Factors that Influence Reduction Loss in Proximal Humerus Fracture Surgery

Jung, Sung-Weon; Shim, Seung Bo; Kim, Hyoung-Min; Lee, Jiheon; Lim, Hae-Seong

doi:10.1097/bot.0000000000000252

Cited by 119 publications

(88 citation statements)

References 25 publications

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“…Medial support was proven to be an important factor for a good functional outcome in other studies 13, 19. Jung et al reported only 1% patients had loss of reduction with adequate medial support in their serials 13 . In this study, the authors held a low threshold for structural allograft augmentation.…”

Section: Discussionmentioning

confidence: 53%

“…Therefore, calcar screws were routinely placed closed to inferior cortex of humeral head in our practice. Medial support was proven to be an important factor for a good functional outcome in other studies 13, 19. Jung et al reported only 1% patients had loss of reduction with adequate medial support in their serials 13 .…”

Section: Discussionmentioning

confidence: 94%

“…Reported negative predictors of loss reduction after plating include osteoporosis, displaced varus fracture, medial comminution fragment, insufficient medial support and inadequacy of reduction 13 . Among them, to restore medial support was the most important factors for maintenance of fracture reduction 19 .…”

Section: Discussionmentioning

confidence: 99%

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The elderly have similar outcomes compared to younger patients after ORIF with locking plate for comminuted proximal humerus fracture

Chang

2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to compare clinical and radiological outcomes of elder and younger patients with comminuted proximal humerus fracture treated with osteosynthesis with locking plate.MethodsA total of 70 patients (30 males and 40 females; mean age 65.4 years) operated on for Neer 3- or 4-part proximal humeral fractures between 2010 and 2016 and followed for at least one-year were included in the study. The reduction was achieved through intraosseous window to minimize soft tissue stripping in all patients and structural allograft at metaphyseal diaphyseal junction was used aggressively to resist varus force. Group 1 consisted of 32 patients aged 70 or older (14 males and 18 females; mean age: 77.8 ± 5.1), while Group 2 consisted of 38 patients younger than 70 (16 males and 22 females; mean age: 58.2 ± 9.3). The groups were compared for their clinical and radiological outcomes.ResultsThere was no significant difference in clinical outcomes by Oxford score (54.8 ± 2.7 vs 56.6 ± 3.4, p = 0.13) and ASES score (89.7 ± 5.7 vs 90.8 ± 8.2, p = 0.68). Two groups had similar radiological outcomes regarding neck shaft angle, greater tip height and offset. However, group 2 had better final shoulder forward elevation (162.6 ± 8.7 vs 135.4 ± 14.7ß, p < 0.05) and shorter duration to achieve maximal range of motion (4.37 ± 2.37 vs 8.14 ± 3.25 months, p < 0.05) than group 1. Two groups had similar complication rates (9.4% vs 7.9%). All the complications were related to greater tuberosity including mal-reduction and avulsion.ConclusionWith the prerequisite of good alignment with robust medial cortical support and untouched soft tissue over medial metaphysis area via intra-osseous reduction, comminution of proximal humeral fracture can achieve satisfactory result and low complication rate by osteosynthesis with locking plate system, regardless of age. In addition, we suggested to use structural bone graft for comminuted medial cortex fracture with multiple fragments or bony defect more than 2 cm.Level of evidenceLevel III Therapeutic study.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 94%

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The elderly have similar outcomes compared to younger patients after ORIF with locking plate for comminuted proximal humerus fracture

Chang

2019

Acta Orthopaedica et Traumatologica Turcica

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“…Many studies have considered that medial support in proximal humerus fracture surgery is crucial to avoid reduction loss and varus displacement. Jung et al [18] revealed that insu cient medial support was an independent risk factor for reduction loss in proximal humerus fractures (p < 0.01). Maier et al [19] also found that short or absent metaphyseal head extension and disruption of medial periosteal hinge reliably predict posttraumatic humeral head ischemia.…”

Section: Discussionmentioning

confidence: 99%

A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Wang

Wang²,

Dong

et al. 2020

Preprint

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Background and hypothesis: The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and Methods: An anatomical study was performed and an anatomical medial locking proximal humerus plate was designed based on the measurement results. Between November 2014 and April 2017, eight cases of proximal humerus fractures with unstable medial columns underwent medial fixation. All surgeries were performed by a single surgeon. Patients were followed clinically and radiographically at 1, 3, 6 and 12 months postoperatively.Results: There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10 degrees in any direction), screw cutout, nonunion, or deep infection occurred.Conclusions: The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.Level of evidence: Retrospective Study

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“…Several parameters, such as varus displacement or medial comminution, were significantly correlated with reduction loss [10, 42], but more specific parameters are needed to detect postoperative failures early.…”

Section: Discussionmentioning

confidence: 99%

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

Saul¹,

Himmelmann²,

Dresing³

2017

TOORTHJ

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Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS® plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.

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Factors that Influence Reduction Loss in Proximal Humerus Fracture Surgery

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 119 publications

References 25 publications

The elderly have similar outcomes compared to younger patients after ORIF with locking plate for comminuted proximal humerus fracture

The elderly have similar outcomes compared to younger patients after ORIF with locking plate for comminuted proximal humerus fracture

A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

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