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Proximal humeral fracture

Yukiko Karita, Yuka Kimura, Shizuka Sasaki, Taisuke Nitobe, Eiichi Tsuda, Yasuyuki Ishibashi
INTRODUCTION: Axillary artery and brachial plexus injuries have been reported to be associated with proximal humeral fractures. In this report, we present two cases of axillary artery and brachial plexus injury secondary to proximal humeral fracture. PRESENTATION OF CASES: Case 1: An 88-year-old woman with cognitive impairment slipped and fell at home. The diagnosis was left proximal humeral fracture. The second day, paralysis of left upper arm due to left axillary artery occlusion appeared...
July 25, 2018: International Journal of Surgery Case Reports
Sjur Oppebøen, Annette K B Wikerøy, Hendrik F S Fuglesang, Filip C Dolatowski, Per-Henrik Randsborg
BACKGROUND: Fixation of proximal humeral fractures (PHF) with locking plates has gained popularity over conservative treatment, but surgery may be complicated with infection, non-union, avascular necrosis (AVN) of the humeral head and fixation failure. Failure to achieve structural support of the medial column has been suggested to be an important risk factor for fixation failure. The aims of this study were to examine the effect of calcar screws and fracture reduction on the risk of fixation failure and to assess long-term shoulder pain and function...
August 9, 2018: Journal of Orthopaedic Surgery and Research
Steven M Cherney, Ryan A Murphy, Timothy S Achor, Andrew M Choo
Proximal humerus fractures involving an articular head split are rare and complex injuries. In the elderly population, arthroplasty is the optimal treatment, while in younger patients, the utility of arthroplasty procedures are limited by concerns of long-term implant survival. As a result, open reduction and internal fixation (ORIF) is still often the first-line treatment option for head splitting injuries. The traditionally described deltopectoral or anterolateral surgical approaches to the proximal humerus rely on indirect reduction and limited visualization of the articular fragments...
July 30, 2018: Journal of Orthopaedic Trauma
Xavier Ohl, Nicolas Bonnevialle, David Gallinet, Nassima Ramdane, Philippe Valenti, Lauryl Decroocq, Pascal Boileau
BACKGROUND: Our purpose was to evaluate the clinical and radiologic outcomes of reverse shoulder arthroplasty for proximal humeral fractures in a large cohort of elderly patients and compare the results in the case of tuberosity excision, failed fixation, or anatomic healing. METHODS: In this retrospective multicenter study, 420 patients underwent review and radiography with a minimum follow-up period of 12 months. The patients were divided into 3 groups according to the status of the greater tuberosity (GT) on the last anteroposterior radiographs: anatomic GT healing (group A, n = 169); GT resorption, malunion, or nonunion (group B, n = 131); and GT excision (group C, n = 120)...
August 3, 2018: Journal of Shoulder and Elbow Surgery
Joan Miquel, F Santana, E Palau, M Vinagre, K Langohr, A Casals, C Torrens
PURPOSE: We aimed to biomechanically evaluate the effect of the supraspinatus tendon on tuberosity stability using two different reverse shoulder arthroplasty (RSA) models for complex proximal humeral fractures (PHFs). METHODS: Four-part proximal humeral fractures were simulated in 20 cadaveric shoulders. Two different RSA designs were implemented: a glenosphere-medialized model and a glenosphere-lateralized model. Tuberosities were reconstructed, and displacement of bony fragments was measured (mm) by placing three sensors: in the humeral diaphysis (D), in the greater tuberosity (GT), and in the lesser tuberosity (LT)...
July 31, 2018: Archives of Orthopaedic and Trauma Surgery
Arthur Lignel, Julien Berhouet, Marc-Alexandre Loirat, Philippe Collin, Hervé Thomazeau, David Gallinet, Pascal Boileau, Luc Favard
INTRODUCTION: Reverse shoulder arthroplasty (RSA) is a key tool in the orthopedic trauma surgeon's arsenal, especially when faced with a proximal humerus fracture in older patients. However, few studies have focused on the glenoid side of RSA in this indication as the implant is placed in a generally healthy scapula. HYPOTHESIS: Glenoid implants for RSA after trauma are well positioned and do not often cause complications. MATERIAL AND METHODS: Retrospective multicenter study of 513 patients who underwent RSA because of a proximal humerus fracture...
July 27, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Lang-Qing Zeng, Lu-Lu Zeng, Yu-Wen Jiang, Hai-Feng Wei, Wen Zhang, Yun-Feng Chen
Background: Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods: We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures (PHFs) with a locking plate between September 2007 and June 2013...
August 5, 2018: Chinese Medical Journal
R Biber, H J Bail, M Geßlein
There is still no gold standard for the treatment of humeral shaft fractures. This might be attributed to the fact that several commonly used treatment methods have shown good clinical results. A bimodal age distribution of humeral shaft fractures with frequency peaks between 20 and 30 years old and above 60 years old is reported. Decision making for conservative or operative treatment depends not only on the injury pattern but is also dependent on individual patient needs. Currently available operative techniques include antegrade and retrograde interlocking medullary nailing as well as the use of longer proximal humeral nails...
July 27, 2018: Der Unfallchirurg
Ali Jabran, Chris Peach, Zhenmin Zou, Lei Ren
BACKGROUND: Treatment of proximal humerus fractures with locking plates is associated with complications. We aimed to compare the biomechanical effects of removing screws and blade of a fixed angle locking plate and hybrid blade plate, on a two-part fracture model. METHODS: Forty-five synthetic humeri were divided into nine groups where four were implanted with a hybrid blade plate and the remaining with locking plate, to treat a two-part surgical neck fracture...
July 25, 2018: BMC Musculoskeletal Disorders
Caio Zamboni, Jorge Rafael Durigan, Felipe Diaz Pimentel, Jose Octavio Soares Hungria, Marcelo Tomanik Mercadante, Patricia Maria de Moraes Barros Fucs
INTRODUCTION: Diaphyseal fractures with proximal humeral extension can be treated using a helical model, so it is lateral on the proximal aspect and on the diaphyseal segment in the anterior surface. OBJECTIVE: Our objective was to evaluate possible rotational deviations using minimally invasive plate osteosynthesis (MIPO) and to determine how it affects upper limb function. METHODS: We followed 11 patients for a period of two years. The proximal approach was anterior-lateral, and the distal approach was anterior, dividing the brachial muscle...
June 18, 2018: Injury
Jean-David Werthel, François Sirveaux, Damien Block
Reverse shoulder arthroplasty is now the standard treatment for displaced, three- or four-part, proximal humeral fractures in patients older than 70 years. Inadequate tuberosity repair or inappropriate humeral stem position are associated with poorer outcomes, notably regarding rotation and stability. Strict operative technique during prosthesis implantation is therefore crucial to obtain reliable and reproducible outcomes. The objective of this article is to describe the surgical technique for reverse shoulder arthroplasty used to treat recent proximal humerus fractures...
July 20, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Y P Acklin, I Zderic, J A Inzana, S Grechenig, R Schwyn, R G Richards, B Gueorguiev
Aims: Plating displaced proximal humeral fractures is associated with a high rate of screw perforation. Dynamization of the proximal screws might prevent these complications. The aim of this study was to develop and evaluate a new gliding screw concept for plating proximal humeral fractures biomechanically. Methods: Eight pairs of three-part humeral fractures were randomly assigned for pairwise instrumentation using either a prototype gliding plate or a standard PHILOS plate, and four pairs were fixed using the gliding plate with bone cement augmentation of its proximal screws...
June 2018: Bone & Joint Research
Eduardo Angeli Malavolta, Jorge Henrique Assunção, Mauro Emilio Conforto Gracitelli, Pedro Antonio Araújo Simões, Danilo Kenji Shido, Arnaldo Amado Ferreira Neto
Objective: To evaluate the correlation between the UCLA and Constant-Murley scores in the surgical treatment of rotator cuff tears and proximal humeral fractures (PHF). Methods: Retrospective study evaluating patients submitted to arthroscopic rotator cuff repair and surgical treatment of PHF with 2-year follow-up. Patients were evaluated by the UCLA and Constant-Murley scores in the preoperative period for the rotator cuff repairs, and 3, 6, 12 and 24 months after surgery for both diagnoses...
July 2018: Revista Brasileira de Ortopedia
Jiun-Liang Chen, Fu-Chun Chang, Shih-Jie Lin, Po-Yao Chuang, Kuo-Ti Peng, Kuo-Chin Huang, Tsan-Wen Huang
BACKGROUND: Locking plate fixation appears to be a standard treatment for proximal humeral fracture. Different locking plate designs might result in different radiographic and functional outcomes. The original version of the Proximal Humeral Internal Locking System (PHILOS; DePuy Synthes, Warsaw, IN, USA) occupied the largest volume of the humeral head by screw distribution, whereas the Zimmer Periarticular Locking Plate (ZPLP) system (Zimmer Biomet, Warsaw, IN, USA) occupied the smallest...
July 13, 2018: Journal of Shoulder and Elbow Surgery
Levon Doursounian, Julien Gaillard, Adeline Cambon-Binder, David Zbili, Alain Sautet
PURPOSE: Hemiarthroplasty (HA) for proximal humerus fracture (PHF) is associated with tuberosity complications like migration, non-union, and resorption. In order to improve the rate of consolidation of the greater tuberosity (GT), we have developed a hollow humeral head prosthesis in which the whole humeral head is inserted and used as autograft. This study is designed to evaluate the consolidation rate of the GT with this device. METHOD: Twenty-two patients at mean age of 68 were treated between 2015 and 2017 for four-part fractures, fracture-dislocations, and head-split fractures with HA including the bony humeral head...
July 11, 2018: International Orthopaedics
Tomas Liskutin, Hobie Summers, William Lack, Mitchell Bernstein
INTRODUCTION: Although most humeral shaft fractures can be treated nonoperatively, many patients do benefit significantly from surgical treatment. The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects. In addition, the approach can be extended both proximally and distally, providing the surgeon a dynamic exposure to the humerus for the treatment of fractures and other pathologies. METHODS: This video highlights a clinical case where a mid-shaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8-hole 4...
August 2018: Journal of Orthopaedic Trauma
Hyo Yang, Hyo-Jin Lee, Yun-Gyoung Lee, Jang-Woon Kim, Yang-Soo Kim
BACKGROUND: Conversion to full-thickness tear in partial-thickness rotator cuff tears (PTRCTs) is based on the quality and thickness of the normal-looking untorn rotator cuff layer. However, whether the untorn tendon is a healthy tissue remains to be elucidated. PURPOSE: To compare the apoptotic gene expression of the untorn articular layer with the torn bursal layer in PTRCTs. STUDY DESIGN: Controlled laboratory study. METHODS: Tendon tissues were harvested from 20 patients undergoing arthroscopic surgery for partial-thickness rotator cuff repair...
August 2018: American Journal of Sports Medicine
Riccardo Luigi Alberio, Matteo Del Re, Federico Alberto Grassi
Background: The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Materials and Methods: From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48-80) were surgically treated with the MIPO technique for proximal humeral fractures...
2018: Advances in Orthopedics
Norio Imai, Naoto Endo, Yugo Shobugawa, Takeo Oinuma, Yasuhito Takahashi, Kazuaki Suzuki, Yuya Ishikawa, Tatsuo Makino, Hayato Suzuki, Dai Miyasaka, Mayumi Sakuma
The aim of this study was to survey the incidence of osteoporotic fragility fractures, which include vertebral, hip, distal radius, and proximal humerus fractures, in patients ≥ 50 years of age, from 2004 to 2015, in Sado City, Japan. We examined temporal changes in the incidence of these fractures from 2010 through 2015. The incidence of vertebral (p < 0.001) and radius fractures (p = 0.001) was lower in 2015 than in 2010, with only the incidence of hip fracture (p = 0.013) being lower in 2015 than in 2004...
June 28, 2018: Journal of Bone and Mineral Metabolism
Simon M Lambert
Interfragmental ischaemia is a prerequisite for the initiation of the inflammatory and immunological response to fracturing of bone.Intrafragmental ischaemia is inevitable: the extent of the initial ischaemic insult does not, however, directly relate to the outcome for healing of the fracture zones and avascular necrosis of the humeral head. The survival of distal regions of fragments with critical perfusion may be the result of a type of inosculation (blood vessel contact), which establishes reperfusion before either revascularization or neo-angiogenesis has occurred...
May 2018: EFORT Open Reviews
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