humeral metadiaphyseal fractures

INTRODUCTION: Humeral shaft fractures are common injuries treated by orthopaedic surgeons. The purpose of this study is to evaluate displaced diaphyseal humerus fractures and describe the incidence and characteristics associated with non or minimally displaced fracture line extension into the proximal metadiaphyseal region of the humerus. METHODS AND MATERIALS: All adult patients with diaphyseal humeral shaft fractures located within the distal two-thirds of the humeral shaft, treated at a single level I trauma institution between 2007 and 2020, were retrospectively identified...

INTRODUCTION: in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients. MATERIALS & METHODS: Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA...

OBJECTIVE: The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis location, on the patient's status and on the residual functional capacity. Metadiaphysis is an area of conflict in the choice between megaprosthesis implant and intramedullary nail osteosynthesis. This study compares these two surgical procedures in terms of reacquired functionality and local control of metastasis...

Osteonecrosis is defined as bone death due to inadequate vascular supply. It is sometimes also called "avascular necrosis" and "aseptic necrosis" when involving epiphysis, or "bone infarct" when involving metadiaphysis. Common sites include femoral head, humeral head, tibial metadiaphysis, femoral metadiaphysis, scaphoid, lunate, and talus. Osteonecrosis is thought to be a common condition most commonly affecting adults in third to fifth decades of life. Risk factors for osteonecrosis are numerous and include trauma, corticosteroid therapy, alcohol use, HIV, lymphoma/leukemia, blood dyscrasias, chemotherapy, radiation therapy, Gaucher disease, and Caisson disease...

Introduction Proximal humeral fractures complicated with metaphyseal and diaphyseal extension are usually treated operatively with 3.5 mm long anatomic proximal humerus plates. However, frequently these comminuted and segmental fracture types may be associated with delayed union, nonunion, and/or plate failure. We present a technique for addressing this fracture pattern by using an anatomic contralateral 4.5 mm distal femoral plate in a reversed fashion. Methods Eleven patients (eight women and three men) with a mean age of 70 years (range, 52 to 84 years) were operated on with the described technique...

BACKGROUND: The purpose of this study was to identify nerves at risk when using a minimally invasive plate osteosynthesis precontoured long proximal humerus locking plate and to evaluate the risk of injury to deltoid insertion and brachialis muscle. METHODS: Ten cadaveric upper limb specimens were used. A transdeltoid anterolateral approach was performed proximally and a second anterior approach was performed distally. A 14-hole "low" long precountored ALPS locking plate (Biomet Trauma; Zimmer Biomet, Warsaw, IN, USA) was used...

BACKGROUND: A minority of proximal humeral fractures extend into the diaphysis and their optimal treatment remains controversial. We evaluated the outcomes and risk of complications in patients with these injuries, treated by a protocol of open reduction and long locking plate fixation (LPF). METHODS: Between 2007 and 2014, all locally resident patients with a proximal humeral fracture extending into the diaphysis were referred to a specialist shoulder clinic. Operative treatment using a protocol of open reduction and LPF was offered to medically fit patients...

The MIPO (Minimally Invasive Plate Osteosynthesis) technique for treating metadiaphyseal fractures of the proximal humerus has gained great attention during the past years. The purpose of this retrospective study was to underline all the important difficulties when the MIPO technique is applied, to propose practical solutions and to evaluate the overall clinical outcome of our patients treated with this technique. A total of 14 patients had been operated in two different surgical units, at San Carlo Borromeo Hospital (Milan, Italy - 11 patients) and in Policlinico Umberto I Hospital (Rome, Italy - 3 patients), between June 2013 and November 2016...

INTRODUCTION: Minimally invasive lateral placement of plates on the humerus may be associated with a risk of injury to the radial nerve. Whereas this potential complication has been investigated in several studies, there is no data regarding potential injuries to the distal insertion of the deltoid muscle when the plates are passed distally in a submuscular tunnel. METHODS: Minimally invasive plate placement was performed on eight arms in fresh cadavers. A lateral deltoid split approach was made and the plates were introduced in an antegrade submuscular manner from proximal to distal...

Minimally invasive plate osteosynthesis (MIPO) has been used for humeral shaft fractures, but concerns exist about soft tissue injuries. The purpose of this study was to report the surgical technique and clinical outcomes of MIPO using a helical plate for metadiaphyseal complex humeral shaft fractures. Twelve patients with acute displacement involving proximal and middle third humeral shaft fractures (AO type C) were treated using the MIPO technique with a helical plate. Fracture union, complications, and functional outcomes were evaluated using the Constant-Murley score and Mayo Elbow Performance Score (MEPS) at final follow-up...

PURPOSE: A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications. METHODS: From 2008 to 2012, 21 such operations were performed; 18 were considered "fragility" fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis...

BACKGROUND: The management of posttraumatic bone loss is complicated and often requires complex reconstructive procedures. No options exist that are specific to the treatment of the growing skeleton that has intercalary bone loss. We have observed reconstitution of the humerus in 2 cases that have precluded extensive management. METHODS: Two pediatric patients sustained traumatic injuries to the upper extremities, including humeral bone loss, and are presented after spontaneous reconstitution of the segmental bone loss...

AIM: The purpose of the article is to highlight a specific fracture pattern encountered by us in the osteoporotic upper humerus. We present our results of management of such metadiaphyseal fractures of the upper humerus with less invasive plating. The additional steps taken to improve final outcome and the reasoning behind each are discussed. PATIENTS AND METHODS: In our department, a total of 13 fractures (in 12 patients) were managed for a metadiaphyseal fracture of the upper humerus between 2010 and 2013...

Metadiaphyseal fractures of long bones are associated with considerable deforming forces, tenuous soft-tissue envelopes, and, often, severely compromised osseous integrity. Contemporary methods to fix complex metadiaphyseal fractures must achieve a balance between the biomechanical and biologic environments. The advent of precontoured locking plates inserted with evolving minimally invasive techniques may achieve both goals. Enthusiasm for their application demands continued scientific validation. Indications and outcomes must be carefully evaluated, and the benefits and limitations of this combination of implant design and surgical execution must be recognized...

Minimal invasive plate osteosynthesis (MIPO) not only meets the criteria of a "biological" osteosynthesis by minimising invasivity as well as iatrogenic soft tissue damage, but can also provide adequate stability for fracture healing and early functional aftertreatment. Up to date, only few publications report on MIPO of humeral shaft fractures mainly using the anterolateral deltopectoral approach for proximal plate insertion. Objective of the present study was to assess the feasibility and clinical outcome of MIPO for metadiaphyseal fractures of the proximal humerus through a lateral approach using angular stable long PHILOS(®)-plates...

The existing classifications of supracondylar fractures of humerus in children are not adequate and do not reflect the variability of this fracture, its requirements as for diagnosis and method of treatment. The article presents a list of classification published in literature starting from the Kocher classification of 1896 until the present schemes. These classifications divide supracondylar fractures into extension or flexion ones or according to the extent of displacement of fragments into 3-4 types. Only Wilkins mentions a different type, metadiaphyseal fracture, the treatment of which differs from usual procedures...

Storey and proximal metadiaphyseal humeral fractures are serious injuries, affecting patients of all age cathegories, however, elderly patients are affected more often. Conservative treatment results in a long-term immobilisation of the extremity, restricts ventilation and reduces the comfort. Former implants did not meet requirements for a stable osteosynthesis and hampered early rehabilitation. The Targon PH long nail (Aesculap, Tuttlingen, SRN) combines advantages of intramedullary fixation within the whole length of the medullary cavity with the use of angle-stable screws in the proximal fixation storey, which extends chances for a reliable osteosynthesis also to the proximal fifth of the humerus...

Treatment of proximal humeral fractures remains controversial, with multiple reported techniques and variable results. Recently, locking plates have become available for fixation of osteopenic and comminuted fractures. This study reports our initial experience with a new locking plate designed specifically for proximal humeral fractures. We observed 16 patients until union or revision with a mean of 12 months' follow-up. Of the 16 patients, 9 had high-energy injuries. There were nine 3-part, five 2-part, and two 4-part fractures...

Obtaining and maintaining the reduction of high-energy, complex fractures involving the periarticular or shaft regions of the bone often is difficult with standard reduction clamps. We present and review a technique in which unicortical fracture fixation plates are applied at provisional states of reduction to maintain that reduction until definitive fixation can be applied. We have termed the technique "reduction plating," and modifications of this concept have proven useful in metadiaphyseal and diaphyseal fractures, periarticular fractures and acetabular fractures...

BACKGROUND: Currently, there is little information concerning periprosthetic humeral fractures after shoulder arthroplasty. Therefore, we reviewed our experience with these fractures to determine the results of treatment, the risk factors for periprosthetic fracture, and the rates of reoperation. METHODS: Between 1976 and 2001, nineteen postoperative periprosthetic humeral fractures occurred among 3091 patients who had undergone shoulder arthroplasty at our institution...