Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis

Campochiaro, Gabriele; Rebuzzi, Manuela; Baudi, Paolo; Catani, Fabio

doi:10.1007/s12306-015-0358-z

Cited by 40 publications

(30 citation statements)

References 24 publications

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“…In the wake of this, Hertel et al went on to identify risk factors of osteonecrosis including (1) short medial calcar extension (< 8 mm), (2) disrupted periosteal hinge, and (3) anatomic neck fracture [48]. A later interrogation of these factors showed that while one risk factor does not increase the risk, all three factors, and more importantly a poor reduction were linked to the risk of osteonecrosis, but this complication only occurred in 3.7% of patients [49]. While osteonecrosis may occur after a proximal humerus fracture, contemporary studies show the reported rate in nonoperative treatments is 2% overall [21], and only 7.9% in operatively treated 3-and 4-part factures [42].…”

Section: Hemiarthroplastymentioning

confidence: 99%

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Kelly

Myeroff

2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this review is to examine trends, outcomes, and principles in treatment of proximal humerus fractures in the elderly with a critical focus on reverse shoulder arthroplasty as a developing treatment option. Recent Findings Recent literature shows an increase in reverse shoulder arthroplasty and a decrease in hemiarthroplasty performed for proximal humerus fractures. More predictable outcomes and lower revision rates are seen in older individuals treated primarily or secondarily with reverse shoulder arthroplasty compared to those treated with hemiarthroplasty. Summary We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old).

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Section: Hemiarthroplastymentioning

confidence: 99%

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Kelly

Myeroff

2020

Curr Rev Musculoskelet Med

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“…In this particular case the combination of a small calcar beak (<8 mm), a destroyed medial hinge and a displaced fracture of the anatomical neck predicts an extremely heightened (97%) risk rate for an avascular necrosis of the humeral head [11]. His criteria are important for surgical planning, especially in combination with a CT. On the other hand actual studies show Hertels criteria considered alone cannot sufficiently predict a humeral head necrosis [12]. At the end the individual variability of vascular perfusion still considerably limits the ability to make a preoperative prognosis concerning the risk of head necrosis after a fracture and subsequent to osteosynthesis [13].…”

Section: Discussionmentioning

confidence: 99%

Multifragmentary dislocated humeral head fracture—A case report of a successful head preserving treatment strategy despite delayed presentation

Bungartz

Matziolis

Rohe

et al. 2016

International Journal of Surgery Case Reports

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HighlightsCase report of multifragmentary and luxated humeral head fracture treated headpreserving despite delayed surgery (120 h).“Avoiding arthroplasty inspite of extrmely high risk of avascular necrosis due to compromised blood supply in luxation oft he humeral head.The headpreserving treatment showed excellent functional and radiologic results keeping a high “quality of life level”.Divergent from the recommended standard−treatment (trauma arthroplasty) of luxated humeral headsplit fractures in a “delayed situation” a head preserving option should be taken into consideration.

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“…1, 20,21,26 La complicación más frecuente que reportamos fue la NAV, principalmente en Neer grado III/IV y con edad avanzada. A pesar de existir amplios estudios que indican los factores de riesgos vascular, dentro de los cuales se indica la severidad de la fractura, 27 Beck y colaboradores indican que existe una asociación de la NAV con la manipulación por el procedimiento quirúrgico, independiente del grado de severidad de la fractura, ya que altera la vascularidad residual por la manipulación. 12 En cuanto a otras complicaciones, como la consolidación viciosa, aflojamiento y pérdida de la reducción, nuestros resultados se encuentran dentro de parámetros similares a la serie de Wong.…”

Section: Wwwmedigraphicorgmxunclassified

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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Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis

Abstract: Hertel's criteria are important in the surgical planning, but they are not sufficient: an accurate evaluation of the calcar area fracture in three planes is required. All fractures involving calcar area should be studied with CT.

Cited by 40 publications

References 24 publications

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Multifragmentary dislocated humeral head fracture—A case report of a successful head preserving treatment strategy despite delayed presentation

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

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