Clinical outcomes and prognostic factors depending on implant design in the treatment of proximal humeral fractures: A retrospective study

Ueyama, Hideki; Yano, Koichi; Kanemura, Masayoshi; Gotani, Hiroyuki; Ito, Sadanao; Sakanaka, Hideki

doi:10.1016/j.jor.2016.06.025

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…11,12,13 La distribución de las características demográficas de nuestra serie es comparable con lo reportado en la literatura, pues, por un lado, hay una mayor frecuencia de casos que se da en mujeres y en pacientes de la tercer edad, sin diferencia de la lateralidad. 14 Por otro lado, no presentamos diferencias en proporción de casos por clasificación de Neer; si bien hay algunos reportes donde predominan los casos de baja severidad (Neer grado II), 11,15,16,17,18,19 generando un posible sesgo de resultados. Kloub y colaboradores, 20 así como Mathews y otros 21 presentaron dos cohortes de seguimiento (n = 137 cada una) y Targon ® PH (Aesculap, Tuttlingen, Alemania) utilizado en pacientes con Neer grado III/IV.…”

Section: Discussionunclassified

Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular

M¹,

Moreno-Degante²,

Gutiérrez-Báez³

et al. 2020

Acta Ortopédica Mexicana

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Artículo original RESUMEN. Introducción: La calidad de reducción en las fracturas de húmero proximal es posible valorarla a través de criterios radiográficos (ACD = ángulo cervicodiafisario; OM = offset medial; DTC = distancia tuberosidadcabeza y ES = espacio subacromial), los cuales predicen la funcionalidad. Sin embargo, estos criterios establecidos para otros implantes no están descritos para el clavo centromedular. Material y métodos: Estudio de cohorte observacional y retrospectivo en pacientes > 18 años con osteosíntesis con clavo centromedular (durante el período de 2014 a 2017), en donde se evaluaron las características demográficas, severidad de lesión (clasificación de Neer) y las mediciones radiográficas progresivas y complicaciones. Resultados: Se analizaron 84 casos, cuya edad en promedio fue de 65 ± 2 años y la media de seguimiento de 13.9 meses. Por clasificación de Neer: 40.4% fueron grado II; 29.7%, grado III y 29.7%, grado IV. La consolidación en varo aumenta 10.7% al final del seguimiento, siendo aquellos pacientes Neer grado III y IV los más frecuentes. La deformidad > 140 o predomina para Neer grado II (n = 15/34). En 30.9%, se presenta un cambio de ACD (ΔACD) ≥ 10 o. En general, 86.9% tiene cambios de DTC < 5 mm. En los casos Neer grado III/IV, 32% tiene una alteración de ES > 5 mm. La complicación más frecuentemente es la necrosis avascular (NAV) con 44% de los casos. Conclusiones: Las ABSTRACT. Introduction: The quality of reduction in proximal humerus fractures is valuable with radiographic criteria (Neck-shaft angle [NSA]; medial offset [MO]; distance head tuberosity [DHT] and subacromial space [SS]) that predict functionality. These criteria set for other implants are not described for the intramedullary nail. Material and methods: Observational cohort study, retrospective, with patients > 18 years, with osteosynthesis with intramedullary nail (2014 to 2017), evaluating demographic characteristics, severity of injury (Neer classification), progressive radiographic measurements and complications. Results: 84 cases with an average age of 65 ± 2 years and an average follow-up of 13.9 months were analyzed. By Neer rating 40.4% were grade II, 29.7% grade III and 29.7% grade IV. Consolidation in varus increases to 10.7% at the end of follow-up, with Neer III and IV patients. The >140 o deformity is prevalent for Neer II (n = 15/34). 30.9% have a change of neck-shaft angle of ≥ 10 o. Overall 86.9% has HTD changes < 5 mm. Cases Neer III/ IV 32% has alteration of SS > 5 mm. The most common complication is avascular necrosis (AVN) with 44% of cases. Conclusions: Radiographic measurements have changes in long-term follow-up. Alterations in NSA (> 10 o) and SS (> 5 mm) occur in higher proportion of Neer III/IV patients, according to the severity of the fracture, favoring Nivel de evidencia: IV Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular Alteration of X-ray measurements in proximal humerus osteosynthesis with intramedullary nail

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Section: Discussionunclassified

Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular

M¹,

Moreno-Degante²,

Gutiérrez-Báez³

et al. 2020

Acta Ortopédica Mexicana

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“…45 Nail design may impact on outcomes as straight nails have been shown to have better outcomes in terms of range of motion than curved nails, and the more medial insertion addresses the lateral cortex comminution better. 46 There is, however, no statistical difference in the outcomes in a recent randomised controlled clinical trial comparing curved to straight nails. 47 The use of threaded bushings to minimise screw back-out and provide more angular stability in osteoporotic bone has been proposed.…”

Section: Nailsmentioning

confidence: 99%

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

et al. 2019

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The ultimate goal of management of proximal humeral fractures in the elderly patient is to get the patient independently mobile. This article will review the current literature regarding this cohort of patient. Recent Cochrane reviews and a large multicentre randomised study question the role of surgical intervention. Implant design is evolving rapidly, and many elderly patients now behave more like the younger patient. There remains little compelling evidence to guide decision-making for the complex proximal humeral fracture in the elderly, and the decision needs to be made on a case-by-case basis taking into account the patient's comorbidities, the fracture pattern and characteristics, the attending surgeon's skill sets, and the availability of equipment.

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Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications

Lópiz

Garríguez-Pérez

Martínez-Illán

et al. 2020

Arch Orthop Trauma Surg

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Clinical outcomes and prognostic factors depending on implant design in the treatment of proximal humeral fractures: A retrospective study

Cited by 3 publications

References 30 publications

Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular

Alteración de mediciones radiográficas en osteosíntesis de húmero proximal con clavo centromedular

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications

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