Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation

Padegimas, Eric M.; Chang, Gerard; Namjouyan, Kamran; Namdari, Surena

doi:10.1016/j.jse.2019.06.014

Cited by 26 publications

(29 citation statements)

References 20 publications

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“…When using internal fixation with a plate in the proximal humerus fracture, there have been reports of clinically poor outcomes with functional loss due to cut-through or cut-out of screws in the proximal head articular side. 12 In particular, when mechanical complications such as cut-out of screws occurred in the humeral head articular cartilage area, poor prognosis could be expected. In the absence of medial support, it was assumed to be vulnerable to varus deformity owing to a lack of inner support.…”

Section: Discussionmentioning

confidence: 99%

“…The inferomedial supporting screw is known to strengthen the medial cortex support, and it may play an important role in osteoporotic fractures with comminution. 12 However, no reports exist on how inferomedial supporting screws reduce stress in the GT area. Although the role of inferomedial supporting screws can be inferred from previous studies, our reports suggest that it is necessary to apply inferomedial supporting screws for 3-part fractures to reduce the stress on the GT fracture sites and increase the bone union of GT.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Studies have shown that placing inferomedial support locking screws is an important technique, particularly in patients with medial comminution, which was common in osteoporotic fracture. 10 - 12 …”

Section: Introductionmentioning

confidence: 99%

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Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis

Kim

Lee²,

Choi³

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Importance of inferomedial supporting screws in preventing varus collapse has been investigated for the proximal humerus fracture. However, few studies reported the results of osteoporotic complex fracture. This study aimed to demonstrate the stress distribution pattern, particularly in osteoporotic 3-part proximal humerus fractures involving greater tuberosity (GT) with different screw configurations. Materials and methods: Using the computed tomography (CT) images of 2 patients, who had osteoporosis and the other had normal bone density, 3-part fractures involving the GT, without medial support were reconstructed. To reflect the osteoporosis or real bone density, Hounsfield unit of CT scans were utilized. A force of 200 N was applied in 30° varus direction. The proximal screws were set in 2 ways: 6 screws without inferomedial supporting screws and 9 screws with inferomedial supporting screws. Qualitative and quantitative analysis of internal stress distribution were performed. Results: The most proximal part area near humeral head vertex and near the 1st screw’s passage and tip had more stress concentrated in osteoporotic 3-part fractures. The stress distribution around the proximal screws was found near the GT fracture line and its lateral side, where the local max values located. Inferomedial supporting screws decreased these effects by changing the points to medial side from the GT. The ratio in osteoporotic bone model decreased to that in normal bone model when inferomedial supporting screws were applied (normal bone, 2.97%–1.30%; osteoporosis bone, 4.76%–1.71%). Conclusions: In osteoporotic 3-part proximal humerus fracture, the stress distribution was concentrated on the area near the humeral vertex, 1st row screw tips, and lateral side region from the GT fracture line. Moreover, inferomedial supporting screws ensured that the stress distribution is similar to that in normal bone setting, particularly in osteoporotic condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis

Kim

Lee²,

Choi³

et al. 2020

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…Restoration of medial hinge is mandatory to prevent varus collapse: a neck shaft angle reduction typically occurs during the first three months after surgery, with a mean loss of 3.8-4.9° 95,96 , leading, in predisposed cases, to varus collapse. Factors associated with varus collapse are: presence of proximal screw cross-threading, initial calcar disruption, and a lack of reduction of calcar support 97 .…”

Section: Varus Collapsementioning

confidence: 99%

Plate osteosynthesis of proximal humerus fractures: treatment options and technical advancements

et al. 2021

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“… 1 - 3 The majority of 2-part PHFs involve medial support (calcar) disruption, which is associated with an increased risk of loss of reduction or varus collapse. 4 - 6 Treatment of PHFs with proximal humeral internal locking system (PHILOS) plates is becoming increasingly common in China. 5 However, the efficacy of treating 2-part PHFs with calcar comminution in patients >60 years old with severe osteoporosis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Cheng

Dong

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction To date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely. Materials and Methods One hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications. Results Median follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain. Conclusion For elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

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Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation

Cited by 26 publications

References 20 publications

Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis

Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis

Plate osteosynthesis of proximal humerus fractures: treatment options and technical advancements

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

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