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Proximal humeral fracture

Paul T Ogink, Frederik R Teunissen, Julie R Massier, Kevin A Raskin, Joseph H Schwab, Santiago A Lozano-Calderon
BACKGROUND AND OBJECTIVES: Allograft reconstruction of the humerus after resection is preferred by many because of bone stock restoration and biologic attachment of ligaments and muscles to the allograft, theoretically obtaining superior stability and functionality. Our aim was to assess the prevalence of complications and the incidence and etiology for revision surgery in humeral allograft reconstructions. METHODS: We included patients 18 years and older who underwent wide resection and allograft reconstruction of the humerus for primary and metastatic lesions at our institution between 1990 and 2013...
December 5, 2018: Journal of Surgical Oncology
Jordi Salvador, Samer Amhaz-Escanlar, Pablo Castillón, Iban Clares, Saioa Quintas, Martí Bernaus, Francesc Anglés, Alberto Jorge-Mora
PURPOSE: Antegrade intramedullary nailing is an alternative for humeral shaft fracture treatment. This surgical technique can be especially demanding in some fracture patterns, leading to problems like malunion and non-union. The purpose of our study is to demonstrate that the use of a nail with cerclage wires could be a safe procedure that facilitate reduction, specially in fractures with abduction of the proximal fragment. MATERIALS AND METHODS: Fifty-six patients were included, from January 2007 to March 2016...
November 24, 2018: Injury
Ji-Qi Wang, Bing-Jie Jiang, Wei-Jun Guo, You-Ming Zhao
BACKGROUND: Although the proximal humeral fractures (PHFs) treated with locking plate have been well applied, there are few studies concerning on the serial HSA changes after locking plate placement. The purpose of this retrospective study was to explored the clinical significance of serial HSA changes after surgery. METHODS: We retrospectively analyzed the clinical data of 122 patients between January 2012 to December 2016 in our hospital. The serial change of the HSA and Neer's score of 122 patients were recorded and analyzed...
November 30, 2018: BMC Musculoskeletal Disorders
Yanxi Chen, Xiaoyang Jia, Minfei Qiang, Kun Zhang, Song Chen
BACKGROUND: This study aimed to determine the difference between computer-assisted virtual surgical technology and 3-dimensional (3D) printing technology in preoperative planning for proximal humeral fractures. METHODS: Between February 2009 and October 2015, 131 patients with 3 and 4-part proximal humeral fractures were divided into 3 groups on the basis of the preoperative planning method: conventional (n = 53), virtual surgical (n = 46), and 3D printing (n = 32)...
November 21, 2018: Journal of Bone and Joint Surgery. American Volume
Davide Blonna, Valeria Allizond, Enrico Bellato, Giuliana Banche, Anna Maria Cuffini, Filippo Castoldi, Roberto Rossi
Preoperative skin preparation plays a major role in preventing postoperative infections. This study aims to compare a single skin preparation (povidone iodine) with a double skin preparation (chlorhexidine gluconate followed by povidone iodine). Forty patients affected by proximal humeral fracture were included in the study. The day of surgery the two skin preparation strategies were performed in the same shoulder, divided into two areas, at the level of the deltopectoral approach. Skin swabs were collected from each area and subjected to microbiological analysis...
2018: BioMed Research International
Tobias Helfen, Georg Siebenbürger, Evi Fleischhacker, Niklas Biermann, Wolfgang Böcker, Ben Ockert
INTRODUCTION: To evaluate outcomes following open reduction and internal fixation of displaced proximal humeral fractures with regards to the surgeon's experience. MATERIAL AND METHODS: Patients were included undergoing ORIF by use of locking plates for displaced two-part surgical neck type proximal humeral fractures. Reduction and functional outcomes were compared between procedures that were conducted by trauma surgeons [TS], senior (>2 years after board certified) trauma surgeons [STS] and trauma surgeons performing ≥50 shoulder surgeries per year [SS]...
2018: PloS One
Aakanksha Agarwal, Abhishek Chandra, Usha Jaipal, Narender Saini
The radial nerve has a long and tortuous course in the upper limb. Injury to the nerve can occur due to a multitude of causes at many potential sites along its course. The most common site of involvement is in the proximal forearm affecting the posterior interosseous branch while the main branch of the radial nerve is injured in fractures of the humeral shaft. Signs and symptoms of radial neuropathy depend upon the site of injury. Injury to the nerve distal to innervation of triceps brachii results in loss of extensor function with sparing of function of the triceps resulting in the characteristic 'wrist drop'...
November 5, 2018: Insights Into Imaging
Pan Cai, Yang Yang, Zhengfeng Xu, Zhe Wang, Xiaoxiao Zhou, Tao Yang
BACKGROUND: Continued debate exists on the management of displaced 3- or 4-part proximal humeral fractures. Only a few studies have compared the efficacy of proximal humeral locking plates (PHLPs) for treating anatomic neck fractures (ANFs) and surgical neck fractures (SNFs). METHODS: The medical data of 31 consecutive patients with displaced 4-part proximal humeral fractures treated with PHLPs between May 2013 and April 2015 were reviewed retrospectively. We divided the patients into the ANF and SNF groups and assessed the neck-shaft angle (NSA), sum of the screw tip-articular surface distance, and other parameters postoperatively at 3 days and at 12 months using shoulder radiographs...
October 31, 2018: Journal of Shoulder and Elbow Surgery
Jan Theopold, Stefan Schleifenbaum, Mirijam Müller, Michael Werner, Niels Hammer, Christoph Josten, Pierre Hepp
BACKGROUND: Treating proximal humerus fractures can be challenging because of large metaphyseal defects that conceal anatomical landmarks. In such cases, medial cortical support with, for example, calcar screws, is mandatory. Nevertheless, varus dislocations and implant failures in patients with impaired bone quality persist. Thus, the need for effective treatment of these patients exists. Hybrid double plate osteosynthesis was introduced as an alternative, yielding similar results as calcar screws...
2018: PloS One
Matthieu Chivot, Damien Lami, Paul Bizzozero, Alexandre Galland, Jean-Noël Argenson
BACKGROUND: The objective of our study was to evaluate the results of surgical treatment by reverse shoulder arthroplasty (RSA) compared with nonsurgical treatment after 2 years of follow-up in patients aged 70 years or older with displaced 3-part or 4-part proximal humeral fractures. METHODS: Two groups were formed: the RSA group (n = 28) and the nonsurgical group (n = 32). Minimum follow-up was 2 years. We included patients with 3-part or 4-part fractures according to the Neer classification...
October 19, 2018: Journal of Shoulder and Elbow Surgery
A Pautasso, S Lea, A Arpaia, G Ferrero, E Bellato, F Castoldi
BACKGROUND: Proximal and shaft humeral fractures are very common worldwide; surgical treatment can be a viable option to reduce limb immobilization and to allow the patient an earlier return to daily activities. The aim of our study was to evaluate the outcomes of patients treated with intramedullary nail in our Institute from January 2010 to December 2016. MATERIALS AND METHODS: This is an observational cohort study. Inclusion criteria were: traumatic proximal and diaphyseal humeral fractures treated with antegrade nail; a minimum follow-up of 6 months...
October 2018: Musculoskeletal Surgery
M A Verdano, D Aliani, C Galavotti, C Maroun, E Vaienti, F Ceccarelli
PURPOSE: The aim of this study is to retrospectively compare clinical and radiographic outcomes of patients treated with non-lateralizing reverse shoulder arthroplasty (RSA) and with humeral lateralizing RSA after proximal humerus fracture (PHF). METHODS: In total, 32 patients (8 men and 24 women), with a mean age of 77.4 (67-92), have been reevaluated (follow-up of 14.3 months) and divided into Grammont group (G-group-16 patients, 2 men and 14 women, mean age 82...
October 2018: Musculoskeletal Surgery
A Padolino, G Porcellini, B Guollo, E Fabbri, G N Kiran Kumar, P Paladini, G Merolla
BACKGROUND: Metal plates are the fixation devices used most frequently to proximal humeral fractures (PHFs). However, in recent years carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates have become increasingly common. This study compares the clinical and radiographic outcomes of 42 Neer three- and four-part PHFs treated with CFR-PEEK or metal (titanium) plates. MATERIALS AND METHODS: Forty-two PHF patients were managed with CFR-PEEK plates (n = 21, males/females 9/12; mean age 57...
October 2018: Musculoskeletal Surgery
Joshua D Namm, Randal P Morris, Fred L Speck, Ronald W Lindsey
BACKGROUND: The objective of this study was to determine the impact of the type and orientation of peripheral screw placement in an eccentrically positioned locking plate on the structural integrity of the plate-diaphyseal bone interface. We hypothesized that central placement of the screw at the end of the plate in this setting is more important than screw type (locking versus nonlocking) to limiting the risk of subsequent fracture. METHODS: Twenty osteoporotic fourth-generation composite left humeri were divided into 4 groups and plated with stainless-steel 6-hole locking plates and 4...
October 17, 2018: Journal of Bone and Joint Surgery. American Volume
Bing Wang, Cheng Zhu, Ping Wang, Zi-Zheng Wu, Qian-Fa Zhang
OBJECTIVE: To explore the effect of postoperative initial neck stem angle on the treatment of proximal humeral fractures with locking plate. METHODS: From June 2014 to Septembetr 2016, 62 patients with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed, including 29 males and 33 females with an average age of(55.95±9.48) years old ranging from 34 to 74 years old. According to the difference of the initial neck stem angle, the patients were divided into three groups, 15 patients in the varus group had less than 127° postoperative initial neck-shaft angle, 36 patients in the normal group had 127° to 145° postoperative initial neck-shaft angle, 11 patients in the valgus group had more than 145° postoperative initial neck-shaft angle...
September 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Giandomenico Logroscino, Fabrizio Donati, Michela Saracco, Luciano Pilloni, Corrado Piconi
Angular stability locking plates are commonly used in proximal humeral fractures, especially in old patients with osteoporotic bones. These implants show good results in short and midterm follow-up, but complications are not uncommon. Here we present a case report to describe a case of early failure of a proximal angular stability plate implanted in a 72 years old female with a highly unstable two part proximal humeral fracture. An optical and metallurgic analysis was also conducted to study the modalities of failure...
October 2018: Trauma Case Reports
M Ceynowa, M Treder, F Dąbrowski, M Piotrowski, R Pankowski, M Rocławski
We present a case of a post-surgical complete dislocation after excessive proximal humeral shortening osteotomy performed in a patient operated on for atrophic non-union of a proximal humeral fracture. This complication has not been previously reported. The dislocation occurred due to extensive laxity of the soft tissue envelope, predominantly the deltoid muscle, as well as rotator cuff tear. The reconstructive procedurę consisted of vertical duplication of the capsule, reinforcement of the repair with coracoacromial ligament, tenodesis of the long head of the biceps tendon to the conjoined tendon and distal transfer of the deltoid muscle...
October 2018: Trauma Case Reports
Guan-Ming Kuang, Tak Man Wong, Jun Wu, Jun Ouyang, Haihua Guo, Yapeng Zhou, Christian Fang, Frankie K L Leung, William Lu
Introduction: The purpose of this study was to test whether local filling of a novel strontium-containing hydroxyapatite (Sr-HA) bone cement can augment the fixation of a locking plate system in a cadaveric proximal humeral facture model. Materials and Methods: Twelve pairs of formalin-treated cadaveric humeri were used. One side in each pair was for cemented group, while the other side was for the control group. The bone mineral density (BMD) of the samples was tested...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
F Reuther, M Petermann, R Stangl
OBJECTIVE: The study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty (RSA) in elderly patients with proximal humeral fractures and assess the role of tuberosity healing on the outcome. DESIGN: Case series SETTING:: Multicentre clinical study of level-2 trauma centres PATIENTS/PARTICIPANTS:: We included 81 patients with a mean age of 78.5 ± 6.5 years (range, 58.5-90.9 years) and a non-reconstructable proximal humeral fracture. INTERVENTION: Modular reverse fracture shoulder arthroplasty...
September 10, 2018: Journal of Orthopaedic Trauma
Ming Li, Yanhua Wang, Yupeng Zhang, Ming Yang, Peixun Zhang, Baoguo Jiang
Objective The optimal surgical intervention on the treatment for proximal humeral fractures (PHFs) remains uncertain. The aim of this study was to evaluate clinical outcomes following fixation of PHFs by intramedullary nails or locking plates Methods The Cochrane Library, PubMed, EMBASE, China Knowledge Resource Integrated (CNKI), Chongqing VIP and Wanfang databases were systematically searched for studies published between January 01, 1996 and December 31, 2016 that investigated intramedullary nail vs. locking plate in the surgical treatment of PHFs...
October 1, 2018: Journal of International Medical Research
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