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Ameziane Y, Imiolczyk JP, Steinbeck J, Warnhoff M, Moroder P, Scheibel M. [Reverse Shoulder Arthroplasty - Current Concepts]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:211-228. [PMID: 38518806 DOI: 10.1055/a-2105-3147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Due to first promising long term outcome data, reverse shoulder arthroplasty experienced an immense increase of usage during the past decade. Moreover, the initial Grammont concept has constantly been refined and adapted to current scientific findings. Therefore, clinical and radiological problems like scapular notching and postoperative instability were constantly addressed but do still remain an area of concern.This article summarises current concepts in reverse shoulder arthroplasty and gives an overview of actual indications like cuff tear arthropathy, severe osteoarthritis, proximal humerus fractures, tumours, fracture sequelae as well as revision surgery and their corresponding clinical and radiological results.
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Ripoll T, Fairag R, Bonomo I, Gastaud O, Psacharopulo D. Axillary Artery Injuries Associated With Proximal Humerus Fractures: A Literature Review and a Proposal of a Novel Multidisciplinary Surgical Approach. Vasc Endovascular Surg 2024; 58:245-254. [PMID: 37823274 DOI: 10.1177/15385744231206834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are common injuries that can lead to axillary artery injury, which carries the risk of not being identified during initial assessment. The aim of this study was to describe the management of suspected axillary artery injury associated with PHF according to our experience and to describe a new multidisciplinary surgical approach. METHODS This was a single-center retrospective study. A database was created for patients admitted for PHF to the emergency department of the Hospital of Cannes between October 2017 and October 2019. Patients admitted with PHF associated with suspected ipsilateral upper limb ischemia, and/or massive diaphysis displacement, and/or upper limb ipsilateral neurological deficits were included in this study. RESULTS In total, 301 patients diagnosed with PHF were admitted within these periods. Among these patients, 12 presented with suspected axillary artery lesions, of whom, 6 were included in the present study and treated according to our new approach. A description of these 6 cases, along with an extensive literature review is presented. CONCLUSION Based on our experience, the endovascular approach proposed for the management of axillary artery injury associated with proximal humerus fractures is effective, feasible and reproducible.
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Affiliation(s)
- Thomas Ripoll
- Service de Chirurgie Vasculaire, Centre Hospitalier de Cannes, Cannes, France
- Service de Chirurgie Orthopédique, Centre Hospitalier de Cannes, Cannes, France
| | - Rayan Fairag
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Iris Bonomo
- Service de Gynécologie, Institut Bergonié, Bordeaux, France
| | - Olivier Gastaud
- Service de Chirurgie Orthopédique, Centre Hospitalier de Cannes, Cannes, France
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Sapienza M, Pavone V, Muscarà L, Panebianco P, Caldaci A, McCracken KL, Condorelli G, Caruso VF, Costa D, Di Giunta A, Testa G. Proximal humeral multiple fragment fractures in patients over 55: Comparison between Conservative treatment and Plate Fixation. Heliyon 2024; 10:e25898. [PMID: 38375257 PMCID: PMC10875435 DOI: 10.1016/j.heliyon.2024.e25898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Proximal humerus fractures account for about 5% of fragility fractures. These involve a significant burden of disability and a reduced quality of life. This study aims to compare functional results and surgical outcomes (closed reduction and internal fixation with the internal closure system of the proximal humerus) and the conservative management of proximal humerus fractures by 2-, 3-, 4-parts, in patients older than 55 years. Between January 2017 and April 2019, 65 patients with 2, 3 or 4-part fractures were retrospectively analyzed: 29 patients (5 males and 24 females) with an average age of 70.8 ± 9.9 years treated non-surgically (conservative group (CG)) and 36 patients (11 males and 25 females) with an average age of 66.2 ± 7.1 years treated surgically with plate fixation (operating group (OG)). Using different evaluation scores, we compared the OG and the CG. Through the DASH score we have seen how at 12 months there is a satisfactory result in patients with conservative treatment (p = 0.0019). Constant-Murley scale shows no difference between the two treatments (p = 0.2300). BARTHEL scale and SST score did not give statistically satisfactory results. Also, after one year of follow-up, patients treated with conservative therapy had a higher improvement in their Range of Motion (ROM) values than patients treated with surgical treatment. The results in terms of pain in NPRS at 3, 6, 12 months are better for conservative groups (p = 0,0000). Our findings suggest that conservative treatment in proximal humeral fractures, particularly in multi-fragmented fractures in patients over 55 years of age, designs an excellent alternative to the surgical option.
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Affiliation(s)
- Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Liliana Muscarà
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Pierpaolo Panebianco
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | | | - Giuseppe Condorelli
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Vincenzo Fabrizio Caruso
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Danilo Costa
- Orthopaedic Division of Policlinico “G.B. Morgagni”, 95125, Catania, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico “G.B. Morgagni”, 95125, Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. “Policlinico Gaspare Rodolico”, University of Catania, Catania, Italy
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D'Almeida SS, Cannon R, Vu NT, Ponce BA, Redden D. Comparing Intramedullary Nails and Locking Plates in Displaced Proximal Humerus Fracture Management: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54235. [PMID: 38496197 PMCID: PMC10944142 DOI: 10.7759/cureus.54235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
This study aims to provide an updated review comparing the complication rates and clinical outcomes of intramedullary nails and locking plates (LPs) in displaced proximal humerus fracture (PHF) management. We performed a systematic review of the Cochrane Central Register of Controlled Trials, Clinical Trials Registry, EMBASE, and PubMed. Studies with level III evidence or higher comparing intramedullary nails and LPs used for internal fixation of displaced PHFs were included. The Methodological Index for Nonrandomized Studies (MINORS) criteria and Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 were used to assess the risk of bias. Our meta-analysis included a comparison of method-related complications, pain scores, range of motion (ROM), and functional scores. A total of 13 comparative studies were included: five randomized controlled trials, three prospective cohort studies, and five retrospective cohort studies. The total number of patients included was 1,253 (677 in the LP group and 576 in the intramedullary nail group). Superior Constant-Murley scores and external rotation ROM were found in the LP group during the early postoperative period. However, long-term functional scores and complication rates were comparable between the two groups. We conclude that intramedullary nailing and LP fixation are both equally effective for the treatment of displaced PHFs. Neither treatment appears superior at this time, and more large-scale randomized controlled trials should be conducted to further evaluate the potential benefit of LPs in the early postoperative period.
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Affiliation(s)
| | - Reily Cannon
- Medicine, Touro College of Osteopathic Medicine, Henderson, USA
| | - Nguyen T Vu
- Medicine, Edward Via College of Osteopathic Medicine, Auburn, USA
| | | | - David Redden
- Research and Biostats, Edward Via College of Osteopathic Medicine, Auburn, USA
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Kimmeyer M, Schmalzl J, Schmidt E, Graf A, Rentschler V, Gerhardt C, Lehmann LJ. Surgical treatment of fracture sequelae of the proximal humerus according to a pathology-based modification of the Boileau classification results in improved clinical outcome after shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:757-769. [PMID: 37690026 PMCID: PMC10858156 DOI: 10.1007/s00590-023-03721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Fracture sequelae of the proximal humerus were classified by Boileau into four types. Since there are pathomorphological differences and specific characteristics within the four types, we have developed a subclassification. For elderly patients, shoulder arthroplasty is mostly recommended. Based on the available literature and clinical trial results, a subclassification could be created that suggests a specific therapy for each subgroup. The aim of this study was to evaluate the endoprosthetic therapy according to the proposed subclassification and to provide an overview of the clinical and radiological results after endoprosthetic treatment of proximal humerus fracture sequelae. METHODS Patients with fracture sequelae of the proximal humerus who underwent arthroplasty according to the suggestion of the subclassification were included. Minimum time to follow-up was twelve months. General condition and several specific shoulder scores as the Constant-Murley Score (CS) were recorded at the follow-up examination. Complication and revision rates were analyzed. RESULTS In total, 59 patients (72.6 ± 10.0 years, 47 females, 12 males) were included. Mean follow-up time was 31.3 ± 17.0 months. Reverse shoulder arthroplasty was performed in 49 patients and anatomic shoulder arthroplasty was performed in ten patients. The CS increased by 47.3 points from preoperative (15.0) to postoperative (62.3). Good or very good clinical results were seen in 61% of the patients. Complications were observed in twelve (20%) patients and revision surgery was performed in nine (15%) patients. CONCLUSION Due to of the variety of fracture sequelae of the proximal humerus, a modification of the Boileau classification seems necessary. This study shows that endoprosthetic treatment for fracture sequelae can significantly improve the shoulder function in elderly patients. Good clinical results can be achieved with a comparatively low revision rate following the treatment suggestions of the proposed subclassification of the Boileau classification. LEVEL OF EVIDENCE IV Case series.
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Affiliation(s)
- Michael Kimmeyer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany.
- Alps Surgery Institute, Clinique Générale Annecy, 4 Chemin de La Tour la Reine, 74000, Annecy, France.
| | - Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany
| | - Evelin Schmidt
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
- University of Jena, Bachstr. 18, 07743, Jena, Germany
| | - Annika Graf
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Verena Rentschler
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Christian Gerhardt
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
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Zheng Y, Tang N, Zhang WJ, Shi W, Zhao WW, Yang K. Comparative efficacy and safety of medical treatments for proximal humerus fractures: a systematic review and network meta-analysis. BMC Musculoskelet Disord 2024; 25:17. [PMID: 38166758 PMCID: PMC10759392 DOI: 10.1186/s12891-023-07053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Various surgical techniques and conservative therapies are useful tools for treating proximal humerus fractures (PHFs), but it is important to understand how to properly utilize them. Therefore, we performed a systematic review and network meta-analysis to compare and rank the efficacy and safety of medical treatments for PHF. METHODS PubMed, Embase, the Cochrane Library, and the ClinicalTrials.gov databases were systematically searched for eligible randomized controlled trials (RCTs) from inception until June 2022. Conservative therapy-controlled or head-to-head RCTs of open reduction internal fixation (ORIF), intramedullary nailing (IMN), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (RTSA) used for the treatment of adult patients with PHF were included. The surface under the cumulative ranking (SUCRA) probabilities were applied to compare and rank the effects of medical treatments for PHF. RESULTS Eighteen RCTs involving 1,182 patients with PHF were selected for the final analysis. Mostly baseline characteristics among groups were well balanced, and the imbalanced factors only included age, injury type, medial comminution, blood loss, and cognitive function in single trial. The SUCRA probabilities found that RTSA provided the best effect on the Constant-Murley score (SUCRA: 100.0%), and the disabilities of the arm, shoulder and hand (DASH) score (SUCRA: 99.0%). Moreover, HA (SUCRA: 85.5%) and RTSA (SUCRA: 68.0%) had a relatively better effect on health-related quality of life than the other treatment modalities. Furthermore, conservative therapy (SUCRA: 84.3%) and RTSA (SUCRA: 80.7%) were associated with a lower risk of secondary surgery. Finally, the best effects on the risk of complications are varied, including infection was observed with conservative therapy (SUCRA: 94.2%); avascular necrosis was observed in HA (SUCRA: 78.1%), nonunion was observed in RTSA (SUCRA: 69.6%), and osteoarthritis was observed in HA (SUCRA: 93.9%). CONCLUSIONS This study found that RTSA was associated with better functional outcomes, while the comparative outcomes of secondary surgery and complications varied. Optimal treatment for PHF should consider patient-specific factors.
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Affiliation(s)
- Yun Zheng
- R & D Center, Beijing Naton Technology Group Co., Ltd, Peking, China
| | - Nan Tang
- Director of Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wen-Jie Zhang
- Comprehensive Business Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wei Shi
- Quality Management Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
| | - Wen-Wen Zhao
- Registration and Regulatory Department, Beijing Naton Technology Group Co, Ltd, Building 1, Yard 9, Chengwan Street, Haidian District, Peking, 100094, China.
| | - Kun Yang
- Quality Management Department, Tianjin Center for Medical Devices Evaluation and Inspection, Tianjin, China
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Iwata H, Takada N, Kuroyanagi G, Yamamoto N, Usami T, Sekiya I, Murakami H. Endosteal strut using a hydroxyapatite/poly-L-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:217-223. [PMID: 37421450 DOI: 10.1007/s00590-023-03638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Proximal humeral fractures cause large intramedullary bone defects after humeral-head reduction. Hydroxyapatite/poly-L-lactide (HA/PLLA) materials are widely used for various fractures. However, the efficacy of endosteal strut using a HA/PLLA mesh tube (ES-HA/PLLA) with a locking plate for treating proximal humeral fractures was not reported. The purpose of this study is to examine the efficacy of ES-HA/PLLA with a proximal humeral locking plate in proximal humeral fractures. METHODS Seventeen patients with proximal humeral fractures treated using ES-HA/PLLA with a locking plate from November 2017 to November 2021 were evaluated. The range of motion of the shoulder and postoperative complications were assessed at the final follow-up. Radiographs were evaluated to assess bone union and loss of reduction by measuring humeral-head height (HHH) and humeral neck-shaft angle (NSA). RESULTS The average flexion and external rotation of the shoulder at the final follow-up were 137° (range, 90-180°) and 39° (range, - 10 to 60°), respectively. All fractures were united. The average HHH and NSA just after the surgery and final follow-up were 12.5 mm and 11.6 mm and 129.9° and 127.4°, respectively. Two patients presented screw perforation of the humeral head. One patient underwent implant removal due to infection. Avascular necrosis of the humeral head was observed in one patient with arthritis mutilans. CONCLUSIONS The use of ES-HA/PLLA with a proximal humeral locking plate resulted in bone union in all patients and prevented postoperative loss of reduction. ES-HA/PLLA is one of the treatment options for proximal humeral fractures.
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Affiliation(s)
- Hidetoshi Iwata
- Department of Orthopedic Surgery, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
| | - Naoya Takada
- Department of Orthopedic Surgery, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Norio Yamamoto
- Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, 773-8236, Japan
| | - Takuya Usami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Isato Sekiya
- Department of Orthopedic Surgery, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Li M, Sun G, Cui J, Lou Q. Risk factors for surgical site infection after closed proximal humerus fractures. Int Wound J 2023; 21:e14515. [PMID: 38009983 PMCID: PMC10898375 DOI: 10.1111/iwj.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.
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Affiliation(s)
- Ming Li
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Guang‐chen Sun
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Jun Cui
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
| | - Qi‐liang Lou
- Department of OrthopaedicsThe First People's Hospital of JiashanJiaxingZhejiangPeople's Republic of China
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Tuphe P, Caubriere M, Hubert L, Lancigu R, Sakek F, Loisel F, Obert L, Rony L. Early rehabilitation after reverse total shoulder prosthesis on fracture of proximal humerus in elderly patients provides better functional outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2951-2957. [PMID: 36914883 PMCID: PMC10010947 DOI: 10.1007/s00590-023-03505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Reverse total shoulder arthroplasty (RSA) has revolutionized the management of proximal humerus fractures (PHF) in the elderly patients. There is few or no consensus regarding to management of postoperative rehabilitation in elderly patients. An early rehabilitation from D1 allowed better functional results compared to rehabilitation started to D30 independently from tuberosities consolidation. METHODS 94 patients operated on for PHF were evaluated retrospectively, with a minimum radio-clinical follow-up of 2 years. Clinical evaluation included mobilities and four functional scores: ASES, quick DASH, gross constant, weighted constant. Radiological evaluation was performed on a frontal shoulder X-ray with evaluation of tuberosities' consolidation. RESULTS The mean follow-up was 45 ± 19 months (24-88 months). Early rehabilitation was significantly associated with a better Constant Score (71.1 ± 17.2 vs. 56.4 ± 15.8; p < 0.001), better adjusted Constant score (92.4 ± 14.2 vs. 80.3 ± 19.5; p < 0.001), better quick DASH (22.8 ± 19.8 vs. 36.7 ± 21.3; p < 0.01), better ASES (78.6 ± 20.2 vs. 63 ± 22; p < 0.001). CONCLUSION In traumatology, functional result of RSA seems not related in tuberosities' union but in rehabilitation in order to limit postoperative stiffness of operated shoulder. An early rehabilitation is related with better clinical and functional results, independently of tuberosities' union. LEVEL OF EVIDENCE 3, control-case study.
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Affiliation(s)
- P Tuphe
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - M Caubriere
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - L Hubert
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - R Lancigu
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France
| | - F Sakek
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - F Loisel
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - L Obert
- Faculté de Médecine et de Pharmacie, Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main & CIC IT 808, C.H.U Besançon, Université de Franche Comte, 25033, Besançon, France
| | - L Rony
- Department of Orthopedic Surgery, C.H.U. Angers, 4 Rue Larrey, 49000, Angers, France.
- Département de Chirurgie Osseuse, C.H.U. Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
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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] [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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Zhelev D, Hristov S, Zderic I, Ivanov S, Visscher L, Baltov A, Ribagin S, Stoffel K, Kralinger F, Winkler J, Richards RG, Varga P, Gueorguiev B. Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique-A Biomechanical Cadaveric Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1604. [PMID: 37763723 PMCID: PMC10536689 DOI: 10.3390/medicina59091604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects-weakening the osteosynthesis construct-are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66-92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment-set as a clinically relevant failure criterion-and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.
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Affiliation(s)
- Daniel Zhelev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Stoyan Hristov
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Stoyan Ivanov
- Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria;
| | - Luke Visscher
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- School of Medicine, Queensland University of Technology, Brisbane 4000, Australia
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’, 1606 Sofia, Bulgaria;
| | - Simeon Ribagin
- Department of Health Pharmaceutical Care, Medical College, University ‘Prof. Dr. Asen Zlatarov’, 8010 Burgas, Bulgaria;
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Franz Kralinger
- Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Trauma and Sports Department, Ottakring Clinic, Teaching Hospital, Medical University of Vienna, 1160 Vienna, Austria
| | - Jörg Winkler
- Cantonal Hospital Graubuenden, 7000 Chur, Switzerland;
| | - R. Geoff Richards
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Peter Varga
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
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12
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Djebara A, Boulnois I, El Fatayri B, Mertl P, David E. Incidence of secondary displacement after osteosynthesis of proximal humerus fractures: a retrospective study of 185 cases. Acta Orthop Belg 2023; 89:531-538. [PMID: 37935239 DOI: 10.52628/89.3.8939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Proximal humerus fractures are the third most common fracture in patients over 65 years of age. There is no clear consensus regarding their treatment. The objective of this retrospective observational study was to calculate the incidence of secondary displacement after osteosynthesis of these fractures and to identify possible risk factors. 185 cases were reviewed and all osteosynthesized fractures between January 2008 and December 2016 were included. Data collected included age, sex, body mass index, alcohol and tobacco use, bone mineral density of the proximal humerus, fracture type, initial displacement, management time, type of treatment, surgeon's experience and expertise, and postoperative reduction quality. A radiographic follow-up was done at least 3 months following the fracture (until consolidation). The definition of secondary displacement was: varus/valgus displacement >10°, tuberosity translation >5 mm, articular effraction or material breakage. 53 secondary displacements were found, with an incidence of 28.6%. Seventy-two percent were diagnosed at the first follow-up visit, which occurred at an average of 29 days postoperatively. Among all factors studied, only two were statistically significant for secondary displacement: 1) low proximal humeral bone density (defined by a Tingart index <4) appears to be a risk factor, with a calculated relative risk of 2.71 (p = 0.04); and 2) the operator's specialization in the upper limb appears to be a protective factor, with a relative risk of 0.27 (p = 0.01). A similar high incidence of complications after osteosynthesis of the proximal humerus is found in the literature, confirming the difficulty in managing these fractures. More attention should be given to patients with low bone density.
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13
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Joo PY, Wilhelm C, Adeclat G, Halperin SJ, Moran J, Elaydi A, Rubin LE, Grauer JN. Comparing Race/Ethnicity and Zip Code Socioeconomic Status for Surgical versus Nonsurgical Management of Proximal Humerus Fractures in a Medicare Population. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00011. [PMID: 37141180 PMCID: PMC10162786 DOI: 10.5435/jaaosglobal-d-22-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/24/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND This study evaluated the effect of race/ethnicity and socioeconomic status (SES) on surgical utilization after proximal humerus fractures in a large Medicare cohort. METHODS The PearlDiver Medicare claims database was used to identify patients aged 65years and older with isolated, closed proximal humerus fractures, for whom race/ethnicity data were available (65.5% of identified fractures). Patients with polytrauma or neoplasm were excluded. Patient demographic, race/ethnicity, comorbidity, and median household income were compared for surgical versus nonsurgical management. Univariate and multivariable logistic regressions were used to determine disparities of surgical utilization based on the abovementioned factors. RESULTS Of 133,218 patients with proximal humerus fracture identified, surgery was conducted for 4446 (3.3%). Those less likely to receive surgery were older (incrementally by increasing age bracket up to 85 years and older odds ratio [OR], 0.16, P < 0.001), male (OR, 0.79, P < 0.001), Black (OR, 0.51, P < 0.001) or Hispanic (0.61, P = 0.005), higher Elixhauser Comorbidity Index (per 2 increase OR, 0.86, P < 0.001), and low median household income (OR, 0.79, P < 0.001). CONCLUSIONS The independent significance of race/ethnicity and SES point to disparities in surgical decision making/access to care. These findings highlight the need for increased attention on initiatives and policies that seek to eliminate racial disparities and improve health equity independent of SES.
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Affiliation(s)
- Peter Y. Joo
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Christopher Wilhelm
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Giscard Adeclat
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Scott J. Halperin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jay Moran
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Ali Elaydi
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Lee E. Rubin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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14
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Risk factors for intra-articular involvement in proximal humeral fractures. Arch Orthop Trauma Surg 2023; 143:1341-1351. [PMID: 35028706 DOI: 10.1007/s00402-021-04293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/27/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Identification of intra-articular involvement in proximal humeral fractures is important for operative decision making. The aim of this study was to identify the risk factors associated with intra-articular involvement in proximal humeral fractures. MATERIALS AND METHODS One hundred consecutive three-dimensional computed tomography reconstructions of proximal humeral fractures were identified. The fracture lines were then accurately transcribed onto a two-dimensional superior view of the humeral head and each fracture was assessed for intra-articular involvement. Statistical analyses were undertaken to identify risk factors for intra-articular involvement and extent of involvement. Furthermore, for each risk factor, common fracture patterns were identified and compared to anatomical landmarks. RESULTS Overall, 58% of the fractures involved the articular surface. High-energy mechanism, female gender, age ≥ 65, and posterior dislocation were risk factors for intra-articular involvement. Low-energy mechanism, female gender, age ≥ 65, varus angulation, and posterior dislocation were risk factors for increased extension of the fracture onto the articular surface. CONCLUSION Intra-articular involvement in proximal humeral fractures is influenced by demographics and fracture characteristics (mechanism of injury, angulation, and dislocation). Patients with identified risk factors should be appropriately evaluated for intra-articular fractures during preoperative planning to assist in operative decision making. LEVEL OF EVIDENCE Basic science; anatomy study.
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15
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Walter N, Szymski D, Kurtz SM, Lowenberg DW, Alt V, Lau E, Rupp M. Proximal humerus fractures - epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data. Bone Joint Res 2023; 12:103-112. [PMID: 36718643 PMCID: PMC9950668 DOI: 10.1302/2046-3758.122.bjr-2022-0275.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS The optimal choice of management for proximal humerus fractures (PHFs) has been increasingly discussed in the literature, and this work aimed to answer the following questions: 1) what are the incidence rates of PHF in the geriatric population in the USA; 2) what is the mortality rate after PHF in the elderly population, specifically for distinct treatment procedures; and 3) what factors influence the mortality rate? METHODS PHFs occurring between 1 January 2009 and 31 December 2019 were identified from the Medicare physician service records. Incidence rates were determined, mortality rates were calculated, and semiparametric Cox regression was applied, incorporating 23 demographic, clinical, and socioeconomic covariates, to compare the mortality risk between treatments. RESULTS From 2009 to 2019, the incidence decreased by 11.85% from 300.4 cases/100,000 enrollees to 266.3 cases/100,000 enrollees, although this was not statistically significant (z = -1.47, p = 0.142). In comparison to matched Medicare patients without a PHF, but of the same five-year age group and sex, a mean survival difference of -17.3% was observed. The one-year mortality rate was higher after nonoperative treatment with 16.4% compared to surgical treatment with 9.3% (hazard ratio (HR) = 1.29, 95% confidence interval (CI) 1.23 to 1.36; p < 0.001) and to shoulder arthroplasty with 7.4% (HR = 1.45, 95% CI 1.33 to 1.58; p < 0.001). Statistically significant mortality risk factors after operative treatment included age older than 75 years, male sex, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, chronic kidney disease, a concomitant fracture, congestive heart failure, and osteoporotic fracture. CONCLUSION Mortality risk factors for distinct treatment modes after PHF in elderly patients could be identified, which may guide clinical decision-making.Cite this article: Bone Joint Res 2023;12(2):103-112.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - David W. Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Edmund Lau
- Exponent Inc, Menlo Park, California, USA
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany, Markus Rupp. E-mail:
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Checketts JX, Steele R, Patel A, Stephens J, Buhrke K, Reddy A, Stallings L, Triplet JJ, Chalkin B. Clinical and functional outcomes of reverse total shoulder arthroplasty supplemented with latissimus dorsi transfer: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:28-36. [PMID: 37588073 PMCID: PMC10426461 DOI: 10.1016/j.xrrt.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background To optimize patients' functional external rotation outcomes, reverse total shoulder arthroplasties (rTSAs) including a latissimus dorsi tendon transfer were undertaken with promising early results and no significant increase in complications in comparison to traditional rTSAs. This was especially utilized for patients with a pronounced combined loss of elevation and external rotation. The purpose of this study is to evaluate and synthesize the findings of all relevant publications assessing the outcomes of rTSAs with associated latissimus dorsi transfer. Methods We thoroughly searched the literature within the PubMed database using a standardized methodology. For our inclusion criteria, we included any study regarding rTSAs that contained functional outcome scores for postoperative range of motion (such as elevation, external rotation, etc.) or postoperative outcomes such as complications (reoperation, infection, etc.) and patient satisfaction. For the extraction of data, we used pilot-tested Google Forms to record extracted data. These data were then converted to spreadsheets (Microsoft Excel [Microsoft, Redmond, WA, USA]). This was done on 2 separate scenarios by 2 authors to ensure accuracy. We used the modified Coleman Methodology Score to assess the methodological quality of the studies in our samples. Meta-analysis mathematics and statistical analysis were performed using Stata software 17 (StataCorp, College Station, TX, USA). Results Our search returned a total of 12 studies containing data of 213 shoulders receiving RTSAs with a latissimus dorsi transfer. Functional outcomes were available for 160 shoulders. The mean preoperative elevation of the affected shoulder was 73.57 degrees, and the mean postoperative elevation was 141.80 degrees. For external rotation, the mean preoperative average was -6.71 degrees, and the mean postoperative average was 22.73 degrees. The absolute Constant score average was 31.56 preoperatively, while the postoperative value was 68.93. In our sample, 25 patients (11.73%) required a revision of the RTSA implant due to complications. Discussion Combined loss of elevation and external rotation can be a severely debilitating condition for those with a glenohumeral pathology. Latissimus dorsi transfer for this condition has been proven to be an effective modality. The reoperation and complication rate appears to be sizable, and as such surgeons should consider this when considering this modality for their patients.
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Affiliation(s)
- Jake X. Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Robert Steele
- Kansas City University College of Medicine, Kansas City, MO, USA
| | - Ashini Patel
- Nova Southeastern University College of Medicine, Ft. Lauderdale, FL, USA
| | - Josh Stephens
- Nova Southeastern University College of Medicine, Ft. Lauderdale, FL, USA
| | - Kate Buhrke
- Idaho College of Osteopathic Medicine, Boise, ID, USA
| | - Arjun Reddy
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Landon Stallings
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
| | - Jacob J. Triplet
- Mayo Clinic, Department of Orthopaedic Surgery, Rochester, MO, USA
| | - Brian Chalkin
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, OK, USA
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Levin JM, Rodriguez K, Polascik BA, Zeng S, Warren E, Rechenmacher A, Helmkamp J, Goltz DE, Wickman J, Klifto CS, Lassiter TE, Anakwenze O. Simple preoperative radiographic and computed tomography measurements predict adequate bone quality for stemless total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:2481-2487. [PMID: 35671925 DOI: 10.1016/j.jse.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Although there is increased utilization of stemless humeral implants in anatomic total shoulder arthroplasty (TSA), there are inadequate objective metrics to evaluate bone quality sufficient for fixation. Our goals are to: (1) compare patient characteristics in patients who had plans for stemless TSA but received stemmed TSA due to intraoperative assessments and (2) propose threshold values of bone density, using the deltoid tuberosity index (DTI) and proximal humerus Hounsfield units (HU), on preoperative X-ray and computed tomography (CT) to allow for preoperative determination of adequate bone stock for stemless TSA. METHODS This is an observational study conducted at an academic institution from 2019 to 2021, including consecutive primary TSAs templated to undergo stemless TSA based on 3-dimensional CT preoperative plans. Final implant selection was determined by intraoperative assessment of bone quality. Preoperative X-ray and CT images were assessed to obtain DTI and proximal humeral bone density in HU, respectively. A receiver operating characteristic curve was used to analyze the potential of preoperative X-ray and CT to classify patients as candidates for stemless TSA. RESULTS A total of 61 planned stemless TSAs were included, with 56 (91.8%) undergoing stemless TSA and 5 (8.2%) undergoing stemmed TSA after intraoperative assessment determined that the bone quality was inadequate for stemless fixation. There were no significant differences between the 2 groups in terms of gender (P = .640), body mass index (P = .296), and race (P = .580). The stem cohort was significantly older (mean age 69 ± 12 years vs. 59 ± 10 years, P = .029), had significantly lower DTI (1.45 ± 0.13 vs. 1.68 ± 0.18, P = .007), and had significantly less proximal humeral HU (-1.4 ± 17.7 vs. 78.8 ± 52.4, P = .001). The receiver operating characteristic curve for DTI had an area under the curve (AUC) of 0.86, and bone density in HU had an AUC of 0.98 in its ability to distinguish patients who underwent stemless TSA vs. short-stem TSA. A threshold cutoff of 1.41 for DTI resulted in a sensitivity of 98% and a specificity of 60%, and a cutoff value of 14.4 HU resulted in a sensitivity of 95% and a specificity of 100%. CONCLUSIONS Older age, lower DTI, and less proximal humeral bone density in HU were associated with the requirement to switch from stemless to short-stem humeral fixation in primary TSA. Preoperative DTI had good ability (AUC of 0.86) and preoperative HU had excellent ability (AUC of 0.98) to categorize patients as appropriate for stemless TSA. This can help surgeons adequately plan humeral fixation using standard preoperative imaging data.
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Affiliation(s)
- Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Kaitlyn Rodriguez
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Breanna A Polascik
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Zeng
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eric Warren
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Albert Rechenmacher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John Wickman
- 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
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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18
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Holschen M, Körting M, Khourdaji P, Bockmann B, Schulte TL, Witt KA, Steinbeck J. Treatment of proximal humerus fractures using reverse shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical outcome and tuberosity healing? Arch Orthop Trauma Surg 2022; 142:3817-3826. [PMID: 34977963 DOI: 10.1007/s00402-021-04281-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The employment of reverse shoulder arthroplasty for dislocated proximal humerus fractures of elderly patients becomes increasingly relevant. The standard inclination angle of the humeral component was 155°. Lately, there is a trend towards smaller inclination angles of 145° or 135°. Additionally, there has been an increased focus on the lateralization of the glenosphere. This retrospective comparative study evaluates clinical and radiological results of patients treated for proximal humerus fractures by reverse shoulder arthroplasty with different inclination angles of the humeral component, which was either 135° or 155°. Additionally, a different lateral offset of the glenosphere, which was either 0 mm or 4 mm, was used. METHODS For this retrospective comparative analysis, 58 out of 66 patients treated by reverse total shoulder arthroplasty for proximal humerus fractures were included. The minimum follow-up was 24 months. Thirty (m = 3, f = 27; mean age 78 years; mean FU 35 months, range 24-58 months) were treated with a standard 155° humeral component and a glenosphere without lateral offset (group A), while 28 patients (m = 2, f = 26; mean age 79 years; mean FU 30 months, range 24-46 months) were treated with a 135° humeral component and a glenosphere with a 4 mm lateral offset (group B). We determined range of motion, Constant score, and the American Shoulder and Elbow Surgeons Shoulder score as clinical outcomes and evaluated tuberosity healing as well as scapula notching. RESULTS Neither forward flexion (A = 128°, B = 121°; p = 0.710) nor abduction (A = 111°, B = 106°; p = 0.327) revealed differences between the groups. The mean Constant Score rated 63 in group A, while it was 61 in group B (p = 0.350). There were no differences of the ASES Score between the groups (A = 74, B = 72; p = 0.270). There was an increased risk for scapula notching in group A (47%) in comparison to group B (4%, p = 0.001). Healing of the greater tuberosity was achieved in 57% of group A and in 75% of group B (p = 0.142). The healing rate of the lesser tuberosity measured 33% in group A and 71% in group B (p = 0.004). CONCLUSIONS Both inclination angles of the humeral component are feasible options for the treatment of proximal humerus fractures in elderly patients. Neither the inclination angle nor the lateral offset of the glenosphere seem to have a relevant influence on the clinical outcome. The healing rate of the lesser tuberosity was higher in implants with a decreased neck-shaft angle. There is an increased risk for scapula notching, if a higher inclination angle of the humeral component is chosen. LEVEL OF EVIDENCE III. Retrospective comparative study.
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Affiliation(s)
- Malte Holschen
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany.
- Raphaelsklinik, Loerstr. 23, 48143, Münster, Germany.
| | - Maria Körting
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | | | - Benjamin Bockmann
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kai-Axel Witt
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | - Jörn Steinbeck
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
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Hohmann E, Keough N, Glatt V, Tetsworth K. Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03436-3. [PMID: 36454289 DOI: 10.1007/s00590-022-03436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing surgical interventions for proximal humerus fractures. METHODS Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1-3 studies from 2000 to 2022 comparing surgical treatment with ORIF, IM nailing, hemiarthroplasty, total and reverse shoulder arthroplasty (RTS) was conducted. Clinical outcome scores, range of motion (ROM), and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Thirty-five studies were included in the analysis. Twenty-five studies had a high risk of bias and were of low and very low quality. Comparisons between ORIF and hemiarthroplasty favored ORIF for clinical outcomes (p = 0.0001), abduction (p = 0.002), flexion (p = 0.001), and external rotation (p = 0.007). Comparisons between ORIF and IM nailing were not significant for clinical outcomes (p = 0.0001) or ROM. Comparisons between ORIF and RTS were not significant for clinical outcomes (p = 0.0001) but favored RTS for flexion (p = 0.02) and external rotation (p = 0.02). Comparisons between hemiarthroplasty and RTS favored RTS for clinical outcomes (p = 0.0001), abduction (p = 0.0001), and flexion (p = 0.0001). Complication rates between groups were not significant for all comparisons. CONCLUSIONS This meta-analysis for surgical treatment of proximal humerus fractures demonstrated that ORIF is superior to hemiarthroplasty, ORIF is comparable to IM nailing, reverse shoulder arthroplasty is superior to hemiarthroplasty but comparable to ORIF with similar clinical outcomes, ROM, and complication rates. However, the study validity is compromised by high risk of bias and low level of certainty. The results should therefore be interpreted with caution. Ultimately, shared decision making should reflect the fracture characteristics, bone quality, individual surgeon's experience, the patient's functional demands, and patient expectations. LEVEL OF EVIDENCE Level III; systematic review and meta-analysis.
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Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, Medical School, University of Pretoria, Pretoria, South Africa.
- Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Natalie Keough
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA
- Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Kevin Tetsworth
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia
- Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia
- Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia
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20
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Guo Z, Sang L, Meng Q, Tian L, Yin Y. Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures. J Orthop Surg Res 2022; 17:481. [PMID: 36335350 PMCID: PMC9636665 DOI: 10.1186/s13018-022-03360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022] Open
Abstract
Background The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. Methods Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. Results A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. Conclusion Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.
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Affiliation(s)
- Zheming Guo
- Department of Orthopaedic Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Linchao Sang
- Department of Orthopaedic Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Qingting Meng
- Department of Orthopaedic Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Lijun Tian
- Department of Orthopaedic Surgery, The Third Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Yingchao Yin
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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21
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Russo R, Cozzolino A, Rotonda GD, Guastafierro A, Viglione S, Malfi PF, Minopoli P, Mottola L, Mortellaro M, Pietroluongo LR. Therapeutic and prognostic predictive value of the Control Volume severity grade on proximal humerus fractures due to bone fragility. Orthop Rev (Pavia) 2022; 14:38568. [DOI: 10.52965/001c.38568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The treatment of proximal humerus fracture complicated by bone fragility is still controversial. The aim of this study is to compare the Neer classification and the Control Volume severity grade for the accuracy in the selection of the type of treatment and for prognostic evaluation. Materials and methods We retrospectively collected the records of all patients admitted at the Emergency Department of our Institute, from 2013 to 2020, for a closed displaced proximal humerus fracture further investigated with a CT scan before treatment decision. We selected all patients with a minimum age of 65 years. The included fractures were retrospectively classified according to Neer, and Control Volume severity grade. The included patients were evaluated with Simple Shoulder Test (SST). A statistical analysis was performed to correlate the type of treatment and the clinical results to the Neer classification and the Control Volume severity grade. Results Sixty-four patients (80%), were available for the telephonically interview at a mean follow up of 4 years and were included. According to the Control Volume model, we identified fracture with a low, medium and high severity grade, in 23 (36%), 13 (20%), and, 28 (44%) cases, respectively. Fifteen patients (23,5%) were conservatively treated, whether fourty-nine patients (76,5%) were operated. We find a statistical correlation between control volume severity grade and type of treatment. No Therapeutic correlation was detected for the Neer classification. A statistical correlation between the severity grade and clinical outcome could be observed only for patients with the same type of treatment. Conclusions The use of Control Volume severity grade is associated with better therapeutic and prognostic informations in confront to the Neer classification.
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Affiliation(s)
| | | | | | | | | | | | | | - Luciano Mottola
- Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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22
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Miltenberg B, Masood R, Katsiaunis A, Moverman MA, Puzzitiello RN, Pagani NR, Menendez ME, Salzler MJ, Drager J. Fracture dislocations of the proximal humerus treated with open reduction and internal fixation: a systematic review. J Shoulder Elbow Surg 2022; 31:e480-e489. [PMID: 35605847 DOI: 10.1016/j.jse.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of proximal humerus fracture dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of devascularization of the humeral head often seen in these injuries. The purpose of this study is to undertake a systematic review of the literature on the functional outcomes, rate of revision, and short- and long-term complications for proximal humerus fracture dislocations treated with open reduction and internal fixation (ORIF). METHODS The PubMed and OVID Embase databases were queried for literature reporting on proximal humerus fracture dislocations treated with ORIF. Data including study design, patient demographics, functional outcomes, and complications were recorded. RESULTS Twelve studies including 294 patients with Neer type 2-, 3-, or 4-part proximal humerus fracture dislocations met the criteria for inclusion. The mean patient age was 53.4 years (19-89 years) with an average follow-up of 2.9 years (1.15-4.9 years). At the final follow-up, the mean Constant score was 73.2 (52-87.3) and the mean Disabilities of the Arm Shoulder and Hand score was 26.6 (17.5-32). Avascular necrosis was observed in 20.0% (0%-82.3%) and nonunion was observed in 3.0% (0%-7.7%) of patients. Conversion to arthroplasty was observed in 10.7% (5%-20%) and a total reoperation was observed in 35.6% (11.8%-89.1%) of patients in studies explicitly reporting these outcomes. In addition to conversion to arthroplasty, common causes of reoperation were revision ORIF (5.2%) and hardware removal (22.2%). CONCLUSION Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates. This information can be used to counsel patients and set expectations about the potential for further surgeries.
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Affiliation(s)
| | - Raisa Masood
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, USA
| | | | | | | | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Mariano E Menendez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Justin Drager
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, USA.
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23
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Entessari M, Bar-Eli H, Bernal J. A Case of Proximal Humerus Fracture Dislocation Presenting With Failed Primary Open Reduction and Internal Fixation Followed by Salvage Reverse Total Shoulder Arthroplasty. Cureus 2022; 14:e29407. [DOI: 10.7759/cureus.29407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
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Does mechanism of injury impact the outcome of operative fixation of geriatric proximal humerus fractures. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04616-w. [PMID: 36098793 DOI: 10.1007/s00402-022-04616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/04/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The purpose of this study is to determine the effects of energy mechanism on outcomes following repair of proximal humerus fractures (PHF) in the middle aged and geriatric population. METHODS Two hundred sixty-nine patients who presented to our academic medical center between 2006 and 2020, and underwent operative treatment of a proximal humerus fracture were prospectively enrolled in an IRB-approved database. Patients above 55 were divided into high energy (motor vehicle accident, pedestrian struck, or fall > 2 stairs) or low energy mechanisms (fall from standing or < 2 stairs). Of 97 patients with complete documentation and follow-up, 72 were included in the low velocity (LV) group and 25 were included in the high velocity (HV) group. Demographic information, primary injury details, healing and time to union, range of motion (ROM), complications, and need for reoperation were assessed at initial presentation and subsequent follow-up appointments. RESULTS Mean age, BMI, and gender were significantly different between the LV and HV cohorts (p = 0.01, 0.04, 0.01). OTA/AO fracture patterns were similar between the groups. (p = 0.14). Bony healing and complications occurred with similar frequency between groups (p = 1.00, 0.062). The most common complications in the LV and HV groups included avascular necrosis (9.7%, 16.0%), and screw penetration (4.2%, 12.0%), while the HV group also had rotator cuff issues including weakness and tendonitis (12.0%). There was no significant difference in need for reoperation between cohorts (p = 0.45). Time to healing, shoulder ROM, and DASH scores did not differ between each group. CONCLUSIONS Energy and mechanism demonstrates similar outcomes in operatively treated proximal humerus fractures. These factors should not play a role in decisions for surgery in these patients and can help guide patient expectations.
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Fisher ND, Driesman A, Saleh H, Egol KA, Konda SR. The Proximal Humerus Outcome Score at One Year (POSY) Predicts Which Patients Have Poor Functional Outcomes Following Operative Fixation of Proximal Humerus Fractures. Cureus 2022; 14:e26631. [PMID: 35949774 PMCID: PMC9356541 DOI: 10.7759/cureus.26631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The ability to predict long-term outcomes following surgical fixation of proximal humerus fractures would help identify patients at risk of poor functional outcomes. The purpose of this study was to develop a simple score based on preoperative data that can accurately predict functional outcomes for patients following operative management of proximal humerus fractures. Methods: Over a 12-year period, all proximal humerus fractures surgically treated with a locked proximal humerus plate at a single institution were enrolled in a prospective database. Inclusion criteria in this analysis were any patient with a minimum of a one-year functional outcome score. Patients were assigned to the poor outcome cohort if their Disabilities of the Arm, Shoulder, and Hand (DASH) score at that time point was greater than 10 points above the mean DASH score. Logistic regression was used to build a predictive formula for cohort membership using p < 0.15 and an area under the receiver operator characteristic curve (AUROC) value was calculated to define the overall predictive capacity. Results: A total of 165 patients with an average age of 60.91±13.5 years met the inclusion criteria, with 47 (28.5%) patients assigned to the poor outcome group and 118 (71.5%) patients assigned to the good outcome group. Older age (p = 0.088), BMI (p = 0.019), age-adjusted CCI (p = 0.001), non-Caucasian race (p = 0.017), no college degree (p < 0.0005), unemployed (p < 0.0005), and worker’s compensation case (p = 0.002) were found to be significant predictors of poorer outcome and were used to create a final formula through logistic regression which predicted the probability of a poor outcome (Nagelkerke R Square = 0.403; Hosmer and Lemeshow = 0.902; AUROC = 0.839 [CI: 0.762-0.917]). Once each patient was assigned a score, cutoff values were defined that divided the cohort into three groups. High-risk patients had a score above 50%, and 19 (73.1%) of these patients had a poor outcome. Conclusions: The POSY score is a tool that can predict the functional outcome at one year or greater following surgical intervention for a proximal humerus fracture. Patients who score above 50% are considered at high risk for a poor functional outcome. In the era of value-based care, the POSY score may be used to direct resource utilization while improving outcomes.
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Tropea A, Tisano A, Bruschetta A, Borzelli D, Migliorato A, Nirta G, Leonardi G, Trimarchi F, Alito A. Comparative FE biomechanical and microbial adhesion analyses on an implanted humerus. J Orthop 2022; 32:78-84. [DOI: 10.1016/j.jor.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
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Kim BS, Kim DH, Choi JH, Choi BC, Cho CH. Is Device Removal Necessary after Fixed-Angle Locking Plate Osteosynthesis of Proximal Humerus Fractures? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030382. [PMID: 35334558 PMCID: PMC8949819 DOI: 10.3390/medicina58030382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate whether device removal in symptomatic patients following locking plate osteosynthesis of a proximal humerus fracture improves the clinical outcomes. Materials and Methods: Seventy-one patients who underwent fixed-angle locking plate osteosynthesis of a proximal humerus fracture were included. Thirty-three patients underwent device removal at a mean time of 10.4 months after index surgery (removal group). Thirty-eight patients who retained the device after index surgery (retention group) were included in the control group. Visual analog scale (VAS) pain score, University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated pre- and postoperatively. Results: At the final follow-up, mean UCLA score, ASES score, and all ROMs were significantly higher in the removal group compared to the retention group (p < 0.001). However, no significant difference in mean VAS pain score was observed between the two groups. Comparison of the clinical outcomes before and after device removal surgery showed significant improvement in all clinical scores and ROMs after device removal (p < 0.001). Conclusions: Device removal surgery in symptomatic patients following locking plate osteosynthesis of a proximal humerus fracture can result in significant improvement in functional outcomes.
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Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Jung-Hoon Choi
- Department of Orthopedic Surgery, Bogang Hospital, 102 Wolbae-ro, Dalseo-gu, Daegu 42801, Korea;
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
- Correspondence: ; Tel.: +82-53-258-4771
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Cappellari A, Trovarelli G, Andriolo M, Berizzi A, Ruggieri P. Reverse shoulder arthroplasty for treatment of proximal humerus complex fractures in elderly: A single institution experience. Injury 2022; 53 Suppl 1:S2-S7. [PMID: 32736824 DOI: 10.1016/j.injury.2020.07.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of complex proximal humerus fractures (PHFs) in the elderly should provide early mobilization to maintain autonomy and self-care possibility, avoiding further surgery for complications. Nowadays, there is not a gold standard for treatment. Aim of our study was to review our experience with the use of Reverse Total Shoulder Arthroplasty (RTSA) for the treatment of these fractures in the elderly, evaluating complications and functional results. MATERIALS AND METHODS Ninety-one patients older than 65 were treated with RTSA at our Institute between June 2005 and December 2017: there were 14 males and 77 females, with a mean age of 76 years (range 65-87 years). There were 58 fractures (20 Neer 3, 38 Neer 4) and 33 fracture-dislocations (7 Neer 3, 26 Neer 4). Complications were recorded, and functional outcomes were evaluated using the DASH score and Constant score (CS). RESULTS Twenty-three complications occurred: 8 cases of scapular notching, 5 neurologic palsies, 4 dislocations, 3 intraoperative diaphyseal fractures, and subclavian artery damage, deep infection, and radiolucent line in one each. No aseptic loosening or breakage was observed. Further surgeries were necessary in 3 cases only, whereas all patients retained their implant at last follow-up. Functional results were satisfactory: mean abduction was 93°, mean flexion was 110°, mean active internal-rotation reached 35°, mean active external-rotation was 25°, mean CS was 54 points and mean DASH score was 45 points. DISCUSSION Surgical treatment of complex PHFs should be a "one-shot surgery," especially in the elderly, since further surgeries could compromise patient outcomes and survival. Additional surgery due to complications is less frequent after RTSA than other techniques. A stable reconstruction permitting early mobilization is fundamental in the elderly. Usually, a prolonged immobilization is recommended after ORIF, TSA, and hemiarthroplasty to provide a stable fixation, whereas RTSA allows early mobilization. CONCLUSIONS In elderly with inadequate bone stock and needing early recovery of autonomy in daily activities, RTSA effectively treats complex PHFs. The incidence of complications requiring revision surgery is low and functional results are satisfactory and predictable.
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Affiliation(s)
- Alessandro Cappellari
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Martina Andriolo
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Antonio Berizzi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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Xiang H, Wang Y, Yang Y, Liu F, Lu Q, Kong L, Li M, Han Y, Wang F. Anatomical study for the treatment of proximal humeral fracture through the medial approach. J Orthop Surg Res 2022; 17:35. [PMID: 35039046 PMCID: PMC8764758 DOI: 10.1186/s13018-021-02897-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy. METHOD Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation. RESULTS The medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3 cm (24.29 ± 3.42 mm) was available for medial plate. ACHA (49.35 ± 8.13 mm, 35.14-68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67-66.76 mm) were about 5 cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk structure should be taken seriously. CONCLUSION The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.
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Affiliation(s)
- Hao Xiang
- Department of Orthopedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324, Jing Wu Road, Jinan, 250021, China
| | - Yan Wang
- Medical Laboratory Diagnosis Center, Jinan Central Hospital, 105 Jie Fang Road, Jinan, 250013, China
| | - Yongliang Yang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China
| | - Qingsen Lu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China
| | - Lingpeng Kong
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China
| | - Mingzhen Li
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China
| | - Yong Han
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China.
| | - Fu Wang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Road, Jinan, 250021, China.
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Silva MR, Linhares D, Leite MJ, Nunes B, Torres J, Neves N, Silva MR. Proximal Humerus Fractures: Epidemiology and trends in surgical management of hospital-admitted patients in Portugal. JSES Int 2022; 6:380-384. [PMID: 35572441 PMCID: PMC9091738 DOI: 10.1016/j.jseint.2021.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Proximal humerus fractures (PHFs) are frequent and associated with significant health care burden. National epidemiological data are limited. Our objective is to characterize the Portuguese population admitted with PHFs and analyze therapeutic management, the impact of associated lesions, and mortality rate. Methods This was a retrospective, observational study of admissions from mainland public hospitals (2000-2015), with primary or secondary diagnosis of PHFs. Incomplete records, pathologic lesions, malunion/nonunion, and hardware removal were excluded. Age, gender, admission date, hospitalization period, associated injuries, treatment, and mortality were recorded. Results A total of 19,290 patients were included. Through the analyzed period, an increase in the absolute number and incidence of PHFs was observed. The mean age at diagnosis was 62.6 ± 21.0 years old (57% elderly; 63.5% female). The mean length of stay was 10.0 ± 14.1 days, higher in patients submitted to arthroplasty (P < .001) and in those with associated fractures (25%; P < .001). A total of 14,482 patients were operated, most frequently with open reduction and internal fixation (28%). The inpatient mortality rate was 3.2%, significantly higher in patients with associated fractures (odds 2.77 for lower limb vs. upper limb). Conclusion There is a trend toward an increase in surgical management of PHFs. The relative proportion of open reduction and internal fixation and arthroplasty (particularly reverse arthroplasty) increased, probably reflecting biomechanical implant properties, fracture pattern, and demand for better functionality. Associated fractures are an important comorbidity, associated with increased mortality and length of stay.
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Kumar S, Mishra A, Singh H, Clark D, Espag M, Tambe A. Surgical fixation of isolated greater tuberosity fractures of the humerus- systematic review and meta-analysis. J Clin Orthop Trauma 2021; 23:101670. [PMID: 34790560 PMCID: PMC8577466 DOI: 10.1016/j.jcot.2021.101670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES A systematic review was undertaken based on PRISMA guidelines to study the results of surgical treatment of Greater Tuberosity fractures of the Humerus by different techniques (Open, Percutaneous or Arthroscopic) and using different fixation devices (Sutures, Screws and Plates). DATA SOURCES Literature searches were performed for studies in English on four online databases (MEDLINE®, Embase®, Ovid® Emcare and CINAHL®) using a pre-planned search strategy. STUDY SELECTION Studies were screened against pre-decided inclusion and exclusion criteria. 24 articles were eligible for inclusion involving 562 patients in all. DATA EXTRACTION A template was used for collection of relevant data regarding the study design, demographics, fracture characteristics, surgical techniques and implants used, outcomes, complications and re-operations. Methodological quality was assessed using a modified Coleman Methodology Score. DATA SYNTHESIS Pooled analysis was conducted for (1) complications/reoperations of different devices; and (2) reported results using standard outcome measures of various techniques. Results were pooled using inverse variance method. When pooling proportions, we used arcsine transformation to account for zero events. CONCLUSION Use of screws was associated with higher rates of total complications (23.7%) as well as reoperations (13.2%), compared to sutures (14.2%; 2.6%) and plates (10.6%; 4.1%). In a subgroup analysis, use of low-profile plates (LPPs) was associated with the lowest rates of total complications (4.97%). The superiority of any surgical technique could not be established using the pooled Constant or ASES scores because there was lack of uniformity in the reporting of outcome measures. Our analysis of complications of the various fixation devices dissuades the use of screws and favours the use of low-profile plates. There is a need for prospective studies comparing arthroscopic suture fixation with open low-profile plate fixation of GT fractures.
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Affiliation(s)
| | - Arya Mishra
- Royal Derby Hospital, UK,Correspondence author. Clinical Fellow in Trauma and Orthopaedics, Derby, DE22 3NE, United Kingdom.
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Zhang X, Zhu CX, He JQ, Hu YC, Sun J. Correlation of CT Values and Bone Mineral Density in Elderly Chinese Patients with Proximal Humeral Fractures. Orthop Surg 2021; 13:2271-2279. [PMID: 34693649 PMCID: PMC8654650 DOI: 10.1111/os.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the correlation between computed tomography (CT) values and bone mineral density (BMD) in elderly Chinese patients with proximal humeral fractures. Methods This was a single‐center retrospective study involving 166 elderly patients with proximal humeral fractures between January and June 2015 in our hospital. Following the inclusion and exclusion criteria, 89 patients were finally enrolled in this study. The spiral CT scanning was performed on these patients, and the CT images were obtained by using MIMICS software. The CT values in axial, coronal, and sagittal images of healthy proximal humeri were measured using a circular region of interest (ROI) by Image J. The bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual‐energy X‐ray absorptiometry (DXA). Spearman rank correlation methods were used for analysis of the association between the proximal humerus average CT value (CTMean) and the lumbar spine as well as femoral neck BMD in patients with proximal humeral fractures, or osteoporotic patients. Results Among the included 89 patients, there were 26 males and 63 females, 69% and 84% of whom were diagnosed with osteoporosis, respectively. The lumbar spine and femoral neck BMD and the CTMean of the proximal humerus were higher in males than females with proximal humeral fractures (P < 0.05). This gender difference was also found in the osteoporotic patient population (P < 0.05). The Spearman rank correlation method showed that the lumbar spine and femoral neck BMD was closely related to the proximal humeral CTMean in males (r = 0.877, P = 0.000; r = 0.832, P = 0.000; respectively) and females (r = 0.806, P = 0.000; r = 0.616, P = 0.000; respectively) with proximal humeral fractures, as well as osteoporotic male (r = 0.745, P = 0.000; r = 0.575, P = 0.000; respectively) and female (r = 0.613, P = 0.000; r = 0.629, P = 0.000; respectively) patients. Conclusions The CT value of the proximal humerus is a rapid and accurate method by which bone quality can be assessed in elderly patients with proximal humeral fractures. Moreover, the CT value of the proximal humerus is an alternative measurement of BMD that can guide surgeons in selecting the appropriate internal fixation material.
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Affiliation(s)
- Xi Zhang
- Department of Traumatics Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Chun-Xia Zhu
- Department of Ultrasounds, Tianjin Hospital, Tianjin, China
| | - Jin-Quan He
- Department of Traumatics Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Traumatics Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Jie Sun
- Department of Traumatics Orthopaedics, Tianjin Hospital, Tianjin, China
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Abstract
Proximal humerus fracture nonunions are heterogenous group of posttraumatic sequelae in both the operatively and nonoperatively treated proximal humerus fracture. The management of these fractures is largely based on the residual morphology. Understanding the relationship of the nonunited and malunited fragments, anatomic location of the fracture, and viability of the residual bone stock will allow for better surgical planning. Patient optimization with nonoperative care, open reduction internal fixation, intramedullary nailing, and shoulder arthroplasty, all have a role in the treatment of proximal humerus fracture nonunions.
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Boyer P, Couffignal C, Bahman M, Mylle G, Rousseau MA, Dukan R. Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate. INTERNATIONAL ORTHOPAEDICS 2021; 45:2917-2926. [PMID: 34554308 DOI: 10.1007/s00264-021-05217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. METHODS A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. RESULTS Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). CONCLUSION Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
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Affiliation(s)
- Patrick Boyer
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Camille Couffignal
- Clinical Research, Biostatistics and Epidemiology Department, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Mohammad Bahman
- Alrazi Hospital, University of Kuwait, Al Sabah Medical Area, Kuwait, Kuwait
| | - Guy Mylle
- Clinique Hartmann, Neuilly Sur Seine, France
| | - Marc-Antoine Rousseau
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Ruben Dukan
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France.
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Izquierdo-Fernández A, Gómez-Rodríguez M, Urbano-Luque M, García-Carmona M, Quevedo-Reinoso R, Minarro JC. Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up. J Orthop Traumatol 2021; 22:38. [PMID: 34559320 PMCID: PMC8463641 DOI: 10.1186/s10195-021-00597-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/01/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE III Controlled cohort study.
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Affiliation(s)
| | - Marta Gómez-Rodríguez
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Maite Urbano-Luque
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Manuel García-Carmona
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Rafael Quevedo-Reinoso
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - José Carlos Minarro
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain.
- , Calle Buenos Aires 5B, 14006, Córdoba, Spain.
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Deng J, Zhang S, Yu Y, Zhang L, Zhang L, Jiang W, Yang K, Xi X. Efficacy of Hemiarthroplasty vs. Locking Plate Fixation for Proximal Humerus Fractures: A Meta-Analysis. Front Surg 2021; 8:651554. [PMID: 34621778 PMCID: PMC8490867 DOI: 10.3389/fsurg.2021.651554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Proximal humerus fractures are common in a clinic and account for ~6% of all adult fractures. Hemiarthroplasty (HA) or locking plate (LP) fixation is currently recommended for the treatment of complex proximal humerus fractures (PHFs); however, there is no uniform standard for optimal surgical treatment or functional recovery. We conducted a meta-analysis to compare the efficacy of LP and HA in the treatment of PHFs. Methods: Relative studies associated with HA and LP were searched in December 2020 in the PubMed, Embase, Cochrane Library, and OVID databases. The quality of the studies, functional outcomes (including the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Short Form Health Survey (SF-12v2), complications, and reoperation rate were extracted and analyzed with the Stata 14.0 software. Results: A total of 958 patients from 12 studies were included in the meta-analysis, which showed that patients treated with LP had a significantly lower reoperation rate, a higher complication rate, and a higher CMS score than those treated with HA. There were no significant differences in ASES, SST, or SF-12v2 scores between treatment groups. Conclusions: Compared with HA, LP exhibited better clinical efficacy in some aspects. However, large sample and randomized, controlled studies are needed for further validation.
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Affiliation(s)
- Jiali Deng
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Shuai Zhang
- Department of Anesthesiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Yuanyuan Yu
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Li Zhang
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Li Zhang
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Wen Jiang
- Department of General Medicine, The Third People's Hospital of Chengdu, Sichuan, China
| | - Kai Yang
- Emergency and Business Management Office, Chengdu Center for Disease Control and Prevention, Sichuan, China
| | - Xiaoyan Xi
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Sichuan, China
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Mohan K, Hintze JM, Morrissey D, Molony D. Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN.
61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity.
40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature.
In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.
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Fang C, Yee DK, Wong TM, Fang E, Pun T, Lau TW, Wong J, Leung F, Liu R, Cheung CC, Tipoe GL, Leung F. Differences in soft tissue damage using a percutaneous versus open approach for antegrade straight humeral nailing: a quantitative and qualitative anatomical study. J Orthop Surg (Hong Kong) 2021; 29:23094990211010548. [PMID: 34008454 DOI: 10.1177/23094990211010548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. MATERIALS AND METHODS We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. RESULTS The percutaneous technique produced greater latitudinal tearing (p = 0.002) and less longitudinal tearing (p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area (p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. CONCLUSIONS Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.
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Affiliation(s)
- Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Dennis Kh Yee
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tak Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Evan Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Terence Pun
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tak Wing Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Janus Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Felix Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Rong Liu
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun Chung Cheung
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - George Lim Tipoe
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
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Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach. Eur J Trauma Emerg Surg 2021; 48:4559-4567. [PMID: 34333689 DOI: 10.1007/s00068-021-01761-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Three part and four-part fractures of the proximal humerus offer challenges in reduction and plate fixation, with considerable debate about use of Deltoid splitting (DS) and Delto-pectoral (DP) approaches, especially when they involving the greater tuberosity. We prospectively compared the results using DS approach and DP approach in these cases, with special focus on functional outcomes, complications, and ease of tuberosity reduction. MATERIALS AND METHODS 84 patients with three- and four-part proximal humerus fracture were alternately allocated the DP approach or DS approach for proximal humerus locking plate fixation. The outcome analysis was done by evaluating relative Constant score and ease of surgical reduction of greater tuberosity; radiological malunion was evaluated using Beredjiklian classification and complications were noted. RESULTS At mean follow-up of 23 months (19-48 months), the mean 'relative Constant score was 74.27 ± 8.19 in the DP group and 73.26 ± 8.02 in the DS group and the difference was statistically insignificant (p = 0.988). There was no significant difference with respect to shoulder ROM, abductor strength, radiological malunion or complications. However, the mean surgical time was significantly less (p value = 0.042) in DS group (65 ± 5 min) in comparison to DP group (92 ± 4.3 min); significantly less difficulties were documented by the surgeon in reducing the greater tuberosity in DS group(p value = 0.02). CONCLUSION Although surgical time was reduced and greater tuberosity reduction was easier in DS group, the other outcomes were similar; either surgical approach can be used based, and can be based on the experience and comfort level of the surgeon.
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Iglesias-Rodríguez S, Domínguez-Prado DM, García-Reza A, Fernández-Fernández D, Pérez-Alfonso E, García-Piñeiro J, Castro-Menéndez M. Epidemiology of proximal humerus fractures. J Orthop Surg Res 2021; 16:402. [PMID: 34158100 PMCID: PMC8220679 DOI: 10.1186/s13018-021-02551-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/10/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Sandra Iglesias-Rodríguez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain.
| | - Diego Matías Domínguez-Prado
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
| | - Alejandro García-Reza
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
| | - Daniel Fernández-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
| | - Elena Pérez-Alfonso
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
| | - Javier García-Piñeiro
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
| | - Manuel Castro-Menéndez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Vigo (Pontevedra), Estrada de Clara Campoamor, 341, 36213, Vigo, Pontevedra, Spain
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Sabah Y, Decroocq L, Gauci MO, Bonnevialle N, Lemmex DB, Chelli M, Valenti P, Boileau P. Clinical and radiological outcomes of reverse shoulder arthroplasty for acute fracture in the elderly. INTERNATIONAL ORTHOPAEDICS 2021; 45:1775-1781. [PMID: 33893521 DOI: 10.1007/s00264-021-05050-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The goal of this study was to assess the clinical outcomes associated with anatomic healing of the greater tuberosity in patients treated for proximal humerus fractures with reverse shoulder arthroplasty. Our hypothesis was that anatomic healing of the greater tuberosity leads to less complications and better functional outcomes. METHODS RESULTS: Patients from the GT+ group presented better functional outcomes than the GT- group in all evaluated outcomes. Mean constant score was 61 ± 14 versus 56 ± 15, and the subjective shoulder value (SSV) was 77 ± 14 versus 64 ± 21 (p < 0.001). Forward elevation was 128° ± 28° versus 107° ± 30° and external rotation was 23° ± 17° versus 14° ± 17° (p < 0.001). Twenty patients presented with at least one prosthetic dislocation (7 GT+ vs 13 GT-) while nine patients were revised for humeral loosening (1 GT+ vs 8 GT-). The use of a fracture specific humeral stem was associated with a higher rate of greater tuberosity healing. CONCLUSIONS Non-anatomic healing of the greater tuberosity was associated with a higher dislocation and humeral loosening rate. Anatomic healing of the greater tuberosity lead to better functional outcomes, less humeral-sided complications, and fewer re-operations.
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Affiliation(s)
- Yann Sabah
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France.
| | - Lauryl Decroocq
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
| | | | | | | | - Mikael Chelli
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
| | | | - Pascal Boileau
- IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort. J Orthop Surg (Hong Kong) 2021; 28:2309499020944114. [PMID: 32996369 DOI: 10.1177/2309499020944114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several factors affect proximal humeral fracture (PHF) morphology. In the presence of glenohumeral osteoarthritis (GOA), the joint kinematics is alternated which might influence fracture configuration. The purpose of this study was to identify fracture patterns in patients with advanced osteoarthritis to facilitate recognition and treatment. METHODS In this retrospective analysis, and computed tomography (CT) scans of all patients undergoing surgical treatment for a PHF during a 5-year period were analyzed. Fracture pattern according to the AO Foundation/Orthopaedic Trauma Association (AO-OTA) classification and the presence of GOA were evaluated. In addition, critical shoulder angle (CSA), glenoid configuration, and glenoid inclination (GI) were measured. RESULTS Of the 713 patients, 574 met the inclusion criteria. A total of 166 patients showed radiological signs of GOA (28.9%). Advanced GOA (stage 2 or 3) was identified in 23 patients (4.0%). In this group, the mean age was 77 ± 10 years, mean CSA was 28.8 ± 4.2°, and the mean GI was 19.0 ± 7.8°. All fractures were extra-articular metaphyseal fractures (5 A2, 11 A3, 7 B1.1). Patients with advanced GOA had more than threefold risk (risk ratio 3.2; confidence interval 95% 2.80-3.74; p < 0.0001) for sustaining a metaphyseal fracture. In patients with GOA grade 1 compared to patients with no radiographic signs of GOA, this could not be observed. CONCLUSION Patients experiencing PHF with radiological signs of advanced GOA have a higher risk of sustaining a metaphyseal fracture compared to individuals with the absence of or mild GOA. To date, no classification system for PHFs takes preexisting osteoarthritis into account, although it might indicate a different treatment and therefore the recognition is crucial.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Bougher H, Buttner P, Smith J, Banks J, Na HS, Forrestal D, Heal C. Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures. JSES Int 2021; 5:198-204. [PMID: 33681838 PMCID: PMC7910723 DOI: 10.1016/j.jseint.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hypothesis This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs). Results Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.
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Affiliation(s)
- Hannah Bougher
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | | | | | - Jennifer Banks
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | - Hyun Su Na
- Mackay Base Hospital, Mackay, QLD, Australia
| | - David Forrestal
- Queensland University of Technology, Brisbane City, QLD, Australia
| | - Clare Heal
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
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Morphometric Characterization of the Collum Chirurgicum. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.856197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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] [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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Wang F, Wang Y, Dong J, He Y, Li L, Liu F, Dong J. A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation. J Orthop Surg Res 2021; 16:29. [PMID: 33422119 PMCID: PMC7796622 DOI: 10.1186/s13018-020-02094-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. MATERIALS AND METHODS We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. RESULTS There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. CONCLUSIONS The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.
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Affiliation(s)
- Fu Wang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Yan Wang
- Medical Laboratory Diagnosis Center, Jinan Central Hospital, 105 Jiefang Road, Jinan, 250013, People's Republic of China
| | - Jinye Dong
- Department of Ultrasound, Weifang People's Hospital, Weifang, 261041, Shandong, People's Republic of China
| | - Yu He
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Lianxin Li
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250021, People's Republic of China.
| | - Jinlei Dong
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jing Wu Road, Jinan, 250021, People's Republic of China.
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Maluta T, Amarossi A, Dorigotti A, Bagnis F, Samaila EM, De Luca L, Pezze L, Magnan B. External fixation can be an option for proximal humerus fractures Neer 3-4. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020017. [PMID: 33559622 PMCID: PMC7944700 DOI: 10.23750/abm.v91i14-s.10979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022]
Abstract
Background: Proximal humeral fractures (PHF) account for 4-6% of all fractures and 25% of humeral fractures. While conservative treatment is the gold standard for simple fractures, there is no consensus about the best treatment choice for complex PHF in the elderly. Recently a new external fixator was introduced in clinical practice for treatment of complex PHF. Aim of the study was to evaluate the functional results of this therapeutic approach. Methods: Data were retrospectively analyzed. Inclusion criteria were: three- and four-part PHF according to Neer, treatment with closed reduction and external fixation, normal Abbreviated Mini Mental Test score, independence in the daily living, non-pathological fracture, glenohumeral joint with moderate osteoarthritic changes and availability of clinical and radiological follow-up. For each patient demographic data, comorbidities, surgery time and estimated blood loss were recorded. Clinical and radiological evaluation were performed at 1, 2, 6, 12 months. Results: 17 patients were enrolled. Mean age was 69.7 years. Fractures were classified according to Neer as type III in 10 cases and type IV in 7 cases. The mean operating time was 22 minutes. Mean Constant score value at follow up was 74 ± 11,52 at 2 months, 82 ± 11,16 at 6 months and 85 ± 9,86 at 12 months. Conclusion: These preliminary results show that the studied system is easy to use, minimally invasive, effective in reducing surgical and hospitalization time. The results in terms of functional recovery are encouraging, showing a reduced number of complications. (www.actabiomedica.it)
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Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5946 patients. J Shoulder Elbow Surg 2020; 29:2538-2547. [PMID: 32684280 DOI: 10.1016/j.jse.2020.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an increasing trend toward the use of reverse total shoulder arthroplasty (RTSA) over stemmed hemiarthroplasty (HA) for the management of proximal humeral fractures. There are limited data available comparing the revision rates for RTSA and HA in the setting of a fracture. The aim of this study was to compare the revision rates for RTSA and HA when used for the treatment of a fracture and to analyze the effect of demographics and prosthesis fixation on these revision rates. METHODS Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from April 16, 2004, to December 31, 2017, included all procedures for primary diagnosis proximal humeral fracture. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models. RESULTS Over the study period, there were 3049 (51%) RTSA and 2897 (49%) HA procedures. The cumulative percent revision rate at 9 years was lower for the RTSA than for the HA: 7.0% (95% confidence interval [CI], 4.8-10.1) compared with 11.7% (95% CI, 10.3-13.2). Between 0 and 6 months, the HA had a significantly lower revision rate than the RTSA (hazard ratio, 0.50; 95% CI, 0.34-0.72; P < .001). Between 6 month and 3 years, the HA had a significantly higher revision rate. For the RTSA, males have a significantly higher rate of revision compared with females. There is a higher rate of early revision due to instability in younger persons (55-64) and males. For both RTSA and HA, cemented prostheses have lower revision rates compared with cementless prostheses. CONCLUSIONS RTSA has a significantly lower revision rate compared with HA for the treatment of proximal humeral fractures in females. Younger patients (<65) and males are at risk of early revision secondary to instability. In these patient groups, either alternatives to RTSA or further attention to fixation of tuberosities and shoulder rehabilitation may be indicated.
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Deltopectoral vs. deltoid split approach for proximal HUmerus fracture fixation with locking plate: a prospective RAndomized study (HURA). J Shoulder Elbow Surg 2020; 29:2190-2199. [PMID: 32650077 DOI: 10.1016/j.jse.2020.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to compare the functional and clinical outcomes between the deltoid split (DS) approach and the classic deltopectoral (DP) approach for locking plate fixation of proximal humerus fractures (PHF) in a prospective randomized multicenter study. METHODS From 2007 to 2015, all patients with a PHF Neer II/III were invited to participate. Exclusion criteria were pre-existing pathology to the limb, patient refusing or too ill to undergo surgery, patient needing another type of treatment (nail, arthroplasty), and axillary nerve impairment. After consent, patients were randomized to one of the 2 treatments using the dark envelope method. Functional outcome was evaluated by validated questionnaires (12-Item Short Form Health Survey: version 2, Quick-DASH) with a minimum follow-up of 12 months. Complications were noted. RESULTS A total of 85 patients (44 DS, 41 DP) were randomized (mean age of 62). Groups were equivalent in terms of age, gender, body mass index, severity of fracture, and preinjury scores. The mean follow-up was 26 months. All clinical outcome measures were in favor of the deltopectoral approach. Specifically, the Q-DASH and SF-12v2 were better in the DP group (12 vs. 26, P = .003 and 56 vs. 51, P = .049, respectively). There were more complications in DS patients, but they did not reach statistical significance. CONCLUSIONS The primary hypothesis on the superiority of the deltoid split incision was rebutted. On the basis of our study, the DP approach seems to offer better function compared with the DS approach for fixation of Neer 2 and 3 PHF fractures fixed with a locking plate.
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