes could improve bone healing. In this retrospective case-control study, over 290 patients who underwent surgical treatment for acute fractures were examined. Bone defects were augmented with calcium phosphate-based bone substitute material (CP) in comparison to with empty defect treatment (ED) between 2011 and 2018. A novel scoring system for fracture healing was introduced to assess bone healing in up to six radiological follow-up examinations. Furthermore, demographic data, concomitant diseases, and complications were subjected to analysis. Data analysis disclosed significantly fewer postoperative complications in the CP group relative to the ED group (p < 0.001). The CP group revealed decreased risks of experiencing complications (p < 0.001), arthrosis (p = 0.01), and neurological diseases (p < 0.001). The fracture edge, the fracture gap, and the articular surface were definably enhanced. Osteosynthesis and general bone density demonstrated similarity (p > 0.05). Subgroup analysis focusing on patients aged 64 years and older revealed a diminished complication incidence within the CP group (p = 0.025). Notably, the application of CP bone substitute materials showed discernible benefits in geriatric patients, evident by decreased rates of pseudarthrosis (p = 0.059). Intermediate follow-up evaluations disclosed marked enhancements in fracture gap, edge, and articular surface conditions through the utilization of CP-based substitutes (p < 0.05). In conclusion, calcium phosphate-based bone substitute materials assert their clinical integrity by demonstrating safety in clinical applications. They substantiate an accelerated early osseous healing trajectory while concurrently decreasing the severity of complications within the bone substitute cohort. In vivo advantages were demonstrated for CP bone graft substitutes.
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Affiliation(s)
- Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Jonas Pawelke
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Sera Elmas
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Vithusha Vinayahalingam
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Thaqif ElKhassawna
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
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11
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Gokaraju K, Ahrens P, Boileau P, Baring T. The N-brace trial: Does arm position during immobilisation of proximal humerus fractures influence outcome - A preliminary study. Shoulder Elbow 2023; 15:513-521. [PMID: 37811388 PMCID: PMC10557930 DOI: 10.1177/17585732221142505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 10/10/2023]
Abstract
Background Traditional initial management of proximal humerus fractures (PHF) involves arm immobilisation in a simple sling (SS) in an internally rotated position. We believe this risks fracture displacement and imbalance of soft tissues, encouraging malunion and stiffness. A neutral-rotation brace (NRB) maintains an arm position which may prevent this, leading to quicker and superior recovery. Methods We randomised patients with two- to four-part PHF into 4 weeks of immobilisation with either a SS or NRB, independent of surgery. Range of motion (ROM), subjective shoulder value (SSV), DASH, Constant-Murley (CMS) and Oxford Shoulder (OSS) scores were assessed at 6-weeks, 3-months and 1-year post-injury. Results The SS group included 11 patients vs 9 in the NRB group. At final follow-up, the SS and NRB groups had mean DASH scores of 42 vs 35, OSS 42 vs 46, CMS 71 vs 86, SSV 84% vs 92%, respectively. ROM was superior with the NRB (elevation 159°, ER 47° and IR score 8 vs 140°, 37° and 7 with SS). Conclusions Despite being a small series, our results demonstrate a trend towards NRB providing better outcomes. This feasibility study supports the need for a larger multi-centre randomised controlled trial comparing these immobilisation methods for PHF.
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Affiliation(s)
- Kishan Gokaraju
- Trauma and Orthopaedic, Northern General Hospital, Sheffield, UK
| | - Philip Ahrens
- Trauma and Orthopaedic, Royal Free London NHS Foundation Trust, London, UK
| | - Pascal Boileau
- Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Nice Hôpital Pasteur, Nice, Provence Alpes-Côte d’Azu, France
| | - Tobias Baring
- Orthopaedics, Homerton University Hospital, London, UK
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12
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Lanzerath F, Loew M, Schnetzke M. Is there still a place for anatomic hemiarthroplasty in patients with high functional demands in primary, nonreconstructable proximal humeral fractures? A clinical and radiographic assessment. J Shoulder Elbow Surg 2023; 32:1909-1917. [PMID: 36907312 DOI: 10.1016/j.jse.2023.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/26/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Vitality-threatening proximal humerus fractures often provide an indication for prosthetic treatment. We investigated the issue of how anatomic hemiprostheses perform in younger, functionally challenging patients with the use of a specific fracture stem and systematic tuberosity management in medium-term follow-up. METHODS Thirteen skeletally mature patients with a mean age of 64 ± 9 years and a minimum follow-up of 1 year after primary open-stem hemiarthroplasty for 3- and 4-part proximal humeral fractures were included. All patients were followed up regarding their clinical course. Radiologic follow-up included fracture classification, healing of tuberosities, proximal migration of the humeral head, evidence of stem loosening, and glenoid erosion. Functional follow-up included range of motion, pain, objective and subjective performance scores, complications, and return to sports rates. We statistically compared treatment success based on the Constant score between the cohort with proximal migration and the cohort with regular acromiohumeral distance by means of the Mann-Whitney U test. RESULTS After an average follow-up period of 4.8 years, satisfactory results were obtained. The absolute Constant-Murley score was 73.2 ± 12.4 points. The disabilities of the arm, shoulder, and hand score was 13.2 ± 13.0 points. Patients reported their mean subjective shoulder value as 86.6% ± 8.5%. Pain was reported as 1.1 ± 1.3 points on a visual analog scale. Flexion, abduction, and external rotation values were 138 ± 31°, 134 ± 34°, and 32 ± 17°, respectively. 84.6% of the referred tuberosities healed successfully. Proximal migration was observed in 38.5% of cases and was associated with worse Constant score results (P = .065). No patient showed signs of loosening. Mild glenoid erosion was apparent in 4 patients (30.8%). All patients who were interviewed and participated in sports before surgery were able to return to their primary sport after surgery and continued to do so during the final follow-up. CONCLUSIONS With narrow indications, use of a specific fracture stem and adequate tuberosity management, successful radiographic and functional results are presented after a mean follow-up of 4.8 years after hemiarthroplasty for primary nonreconstructable humeral head fractures. Accordingly, open-stem hemiarthroplasty appears to remain a possible alternative to reverse shoulder arthroplasty in younger, functionally challenging patients with primary 3- or 4-part proximal humeral fractures.
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Affiliation(s)
- Fabian Lanzerath
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Markus Loew
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Marc Schnetzke
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
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13
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Mannava AS, Braga AC, Fathollahpour A, Ryali N, Lazarevic M. Bullet Wound Blues: A Case Report on Brachial Artery Pseudoaneurysm. Cureus 2023; 15:e42408. [PMID: 37637527 PMCID: PMC10447913 DOI: 10.7759/cureus.42408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Pseudoaneurysms are typically iatrogenic due to the increasing use of the artery for arterial interventions such as invasive vascular radiological procedures, invasive coronary artery procedures, arterial punctures for an arteriogram, or catheterization. Other reasons for pseudoaneurysm formation are intravenous drug use and penetrating trauma. They are more commonly observed in the lower limbs than in the upper limbs. In this case report, we present the occurrence of a brachial artery pseudoaneurysm (BAP) in a 73-year-old male patient who suffered a gunshot wound (GSW) 25 years ago during the war and was admitted to the hospital because of a fall episode. This case represents one of the few documented instances of a pseudoaneurysm formation following a GSW in the United States. Along with that, we describe the subsequent medical care provided to the patient.
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Affiliation(s)
- Anjali S Mannava
- Department of Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Ana C Braga
- Department of Medicine, University of Brasilia, Brasilia, BRA
| | - Ayda Fathollahpour
- Department of Medicine, Iran University of Medical Sciences, Tehran, IRN
| | - Niharika Ryali
- Department of Medicine, Gandhi Medical College, Hyderabad, IND
| | - Milenko Lazarevic
- Department of Internal Medicine, Swedish Covenant Hospital, Chicago, USA
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14
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Jhamnani R, Dhanda MS, Surana A. Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating. Cureus 2023; 15:e42411. [PMID: 37637540 PMCID: PMC10447996 DOI: 10.7759/cureus.42411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Proximal humerus fractures comprise nearly 4%-5% of all fracture types and nearly 25% of fracture humerus. These fractures are commonly seen in the elderly population (people aged 60 years or more). The best way to treat elderly people who have three- or four-part fractures of the proximal humerus is debatable, with many in favour of prosthetic humeral head replacements. This study aimed to assess the functional outcome of proximal humerus fractures managed with a proximal humerus locking plate and to investigate the incidence of complications in these patients. Methodology This retrospective study included 32 cases of proximal humerus fractures managed surgically at a tertiary care teaching hospital in Rajasthan between July 2016 to July 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER scoring system was used to categorise the fractures. Functional assessment was done using Constant Murley's shoulder score. Constant Murley shoulder score was graded as failure (0-69 points), unsatisfactory (70-79), satisfactory (80-89), and excellent (90-100). Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results The mean age was 54.5±6.4 years. Of the total 32 cases of proximal humerus fractures, 12 cases of two-part fractures received an excellent grade, compared to seven cases of three-part fractures. Three two-part fracture cases and two three-part fracture cases all received satisfactory grades. Excellent results (score > 89) were noticed in 62.5% (n = 20) of the instances, satisfactory results (scoring 80-89) in 21.87% (n=7), poor results (score 70-79) in 9.38% (n=3), and failure results (score 70) in 6.25% (n=2). In 65.6% of cases, follow-up showed no complications. Shoulder stiffness and malunion (9.38%) were the most frequent consequences, followed by avascular necrosis (6.25%). Conclusions Based on the findings of this retrospective study, it can be opined that PHILOS plaiting appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilisation, and excellent functional outcomes as observed in this study. Additionally, very few post-operative complication rates again support our conclusion.
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Affiliation(s)
- Rohit Jhamnani
- Orthopaedics, Pacific Medical College and Hospital, Udaipur, IND
| | - Manjeet Singh Dhanda
- Orthopaedics, Shaheed Hassan Khan Mewati (SHKM) Government Medical College, Nuh, IND
| | - Avinash Surana
- Preventive Medicine, Infantry Division, 14 Coprs, Bareilly, IND
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15
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Baker HP, Gutbrod J, Cahill M, Shi L. Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges. Orthop Res Rev 2023; 15:129-137. [PMID: 37396822 PMCID: PMC10312335 DOI: 10.2147/orr.s340536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
Proximal humeral fractures (PHFs) are a common type of fracture, particularly in older adults, accounting for approximately 5-6% of all fractures. This article provides a comprehensive review of PHFs, focusing on epidemiology, injury mechanism, clinical and radiographic assessment, classification systems, and treatment options. The incidence of PHFs varies across regions, with rates ranging from 45.7 to 60.1 per 100,000 person-years. Females are more susceptible to PHFs than males, and the incidence is highest in women over the age of 85. The injury mechanism of PHFs is typically bimodal, with high-energy injuries predominant in younger individuals and low-energy injuries in the elderly. Clinical assessment of PHFs involves obtaining a thorough history, physical examination, and evaluation of associated injuries, particularly neurovascular injuries. Radiographic imaging helps assess fracture displacement and plan for treatment. The Neer classification system is the most commonly used classification for PHFs, although other systems, such as AO/OTA, Codman-Hertel, and Resch classifications, also exist. The choice of treatment depends on factors such as patient age, activity level, fracture pattern, and surgeon expertise. Nonoperative management is typically preferred for elderly patients with minimal displacement, while operative fixation is considered for more complex fractures. Nonoperative treatment involves sling immobilization followed by physiotherapy, with good outcomes reported for certain fracture patterns. Operative management options include closed reduction and percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), or arthroplasty. CRPP is suitable for specific fracture patterns, but the quality of reduction is crucial for favorable outcomes. ORIF is used when CRPP is not feasible, and various surgical approaches are available, each with its advantages and potential complications. PHFs are a significant clinical challenge due to their prevalence and complexity. Treatment decisions should be patient centered based on patient factors and fracture severity.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USA
| | - Joseph Gutbrod
- Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USA
| | - Michael Cahill
- Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USA
| | - Lewis Shi
- Department of Orthopaedic Surgery, the University of Chicago, Chicago, IL, USA
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16
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Klute L, Henssler L, Pfeifer C, Berner A, Schneider T, Kobeck M, Alt V, Kerschbaum M. Predictors of Mortality in Head-Preserving Treatment for Dislocated Proximal Humerus Fractures: A Retrospective Analysis of 522 Cases with a Minimum Follow-Up of 5 Years. J Clin Med 2023; 12:3977. [PMID: 37373670 DOI: 10.3390/jcm12123977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, but there is still inadequate knowledge about mortality risk factors after such injuries. In order to provide the best possible therapy, individual risk factors have to be considered and evaluated thoroughly. There is still controversy regarding treatment decisions for proximal humerus fractures, particularly for the elderly. METHODS In this study, patient data from 522 patients with proximal humerus fractures were obtained from 2004 to 2014 at a Level 1 trauma centre. After a minimum follow-up of 5 years, the mortality rate was assessed, and independent risk factors were evaluated. RESULTS A total of 383 patients (out of 522) were included in this study. For our patient collective, the mean follow-up was at 10.5 ± 3.2 years. The overall mortality rate was 43.8% in our respondent group and was not significantly impacted by concomitant injuries. The binary logistic regression model showed an increased risk for mortality by 10% per life year, a 3.9 times higher mortality risk for men and a 3.4 times higher risk for conservative treatment. The most powerful predictor was a Charlson Comorbidity Index of more than 2, with a 20 times higher mortality risk. CONCLUSIONS Outstanding independent predictors of death in our patient collective were serious comorbidities, male patients, and conservative treatment. This patient-related information should influence the process of decision making for the individual treatment of patients with PHFs.
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Affiliation(s)
- Lisa Klute
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Leopold Henssler
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Pfeifer
- Clinic of Trauma and Hand Surgery, Altötting, Vinzenz-von-Paul-Straße 10, 84503 Altötting, Germany
| | - Arne Berner
- Clinic of Trauma Surgery, Bad Neustadt, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Teresa Schneider
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Miriam Kobeck
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Maximilian Kerschbaum
- Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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17
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AlQahtani SM, Albadran AA, Altalib A, Hamza WM, Hegazi TM. Osteoid Osteoma of the Proximal Humerus: A Case Report and Literature Review. Saudi J Med Med Sci 2023; 11:178-182. [PMID: 37252020 PMCID: PMC10211411 DOI: 10.4103/sjmms.sjmms_350_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/15/2022] [Accepted: 03/26/2023] [Indexed: 05/31/2023]
Abstract
Osteoid osteoma is a common benign primary bone tumor, but it is very uncommon in the proximal humerus. This case report describes the clinical course and treatment of a patient with shoulder pain and osteoid osteoma of the proximal humerus and provides a review of the literature. A 22-year-old healthy male patient presented to our clinic with a 2-year history of constant throbbing right shoulder pain. The patient was referred for orthopedic consultation. A series of plain radiographs, bone scintigraphy, and a magnetic resonance imaging were done and revealed an osseous lesion at the medial aspect of the proximal meta diaphyseal region of the right proximal humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency ablation of the tumor nidus, which was successful and resulted in resolution of symptoms with minimal pain at follow up. This case demonstrates that osteoid osteoma can present with clinical features that mimic various causes for shoulder pain.
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Affiliation(s)
- Saad Mohammed AlQahtani
- Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Adeebah A Albadran
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdulraheem Altalib
- Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wael Mostafa Hamza
- Department of Pathology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tarek M Hegazi
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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18
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El Motassime A, Meschini C, Di Costa D, Rovere G, Matrangolo MR, De Maio F, Farsetti P, Ziranu A, Maccauro G, Vitiello R. Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases. Curr Oncol 2023; 30:3571-3579. [PMID: 37185385 PMCID: PMC10136526 DOI: 10.3390/curroncol30040272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of the most involved sites for metastases. Prosthetic replacement with modular megaprosthesis is one of the treatment choices, but there are several types of complications, such as problems with function and pain. The aim of our study is to assess functional outcomes and shoulder instability in the reconstruction of proximal humerus metastases. (2) Methods: This is a retrospective observational study. Twenty-eight patients, with proximal humerus metastases, admitted to the department of Orthopaedics and Traumatology of our University Hospital between 2014 and 2022 were recruited. Each patient underwent resection and prosthetic replacement surgery with modular megaprosthesis. Clinical evaluation was assessed through MSTS score, WOSI index, and DASH score. (3) Results: Twenty patients were included in the study. Fairly good results, especially regarding pain, function, and emotional acceptance, were obtained in all three tests: DASH, MSTS, and WOSI. Patients who reported shoulder instability actually have worse outcomes than those who report having stable shoulders. In addition, patients with a resection >10 cm have worse outcomes than those who had a resection of 10 cm. No significant differences were found between the deltopectoral approach group and the lateral approach group. (4) Conclusions: Reconstructive surgery with megaprosthesis of the proximal humerus in patients with metastases can be considered a treatment option, especially in patients with pathological fractures or injuries with a high risk of fracture and good life expectancy. This study shows how this type of surgery affects instability, but in terms of functionality, pain, and patient satisfaction, it gives satisfactory results.
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Affiliation(s)
- Alessandro El Motassime
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Cesare Meschini
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Doriana Di Costa
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Fernando De Maio
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
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19
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Liu S, Zhang Y, Cao J, Fu S, Peng A. Bone cemented K-wire fixation versus elastic stable intramedullary nailing fixation of paediatric proximal humerus fractures: A prospective cohort study. Medicine (Baltimore) 2023; 102:e32959. [PMID: 36820597 PMCID: PMC9907912 DOI: 10.1097/md.0000000000032959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The objective of this study is to compare the treatments of pediatric displaced proximal humerus fractures with external-fixation technique using the combination of K-wires and bone-cement versus close reduction and internal fixation technique using elastic stable intramedullary nail. METHODS From April 2016 to March 2020, 72 children with proximal humeral fractures were allocated to group A and 44 children with proximal humeral fractures were allocated to group B. Patients in group A were treated with bone-cemented K-wire fixation, and patients in group B were treated with elastic stable intramedullary nailing. The function of the upper limb was assessed using the Shortened Version of the Disabilities of the Arm, Shoulder and Hand questionnaire and Neer score. Patient satisfaction was assessed using the 10-cm visual analogue scale. RESULTS Bone healing was achieved in group A and B after a mean time of 6.1 ± 1.2 and 6.4 ± 1.1 weeks, respectively. The mean surgical time of groups was 33 ± 9 and 54 ± 12 minutes, respectively. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score of groups were 0.5 ± 1.4 and 0.7 ± 1.5, respectively. Based on Neer score, we obtained 69 excellent and 3 good results in group A, and 41 excellent and 3 good results in group B. There were significant differences regarding duration of operation, cost of treatment, and postoperative angle at bone healing (P < .05). CONCLUSIONS The external cemented K-wire fixation is a useful and reliable alternative technique for the treatment of severely displaced proximal humerus fractures in children. The technique is a minimally invasive procedure with minimal complications.
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Affiliation(s)
- Shibo Liu
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Yanlong Zhang
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinchao Cao
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shijie Fu
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Aqin Peng
- Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- * Correspondence: Aqin Peng, Department of Orthopedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China (e-mail: )
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Jagdale N, Mahamuni R, Pundkar A. Osteochondroma of the Acromion Process: A Rare Case with an Unusual Presentation. J Orthop Case Rep 2023; 13:38-42. [PMID: 37144075 PMCID: PMC10152940 DOI: 10.13107/jocr.2023.v13.i02.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/02/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction Osteochondroma is the most common primary benign bone tumor. It's radiologic characteristics are often pathognomonic. Osteochondromas usually occur at the metaphysis of long bones. The distal end of femur, proximal humerus, proximal tibia, and fibula are the common locations. Most cases present within the first three decades. Case Report A 12-year-old boy presented with osteochondroma of left acromion process. It is very unusual for its location with a mass over the left shoulder extending laterally into deltoid muscle. Radiologic studies showed large pedunculated mass arising from the acromion process. On surgical exploration, we found a pedunculated and well encapsulated mass on the lateral aspect of the left shoulder with a thin hyaline cartilaginous cap. The mass was carefully separated from nearby structures and resected en bloc. Results No post-operative complications were noticed. Patient was prescribed physiotherapy and we have him advised 6-month follow-up till skeletal maturity. Patient had complete range of motion at the last follow-up. He was able to do his all daily activities. Conclusion The acromion is very rare site for osteochondroma with mass extending into lateral deltoid muscle. Careful blunt dissection and protection of nearby structures and fairly good learning curve of surgeon is needed in operating such cases.
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Affiliation(s)
- Nishant Jagdale
- Deparment of Orthopaedics, RCSM GMC, Kolhapur, Maharashtra, India
- Address of Correspondence: Dr. Nishant Jagdale, Department of Orthopaedics, RCSM GMC, Kolhapur, Maharashtra, India. E-mail:
| | - Rahul Mahamuni
- Deparment of Orthopaedics, RCSM GMC, Kolhapur, Maharashtra, India
| | - Akshay Pundkar
- Deparment of Orthopaedics, RCSM GMC, Kolhapur, Maharashtra, India
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Zhang Y, Lu M, Hu X, Li Z, Wang J, Gong T, Zhou Y, Luo L, Min L, Tu C. Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect. Front Bioeng Biotechnol 2023; 10:1098973. [PMID: 36714618 PMCID: PMC9877454 DOI: 10.3389/fbioe.2022.1098973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Tumorous bone defect reconstructions of the proximal humerus with joint sparing is a challenge. Numerous reconstruction methods have been proposed but the proximal residual humerus is commonly sacrificed because of its extremely short length. To preserve the proximal humerus and improve clinical outcomes, we designed a three-dimensional (3D) printed uncemented prosthesis with a porous structure to treat tumorous bone defects of the proximal humerus. Methods: Our analysis included seven patients treated between March 2018 and July 2019. A 3D model was established, and related data were obtained, including the diameter of the humeral head, the resection length, and the residual length. A prosthesis was designed and fabricated based on these data. Functional and oncologic outcomes were recorded, and complications and osseointegration were evaluated. Results: The mean age of the patients was 20.3 years, and the median follow-up period was 26 months. The lengths of the residual proximal humerus were 17.9 mm on average. All the patients had preserved humeral heads and most of the rotator cuff was intact. The average postoperative range of motion (ROM) of the affected shoulder was 83.8°; flexion was 82.5°, extension was 43.8°, and adduction was 16.3°. The average Musculoskeletal Tumor Society score (MSTS) was 94.3%. Good osseointegration was observed on the interface between the bone and prosthesis. Conclusion: A 3D printed porous prosthesis with cone-like structures successfully achieved joint-sparing reconstruction of proximal humeral tumorous defects with satisfying functional outcomes. The preservation of the rotator cuff and humeral head plays an essential role in the function of the shoulder joint.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
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22
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Souleiman F, Theopold J, Henkelmann R, Osterhoff G, Pastor T, Gueorguiev B, Fakler J, Hepp P. Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating. Medicina (B Aires) 2023; 59. [PMID: 36676737 DOI: 10.3390/medicina59010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant-Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23-76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12-97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.
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Muacevic A, Adler JR, Sakhre R. En Bloc Resection With Reconstruction Using a Customized Megaprosthesis in a Case of Proximal Humerus Giant Cell Tumor: A Case Report. Cureus 2023; 15:e34217. [PMID: 36852360 PMCID: PMC9958242 DOI: 10.7759/cureus.34217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
A giant cell tumor is a common, benign but locally aggressive bone tumor faced by orthopedic surgeons. The proximal humerus is a rare site of occurrence for this tumor, and the challenges posed while approaching such a case are discussed in this report of a 29-year-old male who presented with pain, swelling, and restricted motion at the left shoulder. Plain radiographs and MRI were suggestive of an aggressive giant cell tumor of the proximal humerus, which was confirmed on histopathological examination. Due to the lesion's extensive soft-tissue involvement, en-bloc resection with reconstruction was planned, but due to the COVID-19 pandemic, surgery was delayed. During the same period, the patient had trivial trauma to the same shoulder, following which the size of the lesion began increasing. The patient was operated on with en-bloc resection and reconstruction with a custom megaprosthesis; following the surgery, there was a complete resolution of pain and improvement in the range of motion. En bloc resection and replacement with a customized megaprosthesis, though technically demanding, offer a safe and cost-effective modality for limb salvage surgery for large giant cell tumors, with good functional outcomes and decreased chances of recurrence.
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Affiliation(s)
- Alexander Muacevic
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
| | - John R Adler
- Orthopedics and Traumatology, NKP Salve Institute of Medical Sciences & Research Centre, Nagpur, IND
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Chang Z, Zhu Z, Zhang W, Chen H, Liu Y, Tang P. Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population. Front Surg 2023; 10:1138620. [PMID: 36936649 PMCID: PMC10020333 DOI: 10.3389/fsurg.2023.1138620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Age-related changes in the medial column (MC) of the proximal humerus have a major impact on fracture management; however, the changes in the morphological features remain unclear. This study aimed to investigate the age-related changes in the morphological features of MC and present the morphological grading. Methods One hundred computed tomography (CT) images of the proximal humerus of 100 individuals (19-95 years) were retrospectively obtained. The individuals were categorized into five age groups to quantify the differences among different ages; the youngest group (18-44 years) served as the baseline group. Parameters of the morphological features were measured on CT images with multiplanar reconstruction based on an explicit definition of MC, including length, thickness, width, oblique thickness (DSM), humeral head diameter (DHM), and ratio (RSM) of DSM to DHM. The morphological grading of MC was presented based on the value of RSM deviating different standard deviations (SD) from the mean value in the baseline group. Results Significant negative correlations were observed between age and the morphological parameters of MC (r ranged from -0.875 to -0.926; all P < 0.05), excluding DHM (r = 0.081, P = 0.422). Significant differences in the values of morphological feature parameters were detected among the five age groups (all P < 0.001). The highest mean values of morphological feature parameters were observed in the youngest group (18-44 years), which decreased gradually with increasing age until the lowest mean values were observed in the oldest group (≥90 years) (all P < 0.05). The morphological features of MC were categorized into three grades based on the value of RSM deviating 1.5 SD or 3 SD from the mean value in the baseline group. Conclusion Our study shows that the parameter values of morphological features of MC decreased with increasing age. The morphological features of MC could be categorized into three grades. Our findings may provide a more comprehensive insight into age-related changes in the morphological features of MC that facilitate risk stratification and optimize the management of proximal humeral fractures.
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Affiliation(s)
- Zuhao Chang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhengguo Zhu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- AI Sports Engineering Lab, School of Sports Engineering, Beijing Sport University, Beijing, China
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Correspondence: Hua Chen Yujie Liu
| | - Yujie Liu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Correspondence: Hua Chen Yujie Liu
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Muacevic A, Adler JR, Eager JJ, Sajid S, Cervantes M. Primary Intraosseous Malignant Peripheral Nerve Sheath Tumor of the Humerus: Report of a Rare Case. Cureus 2022; 14:e33178. [PMID: 36726883 PMCID: PMC9886069 DOI: 10.7759/cureus.33178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/01/2023] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) usually arise in the soft tissues. Intraosseous MPNSTs are rare. They may arise de novo but are typically associated with neurofibromatosis type 1 (NF1) and radiation therapy. Our patient is a 58-year-old female patient that presented with right shoulder pain. An MRI showed a shoulder mass, and percutaneous bone biopsy demonstrated morphology suggestive of an MPNST; besides, on immunohistochemistry, SOX10 was positive, and H3K27me3 expression was entirely lost. The patient underwent total resection of the right proximal humerus and endoprosthetic shoulder reconstruction, followed by radiation therapy and chemotherapy. Only a few cases in the mandible, spine, maxilla, ulna, metacarpal, tarsal, and one in the humerus have been published. In this paper, we contribute with an additional case of primary intraosseous MPNST in the humerus and a brief literature review.
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26
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Hättich A, Harloff TJ, Sari H, Schlickewei C, Cramer C, Strahl A, Frosch KH, Mader K, Klatte TO. Influence of Fracture Reduction on the Functional Outcome after Intramedullary Nail Osteosynthesis in Proximal Humerus Fractures. J Clin Med 2022; 11. [PMID: 36431338 DOI: 10.3390/jcm11226861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Optimal treatment of proximal humeral fractures (PHF) is still controversial. Therefore, we aim to investigate the influence of fracture reduction after intramedullary nailing of a PHF on the clinical outcome. Methods: Patients treated with intramedullary nail for PHF from 2013−2018, (minimum follow-up 12 months) were retrospectively included. Constant Score (CS), DASH and Simple Shoulder Test (SST) were collected. Postoperative radiographs were used to determine head-shaft-alignment (HSA), head-shaft-displacement (HSD), integrity of the medial hinge and the cranialization of the greater tuberosity (CGT). The results of fracture reduction were categorized as either “anatomical”, “acceptable” or as “malreduction”. Malreduction exists when at least one of the following parameters are present: HSA > 150/< 110°, HSD >5 mm, CTM > 5 mm or lack of integrity of the medial hinge. Results: 42 patients (mean age 65.5 ± 14.1 years, 15 male, 27 female) with a mean follow-up time of 43 months were included. The average CS was 60 ± 30, DASH 49.8 ± 24.3 and SST 62.9 ± 26.9. There was an “anatomic” reduction in 9 (21.4%), “acceptable” in 7 (16.6%) and a “malreduction” in 26 (62%) patients. Comparing the combined “anatomical” and “acceptable” reduction group with the “malreduction” group, worse scores were observed in the “malreduction” group (CS 67.2 vs. 55.2, DASH 45.2 vs. 51.9, SST: 69.3 vs. 58.6) without statistical significance (CS: p = 0.095, DASH: p = 0.307, SST: p = 0.400). By means of multiple logistic regression analyses no statistically significant risk factors were identified for lower DASH, CS and SST scores. Conclusions: Anatomical fracture reduction using intramedullary nails has a positive effect on postoperative outcome for the 3 scores recorded, without reaching statistical significance.
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Andersen L, Krueger D, Bernatz J, Binkley N, Anderson PA, Grogan B. Humeral BMD can be Measured With DXA and Is Lower in the Surgical Arm After Total Shoulder Arthroplasty. J Clin Densitom 2022; 25:448-455. [PMID: 36114106 DOI: 10.1016/j.jocd.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND As arthroplasty leads to bone loss, we hypothesized that humeral bone mineral density (BMD) is lower after total shoulder arthroplasty (TSA) in the operative versus non-operative arm. However, there is no clinical approach to measure humeral BMD with dual-energy x-ray absorptiometry (DXA). The purposes of this pilot study were to develop DXA methodology to measure humerus BMD, propose humerus regions of interest (ROIs), compare TSA BMD to the non-operative arm, correlate humeral BMD with standard sites, and evaluate measurement reproducibility. METHODOLOGY Thirty-eight adults 1-5 years post-TSA had standard clinical DXA scans plus full humerus scans using the atypical femur fracture feature; precision was assessed in a subset (n = 32). Six custom ROIs were used to measure BMD throughout the humerus. Radius and humeral BMD were compared between arms by paired t-test and correlated ipsilaterally using Pearson's Correlation. Custom ROI BMD precision was assessed using the International Society for Clinical Densitometry (ISCD) advanced precision calculator. RESULTS Study included 38 subjects (24M/14F), with mean (SD) age and time post-surgery of 69.6 (7.7) years and 2.5 (1.3) years respectively. BMD was lower (p < 0.01) at all custom humerus sites (3.8% to 8.2%) on the surgical side but not different at radius sites. Humeral BMD correlated positively with ipsilateral ultra-distal and 1/3 radius (r = 0.54 to 0.86; p < 0.05). Custom BMD precision (%CV) ranged from 6.0-16.0%. CONCLUSIONS Humerus BMD can be measured using DXA and is lower in the TSA arm. Radius BMD correlated with humeral BMD but was not lower in the surgical arm. BMD precision was worse than usual clinical sites; use of software optimized for the femur is a notable limitation and likely contributes to suboptimal precision. Further study to assess the clinical utility of humeral BMD is needed. Automation and optimization of these measurements should improve precision.
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Affiliation(s)
- Lucas Andersen
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison.
| | - Diane Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison
| | - James Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | - Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | - Brian Grogan
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
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Rossi LA, Tanoira I, Ranalletta M, Kunze KN, Farivar D, Perry A, Chahla J. Cemented vs. uncemented reverse shoulder arthroplasty for proximal humeral fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e101-e119. [PMID: 34737086 DOI: 10.1016/j.jse.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this systematic review was to compare functional outcomes, complications, and revision rates between cemented and uncemented reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs). METHODS A systematic search was performed in April 2021 within PubMed, Scopus Web of Science, and Cochrane Library databases for clinical studies reporting outcomes of RSA performed for PHF. Included studies were published in English, had a minimum 1-year follow-up, specified whether the humeral stem was cemented (cRSA) or uncemented (ucRSA), and were evidence level I-IV. Data including range of motion (ROM), functional status, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant-Murley score, visual analog scale (VAS) score, tuberosity healing, complications, and reoperations were extracted. DerSimonian-Laird random effects models with subgroup stratification analyses were applied to investigate differences in outcomes between patients with cRSA and ucRSA. RESULTS A total of 45 studies comprising 1623 patients were included. The overall pooled age was 75.9 ± 3.4 years. At a mean follow-up of 34.6 (range, 12-108) months, there were no significant differences in ROM, VAS score, Constant-Murley score, rate of tuberosity healing, or reoperation rates between the cRSA and ucRSA cohorts. The mean postoperative ASES score in the cRSA cohort (73.9, 95% CI 71.4-76.5) was significantly lower than the ucRSA cohort (82.9, 95% CI 75.9-90.0, P = .013). The incidence of postoperative all-cause complications was significantly lower in the cRSA cohort (5.5%, 95% CI 4.0%-6.9%) compared with the ucRSA cohort (9.7%, 95% CI 4.5%-14.9%, P = .044). CONCLUSION The use of uncemented humeral stems in RSA for PHF confers similar functional results to the use of cemented stems in terms of pain, range of motion, functional scores, and tuberosity healing. Although the rate of complications was significantly higher in the uncemented cohort compared with the cemented cohort (9.7% vs. 5.5%, respectively), the rate of reoperations was similar between the groups (1.6% vs. 1.9%, respectively). The uncemented reverse prosthesis seems to be a valid alternative for the management of patients with complex proximal humerus fractures.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Allison Perry
- University of Cincinnati College of Medicine, Chicago, IL, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, IL, USA
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Navarrete-Peñaloza BI, Hernández-Amaro H. [Direct medical cost of late rehabilitation in workers with conservatively managed proximal humerus fracture]. Acta Ortop Mex 2022; 36:14-19. [PMID: 36099568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Eighty percent of the Proximal humerus fractures are not displaced or minimally displaced and stable. The international treatment recommendation is conservative. Immobilization of the limb carries risk of stiffness, pain and decreased function. Currently being used rehabilitation programs with early mobilization of the injured shoulder within the first week post-fracture, with evidence of early functional and labor recovery and with no risk for displacement of fragments. However, in our country, these patients start rehabilitation late, which leads to a delay in the recovery of functionality and delay in returning to work, translating into increased costs. At the moment there is no national benchmark for the cost of this late-onset rehabilitation. MATERIAL AND METHODS From a non-probabilistic sample for convenience, were analyzed records of 52 patients, treated in the period from January to December 2019. Inclusion criteria were workers diagnosed with a proximal humeral fracture, conservative management; exclusion criteria were peripheral nerve injury, aggregate fracture or surgically treated. RESULTS The mean direct medical cost was $19,090.69 Mexican pesos, directly proportional to the days of stay in the unit and disability. CONCLUSION Late rehabilitation leads to more days of disability than recommended by the based guidelinesin the workload, therefore, higher cost.
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Affiliation(s)
- B I Navarrete-Peñaloza
- Unidad de Medicina Física y Rehabilitación Norte. Unidad Médica de Alta Especialidad (UMAE) «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS). Ciudad de México. México
| | - H Hernández-Amaro
- Clínica de Educación e Investigación en Salud. Unidad Médica de Alta Especialidad (UMAE) «Dr. Victorio de la Fuente Narváez», Instituto Mexicano del Seguro Social (IMSS). Ciudad de México. México
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Rajasekaran RB, Ashford R, Stevenson JD, Pollock R, Rankin KS, Patton JT, Gupta S, Cosker TDA. Reconstruction after resection of a proximal humeral tumour : what challenges remain? Bone Joint J 2022; 104-B:3-5. [PMID: 34969269 DOI: 10.1302/0301-620x.104b1.bjj-2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raja B Rajasekaran
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Robert Ashford
- East Midlands Sarcoma Service, Nottingham University Hospitals, Nottingham, UK
| | | | - Rob Pollock
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Kenneth S Rankin
- North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals, Newcastle upon Tyne, UK
| | | | - Sanjay Gupta
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Thomas D A Cosker
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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Houdek MT, Wagner ER, Rose PS, Barlow JD, Elhassan BT, Sanchez-Sotelo J. Allograft prosthetic composite reconstruction using a reverse total shoulder arthroplasty for failed oncologic proximal humerus reconstruction. J Surg Oncol 2021; 125:775-781. [PMID: 34913481 DOI: 10.1002/jso.26772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Endoprosthetic or allograft reconstruction are the preferred reconstruction techniques for proximal humeral bone tumors. Failure of these reconstructions may occur, but historically revision is performed rarely due to the lack of reliable options. Reverse shoulder arthroplasty with an allograft prosthetic composite (rAPC) may provide a revision option. The purpose of the current study was to evaluate our institutional outcome of these procedures. METHODS Eleven (6 male, 5 female) patients (mean age 51 ± 17 years) underwent revision of a failed oncologic reconstruction of the proximal humerus utilizing a rAPC. The most common indication for revision was subluxation (n = 6) and the most common previous implant was an endoprosthesis (n = 5). RESULTS Revision resulted in improvements in shoulder elevation (39° vs. 62°, p = 0.02), external rotation (13° vs. 25°, p = 0.04), American Shoulder and Elbow Surgeons score (39 vs. 58, p = 0.004) and Musculoskeletal Tumor Society Scores (51% vs 69%, p = 0.002). There were 2 re-revision procedures performed. One for an allograft fracture and one for allograft resorption and loosening. CONCLUSIONS Revision with a rAPC can effectively restore patient function. Due to the complexity of the cases, we advocate for these procedures to be performed by subspecialty upper extremity surgeons trained in complex revision shoulder arthroplasty.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ferlauto HR, Wickman JR, Lazarides AL, Hendren S, Visgauss JD, Brigman BE, Anakwenze OA, Klifto CS, Eward WC. Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review. J Shoulder Elbow Surg 2021; 30:e647-e658. [PMID: 34273534 DOI: 10.1016/j.jse.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND In recent years, there has been growing interest in the use of reverse total shoulder arthroplasty (rTSA) for reconstruction of the proximal humerus after oncologic resection. However, the indications and outcomes of oncologic rTSA remain unclear. METHODS We conducted a systematic review to identify studies that reported outcomes of patients who underwent rTSA for oncologic reconstruction of the proximal humerus. Extracted data included demographic characteristics, indications, operative techniques, outcomes, and complications. Weighted means were calculated according to sample size. RESULTS Twelve studies were included, containing 194 patients who underwent rTSA for oncologic reconstruction of the proximal humerus. The mean patient age was 48 years, and 52% of patients were male. Primary malignancies were present in 55% of patients; metastatic disease, 30%; and benign tumors, 9%. The mean humeral resection length was 12 cm. The mean postoperative Musculoskeletal Tumor Society score was 78%; Constant score, 60; and Toronto Extremity Salvage Score, 77%. The mean complication rate was 28%, with shoulder instability accounting for 63% of complications. Revisions were performed in 16% of patients, and the mean implant survival rate was 89% at a mean follow-up across studies of 53 months. CONCLUSIONS Although the existing literature is of poor study quality, with a high level of heterogeneity and risk of bias, rTSA appears to be a suitable option in appropriately selected patients undergoing oncologic resection and reconstruction of the proximal humerus. The most common complication is instability. Higher-quality evidence is needed to help guide decision making on appropriate implant utilization for patients undergoing oncologic resection of the proximal humerus.
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Affiliation(s)
- Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Bu G, Sun W, Li J, Yang T, Li M, Wei W. MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly. Geriatr Orthop Surg Rehabil 2021; 12:21514593211043961. [PMID: 34595046 PMCID: PMC8477691 DOI: 10.1177/21514593211043961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 01/11/2023] Open
Abstract
Background Proximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. Methods A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. Results No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). Conclusions Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.
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Affiliation(s)
- Guoyun Bu
- Department of Orthopedic, Tianjin Hospital, Tianjin, China
| | - Weitang Sun
- Department of Orthopedic, The 3rd People Hospital of Qingdao, Shandong Province, China
| | - Jian'an Li
- Department of Orthopedic, Tianjin Hospital, Tianjin, China
| | - Tao Yang
- Department of Orthopedic, Tianjin Hospital, Tianjin, China
| | - Mingxin Li
- Department of Orthopedic, Tianjin Hospital, Tianjin, China
| | - Wanfu Wei
- Department of Orthopedic, Tianjin Hospital, Tianjin, China
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Cunningham DJ, LaRose MA, Anakwenze OA, Klifto CS, Richard MJ, Ruch DS, Gage MJ. Fracture location impacts opioid demand in upper extremity fracture surgery. Injury 2021; 52:2314-2321. [PMID: 34059324 DOI: 10.1016/j.injury.2021.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Opioid sparing protocols should be formulated with appropriate demand. Specific fracture location has been hypothesized as an important predictor of post-operative pain. The purpose of this study is to evaluate the impact of fracture location on perioperative opioid demand after surgery with the hypothesis that this factor would be significantly associated with perioperative opioid demand in upper extremity fracture surgery. METHODS A national database was used to identify1-month pre-operative to 1-year postdischarge opioid demand in oxycodone 5-mg equivalents in 336,493 patients undergoing fracture fixation of the clavicle through distal radius between 2010 and 2020. Three timeframes were evaluated: 1-month pre-op to 90-days post-discharge, 3 months post-discharge to 1-year post-discharge, and 1-month pre-op to 1-year postdischarge. Multivariable main effects linear and logistic regression models were constructed to evaluate the changes in opioids filled, opioid prescriptions, and odds of two or more opioid prescriptions in these timeframes based on fracture location with adjustment for age, sex, obesity, pre-operative opioid usage, and polytrauma. RESULTS Compared to distal radius fracture fixation, fixation of elbow, distal humerus, humeral shaft, and proximal humerus fractures were associated with large, significant increases in 1-month pre-op to 1-year post-discharge opioid filling (33.5 - 63.4 additional oxycodone 5-mg equivalents, all p<0.05) and number of filled prescriptions (0.33 - 0.92 additional prescriptions, all p<0.05) compared to patients with other operatively treated upper extremity injuries. DISCUSSION Fracture location was a significant predictor of perioperative opioid demand. Elbow, distal humerus, humeral shaft, and proximal humerus fracture fixation was associated with the largest increases in opioid demand after upper extremity fracture fixation. Patients with these injuries may be at highest risk of extensive opioid consumption. LEVEL OF EVIDENCE Level III, retrospective, observational cohort study.
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Affiliation(s)
- Daniel J Cunningham
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Micaela A LaRose
- Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710
| | - Oke A Anakwenze
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Christopher S Klifto
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Marc J Richard
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - David S Ruch
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710
| | - Mark J Gage
- Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710.
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Amen TB, Varady NH, Birir A, Hayden BL, Chen AF. Morbidity and mortality of surgically treated pathologic humerus fractures compared to native humerus fractures. J Shoulder Elbow Surg 2021; 30:1873-1880. [PMID: 33220410 DOI: 10.1016/j.jse.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite an increasing prevalence of patients sustaining pathologic fractures of neoplastic origin, few studies have investigated 30-day postoperative complication profiles after surgical treatment of pathologic humerus fractures. The purposes of this study were to use a large nationally representative database to determine short-term complication profiles after surgical treatment of pathologic humerus fractures and assess how these complications compared with more commonly studied native humerus fractures. METHODS Using the National Surgical Quality Improvement Program database, we identified 30,866 patients who underwent surgical treatment for either pathologic (n = 449) or native humerus fractures (n = 30,417) from 2007 to 2017. Thirty-day postoperative complication profiles were ascertained and compared between the 2 groups using χ2 analyses. Three logistic regression models were then performed to determine which complications were primarily attributable to the pathologic fracture itself vs. the increased comorbidity burden faced by these patients. RESULTS Patients with pathologic humerus fractures experienced significantly higher rates of death (6.0% vs. 0.3%, P < .001), serious adverse events (12.2% vs. 3.7%, P < .001), minor complications (15.8% vs. 4.8%, P < .001), extended postoperative lengths of stay (42.3% vs. 21.3%, P < .001), discharge to facilities (22.3% vs. 13.5%, P < .001), and readmissions (14.8% vs. 3.4%, P < .001) compared with patients with native humerus fractures. With respect to specific complications, patients with pathologic fractures were at significantly higher risk of pulmonary complications (1.3% vs. 0.3%, P < .001), renal complications (0.7% vs. 0.2%, P = .007), thromboembolic complications (1.6% vs. 0.6%, P = .01), and transfusions (15.1% vs. 4.1%, P < .001). CONCLUSION After surgical treatment, patients with pathologic humerus fractures had significantly higher complication rates compared with native humerus fractures, suggesting that guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin. These findings have significant implications for preoperative patient counseling and may be used to negotiate higher reimbursement rates for these patients given a significantly higher morbidity and mortality than was previously described in literature. Postoperatively, orthopedic surgeons should closely monitor patients with pathologic humerus fractures for deep vein thrombosis, renal complications, and pulmonary complications, use blood-sparing techniques, and employ a multidisciplinary approach to help manage and prevent a more heterogeneous profile of postsurgical complications.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aseal Birir
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Zeng LQ, Chen YF, Jiang YW, Zeng LL, Miao XG, Liang WG. A new low-profile anatomic locking plate for fixation of comminuted, displaced greater tuberosity fractures of the proximal humerus. J Shoulder Elbow Surg 2021; 30:1402-1409. [PMID: 32949759 DOI: 10.1016/j.jse.2020.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/16/2020] [Accepted: 08/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although various implants exist for the fixation of isolated greater tuberosity fractures, few implants are specifically designed for such fractures. The purpose of this study was to investigate the clinical and radiologic outcomes of open reduction-internal fixation with a low-profile anatomic locking plate for comminuted greater tuberosity fractures of the proximal humerus. METHODS From November 2012 to February 2018, 24 patients with displaced and comminuted isolated greater tuberosity fractures were treated with the new low-profile anatomic locking plate. To determine clinical outcomes, we evaluated active range of motion; the visual analog scale pain score; the Constant-Murley score; the Disabilities of the Arm, Shoulder and Hand score; radiographs; and complications. RESULTS In all cases, a mean follow-up period of 29.3 months (range, 18-48 months) was completed. All patients achieved bone union with a mean healing time of 11.3 weeks (range, 8-16 weeks). The mean Constant-Murley score was 91.1 points (range, 69-100 points), with a rate of good to excellent results of 95.8%. The average Disabilities of the Arm, Shoulder and Hand score was 9.9 points (range, 2-25 points), and the mean visual analog scale pain score was 1.1 points (range, 0-4 points). Mean active forward flexion, abduction, external rotation, and internal rotation (level) were 157°, 152°, and 40°, and T11, respectively. Postoperatively, 1 patient had persistent shoulder stiffness, and 1 patient had recurrence of shoulder dislocation because of a falling injury during badminton. No serious complications such as subacromial impingement, malunion, nonunion, loss of reduction, or implant failure occurred. CONCLUSIONS The new low-profile anatomic locking plate was useful for the treatment of comminuted isolated greater tuberosity fractures as it provided reliable stability and satisfactory radiographic and functional results. The described technique is a simple and effective method and provides a new reliable option for the treatment of isolated greater tuberosity fractures.
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Affiliation(s)
- Lang-Qing Zeng
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, China
| | - Yun-Feng Chen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Wen Jiang
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, China
| | - Lu-Lu Zeng
- Department of Anesthesiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, China
| | - Xiao-Gang Miao
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, China
| | - Wei-Guo Liang
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
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Agrawal AC, Choudhary R, Verma S. The Successful Management of a Repetitively Infected Recurrent Proximal Humerus Giant Cell Tumour of 20 Years' Duration With Two-Staged Surgery: A Rare Case Report. Cureus 2021; 13:e14492. [PMID: 34007746 PMCID: PMC8122010 DOI: 10.7759/cureus.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The recurrence of giant cell tumour of bone (GCTB) is quite well known. It is mainly attributed to the presence of microscopic tumour remnants left behind after tumour treatment by intralesional curettage. This condition becomes more serious and alarming when the lesion gets infected postoperatively. Several studies have indicated that the role of adjuvants in preventing the recurrence of GCTs is limited, and complete removal of malignant cells is often mandatory. We present a rare case GCT of the proximal humerus in a female patient who developed repetitive recurrences of the tumour; her salvage procedures were also complicated by the development of infection after every treatment procedure for over 20 years. The patient was finally treated successfully with a two-stage revision and reconstruction procedure.
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Affiliation(s)
- Alok C Agrawal
- Orthopaedics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ranjeet Choudhary
- Orthopaedics and Trauma, All India Institute of Medical Sciences, Raipur, Raipur, IND.,Orthopaedics and Trauma, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Shilp Verma
- Orthopaedic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Gulia A, Puri A, Gupta S, Kurisunkal V. 'Umbrella construct' - an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours. Shoulder Elbow 2021; 13:188-194. [PMID: 33897850 PMCID: PMC8039762 DOI: 10.1177/1758573219895988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/15/2022]
Abstract
AIM Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique 'Umbrella construct' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. METHODS Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14-36 years). The maximum longitudinal extent of disease was 9 cm (range 5-9 cm). RESULTS The median follow-up was 54 months (range 34-122 months). The mean allograft incorporation time was 7 months (5-8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23-29). CONCLUSIONS Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.
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Affiliation(s)
- Ashish Gulia
- Ashish Gulia, Tata Memorial Hospital, Main building
OPD - 93, Dr Ernst Borges Road, Parel, Mumbai 400012, India.
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Sam CX, Anwar AZ, Ahmad AR, Solayar GN. Early Experience of Reverse Total Shoulder Arthroplasty in a Public Hospital in Malaysia. Malays Orthop J 2021; 15:119-123. [PMID: 33880158 PMCID: PMC8043626 DOI: 10.5704/moj.2103.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of cuff tear arthropathy, arthritis and fracture sequelae. This study aimed to assess the short-term outcomes following reverse total shoulder arthroplasty for patients in a large public hospital in Malaysia. Materials and Methods: We identified and performed five primary reverse total shoulder arthroplasties between 1 May 2019 and 1 June 2020. All patients were contactable and available for analysis. Assessment of functional outcomes was performed using the Constant-Murley score, the patient satisfaction score (PSS), and imaging studies. The mean follow-up from operation to the time of reporting was 9.6 months (range, 3 to 14 months) Results: The median age for our patients was 58 years (±11.91). The most common indication for surgery was post-traumatic arthritis, followed by rotator cuff arthropathy and osteoarthritis. The mean Constant score improved from 9.0 pre-operatively to 52.3 post-operatively at a mean of 9.6 months. The majority of the patients were satisfied with the surgery as the post-operative range of motion, especially anterior elevation and abduction, improved in four of our patients and there were no short-term complications, for example, of infection or revisions, reported at the last follow-up. Conclusion: This study has shown that reverse total shoulder arthroplasty can yield good short-term outcomes for the treatment of complex shoulder problems in addition to cuff tear arthropathy. It should be considered a treatment for rotator cuff tears, severe arthritis and ≥ 3 parts proximal humeral fractures.
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Affiliation(s)
- C X Sam
- Department of Orthopaedics, International Medical University, Seremban, Malaysia
| | - A Z Anwar
- Department of Orthopaedics, Tuanku Ja'afar Hospital, Seremban, Malaysia
| | - A R Ahmad
- Department of Orthopaedics, Tuanku Ja'afar Hospital, Seremban, Malaysia
| | - G N Solayar
- Department of Orthopaedics, International Medical University, Seremban, Malaysia
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40
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Konda SR, Johnson JR, Dedhia N, Kelly EA, Egol KA. Can We Stratify Quality and Cost for Older Patients With Proximal and Midshaft Humerus Fractures? Geriatr Orthop Surg Rehabil 2021; 12:2151459321992742. [PMID: 33680532 PMCID: PMC7900848 DOI: 10.1177/2151459321992742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: This study sought to investigate whether a validated trauma triage tool can
stratify hospital quality measures and inpatient cost for middle-aged and
geriatric trauma patients with isolated proximal and midshaft humerus
fractures. Materials and Methods: Patients aged 55 and older who sustained a proximal or midshaft humerus
fracture and required inpatient treatment were included. Patient
demographic, comorbidity, and injury severity information was used to
calculate each patient’s Score for Trauma Triage in the Geriatric and
Middle-Aged (STTGMA). Based on scores, patients were stratified to create
minimal, low, moderate, and high risk groups. Outcomes included length of
stay, complications, operative management, ICU/SDU-level care, discharge
disposition, unplanned readmission, and index admission costs. Results: Seventy-four patients with 74 humerus fractures met final inclusion criteria.
Fifty-eight (78.4%) patients presented with proximal humerus and 16 (21.6%)
with midshaft humerus fractures. Mean length of stay was 5.5 ± 3.4 days with
a significant difference among risk groups (P = 0.029). Lower risk patients
were more likely to undergo surgical management (P = 0.015) while higher
risk patients required more ICU/SDU-level care (P < 0.001). Twenty-six
(70.3%) minimal risk patients were discharged home compared to zero high
risk patients (P = 0.001). Higher risk patients experienced higher total
inpatient costs across operative and nonoperative treatment groups. Conclusion: The STTGMA tool is able to reliably predict hospital quality measures and
cost outcomes that may allow hospitals and providers to improve value-based
care and clinical decision-making for patients presenting with proximal and
midshaft humerus fractures. Level of Evidence: Prognostic Level III.
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Affiliation(s)
- Sanjit R Konda
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA.,Jamaica Hospital Medical Center, Queens, NY, USA
| | - Joseph R Johnson
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
| | - Nicket Dedhia
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
| | - Erin A Kelly
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
| | - Kenneth A Egol
- NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA.,Jamaica Hospital Medical Center, Queens, NY, USA
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Xue Z, Pei Z, Zhang H, Tang C, Jia J, Zhang K, Zhang K, Wang L, Guan Z. Histological characteristics of bone in-growth of proximal humeral implants with different spatial structures. Aging (Albany NY) 2021; 13:4291-4298. [PMID: 33495410 PMCID: PMC7906205 DOI: 10.18632/aging.202391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
This study compares the longitudinal histological characteristics of proximal humeral implants with different spatial structures in rabbits. Thirty skeletally-mature male rabbits were divided into a trabecular structure group and regular hexahedron structure group according to the different spatial structures of a biological titanium alloy screw inserted into the greater tuberosity of the proximal humerus. Samples were collected 3, 6, and 12 weeks after the implantation surgery. Histological results showed that the amount of bone in-growth in the porous cavity of the screw implant increased over time. Quantitative analysis showed there was significantly more bone in-growth in the trabecular structure group than the classic structure group 3 weeks (25.4% ± 6.9% vs 19.6% ± 3.7%, P < 0.05) and 6 weeks (31.2% ± 1.7% vs 26.9% ± 5.3, P < 0.05) after the implantation surgery. No significant difference was detected between the two groups 12 weeks after the surgery (41.7% ± 2.5% vs 39% ± 4.1%, P > 0.05). Our data found that bone in-growth significantly differed among the three time points (P < 0.05) in both groups, but not between the implants with different spatial structures 12 weeks after the surgery.
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Affiliation(s)
- Zhe Xue
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Zheng Pei
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Hui Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Junxiu Jia
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Kun Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Keshi Zhang
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
| | - Luning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Haidian 100083, Beijing, P.R. China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, ShiJingshan 100144, Beijing, P.R. China
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Jones C, Rulon Z, Arthur W, Ottwell R, Checketts J, Detweiler B, Calder M, Adil A, Hartwell M, Wright DN, Vassar M. Evaluation of spin in the abstracts of systematic reviews and meta-analyses related to the treatment of proximal humerus fractures. J Shoulder Elbow Surg 2021; 30:2197-2205. [PMID: 33482369 DOI: 10.1016/j.jse.2020.11.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research has shown that many physicians rely solely on abstracts to make clinical decisions. However, many abstracts have been shown to be misleading. The primary objective of this study was to identify the prevalence of spin - bias towards particular results - within the abstracts of systematic reviews and meta-analyses pertaining to the treatment of proximal humerus fractures, one of the most common osteoporotic fractures among elderly patients. METHODS We systematically searched MEDLINE and Embase databases to identify systematic reviews and meta-analyses examining the treatment of proximal humerus fractures. Screening and data extraction occurred in a masked, duplicate fashion. The nine most severe types of spin that occur within abstracts were extracted along with study characteristics, including journal recommendations to adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and year in which the review was performed, to identify potential associations. We subsequently explored the association between spin and the methodological quality of a systematic review using the revised A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) appraisal instrument. RESULTS Our search retrieved 505 articles, of which 73 systematic reviews met inclusion criteria. We found that 34.2% (25/73) of the included systematic reviews contained spin. Spin type 3 (selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention) was the most common type identified (12/73, 16.4%). Three spin types were not identified in any of the abstracts. Spin was 3.2 (OR 3.2; 95% CI, 1.02-10.02) times more likely to be present in systematic reviews published in journals recommending adherence to PRISMA. Furthermore, the odds of an abstract containing spin was 1.25 (OR 1.25; 95% CI, 1.02-1.52) times more likely to be present in systematic reviews for each year after 2000. No other study characteristics were associated with spin. The methodological quality of 24 studies were rated as "critically low" (32.9%), 14 were "low" (19.2%), 28 were "moderate" (38.4%), and 7 were "high" (9.6%), but these findings were not associated with spin. CONCLUSION Spin was present in systematic review abstracts regarding treatment of proximal humerus fractures. Measures such as education on the subject of spin and improved reporting standards should be implemented to increase awareness and reduce incidence of spin in abstracts. LEVEL OF EVIDENCE OF THE STUDY PERFORMED Basic Science Study; Research Methodology.
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Affiliation(s)
- Caleb Jones
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Zane Rulon
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Wade Arthur
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Jake Checketts
- Department of Orthopedic Surgery, Oklahoma State University Center Medical Center, Tulsa, OK, USA
| | - Byron Detweiler
- Department of Orthopedic Surgery, Oklahoma State University Center Medical Center, Tulsa, OK, USA
| | - Mark Calder
- Orthopedic & Trauma Services of Oklahoma, Tulsa, OK, USA
| | - Abrar Adil
- Orthopedic & Trauma Services of Oklahoma, Tulsa, OK, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Drew N Wright
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Imiolczyk JP, Moroder P, Scheibel M. Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures-A Retrospective, Observational Study. J Clin Med 2021; 10:E175. [PMID: 33419012 DOI: 10.3390/jcm10020175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Tuberosity healing and stem design can be outcome-dependent parameters in hemiarthroplasty for proximal humerus fractures (PHF). The relevance of fracture-specific stem design in reverse shoulder arthroplasty (RSA) is still a matter of debate. This retrospective study evaluates tuberosity healing and function for fracture specific stems (A) compared to conventional stems (B) in RSA for complex PHF in 26 patients (w = 21, mean age 73.5 years). Clinically, range of motion (ROM), Constant-Murley-Score (CS), Subjective Shoulder Value (SSV), and external rotation lag signs (ERLS) were evaluated. Healing of greater tuberosity (GT) and lesser tuberosity (LT), scapular notching, and loosening were examined radiologically. There were no statistical significant differences with regards to CS (A: 73 ± 11; B: 77 ± 9 points), SSV (A: 78% ± 11%; B: 84% ± 11%), external rotation (A: 18° ± 20°; B: 24° ± 19°), or internal rotation (A: 5.7 ± 2.2; B: 6.7 ± 2.8 CS-points) (p > 0.05). Mean forward flexion was superior for group A (p = 0.036). Consolidation of GT (82%) and LT (73%) was similar in both groups. Anatomical healing was slightly higher in group B (p > 0.05). Scapular notching was found in 27% (A) and 55% (B) (p > 0.05). RSA for PHF provides good to excellent clinical results. The quantitative and qualitative union rate for both cohorts was similar, indicating that fracture stems with open metaphyseal designs to allow for bone ingrowth do not improve tuberosity healing. ERLS correlates with a worse function in CS and ROM in all planes.
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Tanoira I, Brandariz RN, Cerruti W, Gallucci G, Ranalletta M. [Tuberculosis in the proximal humerus. A rare diagnosis in joint infections]. Medicina (B Aires) 2021; 81:103-106. [PMID: 33611252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiologica l, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspe cific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.
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Affiliation(s)
- Ignacio Tanoira
- Departamento de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
- Centro de Ortopedia y Traumatología de Quilmes, Buenos Aires, Argentina
| | - Rodrigo N Brandariz
- Departamento de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina. E-mail:
| | - Walter Cerruti
- Centro de Ortopedia y Traumatología de Quilmes, Buenos Aires, Argentina
| | - Gerardo Gallucci
- Departamento de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
- Centro de Ortopedia y Traumatología de Quilmes, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Departamento de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
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Evans DR, Saltzman EB, Anastasio AT, Guisse NF, Belay ES, Pidgeon TS, Richard MJ, Ruch DS, Anakwenze OA, Gage MJ, Klifto CS. Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures. JSES Int 2020; 5:212-219. [PMID: 33681840 PMCID: PMC7910730 DOI: 10.1016/j.jseint.2020.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hypothesis We hypothesized that the modified Fragility Index (mFI) would predict complications in patients older than 50 years who underwent operative intervention for a proximal humerus fracture. Methods We retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a proximal humerus fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates as well as length of stay (LOS) were recorded. Univariate as well as multivariable statistical analyses were performed, controlling for age, sex, body mass index, LOS, and operative time. Results We identified 2,004 patients (median age, 66 years; interquartile range: 59-74), of which 76.2% were female. As mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 2.8% to 6.7% (P-value = .005), rate of discharge to rehabilitation facility increased from 7.1% to 25.3% (P-value < .001), and rates of any complication increased from 6.5% to 13.9% (P-value < .001). Specifically, the rates of renal and hematologic complications increased significantly in patients with mFI of 2 or greater (P-value = .042 and P-value < .001, respectively). Compared with patients with mFI of 0, patients with mFI of 2 or greater were 2 times more likely to be readmitted within 30 days (odds ratio = 2.2, P-value .026). In addition, patients with mFI of 2 or greater had an increased odds of discharge to a rehabilitation center (odds ratio = 2.3, P-value < .001). However, increased fragility was not significantly associated with an increased odds of 30-day reoperation or any complication after controlling for demographic data, LOS, and operative time. Conclusion An increasing level of fragility is predictive of readmission and discharge to a rehabilitation center after open reduction and internal fixation of proximal humerus fractures. Our data suggest that a simple fragility evaluation can help inform surgical decision-making and counseling in patients older than 50 years with proximal humerus fractures.
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Affiliation(s)
| | - Eliana B Saltzman
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Elshaday S Belay
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tyler S Pidgeon
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Marc J Richard
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - David S Ruch
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark J Gage
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
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Walters JM, Ahmadi S. High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review. Geriatr Orthop Surg Rehabil 2020; 11:2151459320971568. [PMID: 33354380 PMCID: PMC7734485 DOI: 10.1177/2151459320971568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/29/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.
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Affiliation(s)
- Jordan M Walters
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shahryar Ahmadi
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Braig ZV, Tagliero AJ, Rose PS, Elhassan BT, Barlow JD, Wagner ER, Sanchez-Sotelo J, Houdek MT. Humeral stress shielding following cemented endoprosthetic reconstruction: An under-reported complication? J Surg Oncol 2020; 123:505-509. [PMID: 33259663 DOI: 10.1002/jso.26300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The proximal humerus is a common location for primary and non-primary tumors. Reconstruction of the proximal humerus is commonly performed with an endoprosthesis with low rates of structural failure. The incidence and risk factors for stress shielding are under reported. METHODS Thirty-nine (19 male, 20 female) patients underwent resection of the proximal humerus and reconstruction with a cemented modular endoprosthesis between 2000 and 2018. The mean resection length was 12 ± 4 cm and was most commonly performed for metastatic disease (n = 26, 67%). RESULTS Stress shielding was observed in 9 (23%) patients at a mean of 29 (6-132) months postoperatively. Patients with stress shielding were noted to have shorter intramedullary stem length (87 vs. 107 mm, p < .001), longer extramedullary implant length (16 vs. 14 cm, p = .01) and a higher extramedullary implant to stem length ratio (2.1 vs. 1.1, p < .001). The incidence of stress shielding was higher (p = .003) in patients reconstructed with 75 mm stem (n = 6, 67%) lengths. CONCLUSION Stress shielding of the humerus was associated with the use of shorter stems and long extramedullary implants. The long-term ramifications of stress shielding on implant stability, complications at the time of revision surgery, and overall patient outcomes remain unknown.
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Affiliation(s)
- Zachary V Braig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, USA
| | | | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Houdek MT, Bukowski BR, Athey AG, Elhassan BT, Barlow JD, Morrey ME, Rose PS, Wagner ER, Sanchez-Sotelo J. Comparison of reconstructive techniques following oncologic intraarticular resection of proximal humerus. J Surg Oncol 2020; 123:133-140. [PMID: 33095924 DOI: 10.1002/jso.26271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The proximal humerus is a common site of primary and metastatic disease in the upper extremity. Historically, the goal of a hemiarthroplasty reconstruction was to provide a stable platform for hand and elbow function, with limited shoulder function. Techniques utilizing a reverse endoprosthesis (endoprosthetic replacement [EPR]) and allograft-prosthetic composite (APC) have been developed; however, there is a paucity of comparative studies. METHODS A total of 83 (42 females, 41 males) patients undergoing an intraarticular resection of the humerus were reviewed. Reconstructions included 30 reverse and 53 hemiarthroplasty; including hemiarthroplasty EPR (n = 36) and APC (n = 17), and reverse EPR (n = 20) and APC (n = 10). RESULTS Reverse reconstructions had improved forward elevation (85° vs. 44°, p < .001) and external rotation (30° vs. 21°; p < .001) versus a hemiarthroplasty. Reverse reconstructions had improved American Shoulder and Elbow Surgeons scores (65 vs. 57; p = .01) and Musculoskeletal Tumor Society 93 scores (72 vs. 63; p < .001) versus hemiarthroplasty. Subluxation of the reconstruction was a common (n = 23, 27%), only occurring in hemiarthroplasty patients (EPR [n = 13, 36%] and APC [n = 10, 59%]). CONCLUSION The current series highlights the improved functional outcome in patients undergoing reconstruction with a reverse arthroplasty compared to the traditional hemiarthroplasty. Currently reverse shoulder arthroplasty (APC or EPR) is our preferred methods of reconstruction in this patient population.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon R Bukowski
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander G Athey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, USA
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Bergdahl C, Wennergren D, Ekelund J, Möller M. Mortality after a proximal humeral fracture. Bone Joint J 2020:1-7. [PMID: 32921146 DOI: 10.1302/0301-620x.102b9.bjj-2020-0627.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to investigate the mortality following a proximal humeral fracture. Data from a large population-based fracture register were used to quantify 30-day, 90-day, and one-year mortality rates after a proximal humeral fracture. Associations between the risk of mortality and the type of fracture and its treatment were assessed, and mortality rates were compared between patients who sustained a fracture and the general population. METHODS All patients with a proximal humeral fracture recorded in the Swedish Fracture Register between 2011 and 2017 were included in the study. Those who died during follow-up were identified via linkage with the Swedish Tax Agency population register. Age- and sex-adjusted controls were retrieved from Statistics Sweden and standardized mortality ratios (SMRs) were calculated. RESULTS A total of 18,452 patients who sustained a proximal humeral fracture were included. Their mean age was 68.8 years (16 to 107) and the majority (13,729; 74.4%) were women. A total of 310 (1.68%) died within 30 days, 615 (3.33%) within 90 days, and 1,445 (7.83%) within one year after the injury. The mortality in patients sustaining a fracture and the general population was 1,680/100,000 and 326/100,000 at 30 days, 3,333/100,000 and 979/100,000 at 90 days, and 7,831/100,000 and 3,970/100,000 at one year, respectively. Increasing age, male sex, low-energy trauma, type A fracture, concomitant fractures, and non-surgical treatment were all independent factors associated with an increased risk of mortality. CONCLUSION Compared with the general population, patients sustaining a proximal humeral fracture have a significantly higher risk of mortality up to one year after the injury. The risk of mortality is five times higher during the first 30 days, diminishing to two times higher at one year, suggesting that these patients constitute a strikingly frail group, in whom appropriate immediate management and medical optimization are required.
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Affiliation(s)
- Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Jan Ekelund
- Centre of Registers, Western Healthcare Region, Gothenburg, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Lichtl AJ, Lee CS. Primary total shoulder arthroplasty in the setting of a benign enchondroma. J Shoulder Elbow Surg 2020; 29:e345-e349. [PMID: 32815810 DOI: 10.1016/j.jse.2020.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
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