Different treatments for 3- or 4-part proximal humeral fractures in the elderly patients: A Bayesian network meta-analysis of randomized controlled trials

Guo, Jiale; Peng, Caiju; Hu, Ziyan; Li, Yehai

doi:10.3389/fsurg.2022.978798

Cited by 3 publications

(2 citation statements)

References 39 publications

(20 reference statements)

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“…These age-related changes in MC may be responsible for the increased risk of proximal humeral fractures (PHFs) and higher fracture severity (1,4,6,7). Furthermore, incompetent MC, i.e., fragile with impaired strength, due to advanced age is also associated with a higher risk of fracture complications (8)(9)(10)(11)(12). Conversely, elderly patients with severe osteopenia treated with integrity restoration of MC could achieve a satisfactory prognosis, similar to that of younger patients (13-16).…”

Section: Introductionmentioning

confidence: 99%

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population

Chang

Zhu²,

Zhang³

et al. 2023

Front. Surg.

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BackgroundAge-related changes in the medial column (MC) of the proximal humerus have a major impact on fracture management; however, the changes in the morphological features remain unclear. This study aimed to investigate the age-related changes in the morphological features of MC and present the morphological grading.MethodsOne hundred computed tomography (CT) images of the proximal humerus of 100 individuals (19–95 years) were retrospectively obtained. The individuals were categorized into five age groups to quantify the differences among different ages; the youngest group (18–44 years) served as the baseline group. Parameters of the morphological features were measured on CT images with multiplanar reconstruction based on an explicit definition of MC, including length, thickness, width, oblique thickness (DSM), humeral head diameter (DHM), and ratio (RSM) of DSM to DHM. The morphological grading of MC was presented based on the value of RSM deviating different standard deviations (SD) from the mean value in the baseline group.ResultsSignificant negative correlations were observed between age and the morphological parameters of MC (r ranged from −0.875 to −0.926; all P < 0.05), excluding DHM (r = 0.081, P = 0.422). Significant differences in the values of morphological feature parameters were detected among the five age groups (all P < 0.001). The highest mean values of morphological feature parameters were observed in the youngest group (18–44 years), which decreased gradually with increasing age until the lowest mean values were observed in the oldest group (≥90 years) (all P < 0.05). The morphological features of MC were categorized into three grades based on the value of RSM deviating 1.5 SD or 3 SD from the mean value in the baseline group.ConclusionOur study shows that the parameter values of morphological features of MC decreased with increasing age. The morphological features of MC could be categorized into three grades. Our findings may provide a more comprehensive insight into age-related changes in the morphological features of MC that facilitate risk stratification and optimize the management of proximal humeral fractures.

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Section: Introductionmentioning

confidence: 99%

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population

Chang

Zhu²,

Zhang³

et al. 2023

Front. Surg.

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“…1,4 While most PHFs are minimally displaced or nondisplaced, for which conservative management is usually recommended, 1,5 controversy exists regarding optimal management of displaced and comminuted PHF. 6,7 There are a number of fixation techniques, such as tension-band routing, locking plate fixation, and intramedullary nailing over the past decade [8][9][10][11][12][13][14] ; however, no single technique demonstrated evidence-based superiority. Although locking plate fixation is considered as the standard treatment, complication rates are still unsatisfactory.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

2022

Orthopaedic Surgery

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ObjectiveRestoration of the medial support is especially important for the treatment of proximal humeral fractures. The objective of this study was to investigate the radiographic and clinical outcomes of intramedullary nail fixation with a special focus on the presence of calcar comminution.MethodsIn this retrospective study of patients with displaced proximal humeral fractures that were treated by intramedullary nail between January 2018 and July 2021, fracture morphology and the calcar integrity were noted on preoperative radiographs. Patients were divided into two groups according to calcar integrity. During follow‐up, radiological assessment and functional outcome, including the deltoid tuberosity index (DTI), neck shaft angle (NSA), visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, active and passive range of motion, were performed. A Student t‐test and univariate logistic regression analysis was used.ResultsA total of 83 patients (54 female, 29 male) had complete follow‐up (average, 12.8 months; range, 10 to 33 months) and functional assessment in our study. The average age was 58.6 years (range, 20 to 89 years). The mean loss of NSA was 4° (range, 0°–12°) and no significant difference was found between two groups (p = 0.27). DTI had an average of 1.50 ± 0.19 (range 1.13–2.04). Patients with intact calcar achieved greater range of forward elevation (129.06 ± 11.91 vs. 121.05 ± 11.97, p = 0.01), and higher SST scores (8.61 ± 1.85 vs. 7.37 ± 2.22, p = 0.02). Two groups showed similar outcomes in VAS, ASES score, and range of abduction. One patient demonstrated a proximal interlocking screw cutting through and osteonecrosis of the humeral head, who underwent a second surgery for screw removal. There were no cases of infection, malunion, nonunion, nerve injury, subacromial impingement, or rotator cuff tear during the study period.ConclusionIntramedullary nail can favorably be used to manage proximal humeral fractures with good early radiographic and functional outcomes, even for those with comminuted calcar.

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Postoperative outcomes of third-generation shoulder hemiarthroplasties for three-and four-part proximal humeral fractures: A systematic review of published studies from 2012 to 2022

Anazor,

Relwani,

Dhinsa

2024

Journal of Clinical Orthopaedics and Trauma

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Different treatments for 3- or 4-part proximal humeral fractures in the elderly patients: A Bayesian network meta-analysis of randomized controlled trials

Cited by 3 publications

References 39 publications

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population

Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

Postoperative outcomes of third-generation shoulder hemiarthroplasties for three-and four-part proximal humeral fractures: A systematic review of published studies from 2012 to 2022

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