Fracture dislocations of the proximal humerus treated with open reduction and internal fixation: a systematic review

Miltenberg, Benjamin; Masood, Raisa; Katsiaunis, Apostolos; Moverman, Michael A.; Puzzitiello, Richard N.; Pagani, Nicholas R.; Menendez, Mariano E.; Salzler, Matthew J.; Drager, Justin

doi:10.1016/j.jse.2022.04.018

Cited by 9 publications

(7 citation statements)

References 35 publications

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“…In our cohort, we found two patients with avascular necrosis. This is comparable to values given in the literature, where the rate can go up to 20% for revision cases [ 46 ]. Combining the aforementioned cohorts (4/60 patients, 6.7%), it seems that double plating does not lead to an unusual high rate of avascular necrosis.…”

Section: Discussionsupporting

confidence: 89%

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Michel

Raschke

Katthagen

et al. 2023

JCM

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Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. The mean age was 59.5 ± 12 years and the leading fracture type was a varus dislocation (Resch type IV in 55.3%). A head-split was present in 22.9% of the cases. The primary outcome measurement was the radiological neck shaft angle (NSA). The radiological follow-up was 21 ± 16.6 months and the NSA did not differ between the intraoperative and follow-up time point (131.5 ± 6.9° vs. 136.6 ± 13.7°; p = 0.267). The clinical follow-up was 29.5 ± 15.3 months. The Constant-score was 78.5 ± 17 points, the simple-shoulder-test (SST) was 9.3 ± 3.2 points and the subjective shoulder value (SSV) was 78.8 ± 19.5%. The over-all complication rate was 31.4%, and without stiffness 14.3%. An avascular necrosis occurred in two patients (5.7%). In conclusion, this study shows good radiological and functional outcomes after double plating of highly complex proximal humeral fractures, while the complication rate is comparable to the literature. Double plating is a viable option especially for younger patients with complex fractures as a potential alternative to fracture arthroplasty.

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Section: Discussionsupporting

confidence: 89%

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Michel

Raschke

Katthagen

et al. 2023

JCM

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“…Open reduction and internal fixation in cases of dislocation fracture are part of the therapeutic arsenal. However, Miltenberg et al found a 20% rate of aseptic osteonecrosis of the humeral head and a 35.6% rate of reoperation in a systematic review of 294 dislocation fractures treated by open reduction and internal fixation at a follow-up of 2.9 years 11 . Fraser et al, in a randomized controlled trial, showed the superiority of RTSA over plate fixation for proximal humerus fractures in the elderly at 2 years, with a Constant score of 68 points in the RTSA group vs. 54 in the plate fixation group 12 .…”

Section: Discussionmentioning

confidence: 99%

“Champagne Fracture”: A Superior Fracture-Dislocation of the Proximal Humerus

Bozon

D'Allais

Barret

et al. 2023

JBJS Case Connector

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A 79-year-old right-handed woman presented with an indirect trauma to her left shoulder after a fall down the stairs. X-rays and computed tomography showed a four-part glenohumeral fracture-dislocation with a subcutaneous ectopic location of the humeral head in the retroclavicular space. A reverse total shoulder arthroplasty was performed using a deltopectoral approach with direct superior extraction of the humeral head. The result at 2 years was a subjective shoulder value of 80%, an absolute Constant score of 59, and a relative Constant score of 92/100. To the best of our knowledge, this is the first description in the literature of such a lesion of superior glenohumeral fracture-dislocation and its treatment. Shoulder dislocations are very common injuries in the general population, affecting 23.9 people per 100,000 inhabitants per year in the United States 1 . Shoulder fracture-dislocation are rarer lesion entities than simple dislocations 2 . In regard to the direction of dislocation, anterior dislocations are the most common (72% of cases), followed by posterior dislocation 3 . Some uncommon dislocations were also published, with erect dislocations being a classic example. They represent inferior dislocations of the humeral head, typically resulting from injuries in a hyperabducted position 4 . Rare cases of intrathoracic 5 , superior 6 , or even retroperitoneal 7 dislocations have been reported.A patient was treated for a four-part glenohumeral fracturedislocation with a subcutaneous ectopic location of the humeral head in the retroclavicular space. After a collegial decision by the traumatological team, a reverse total shoulder arthroplasty was performed. The objective of this case report was to present the clinical and radiographic outcomes of the case at 2 years after the procedure.The medical information was anonymized, and the patient's consent for the use of this data was obtained.

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“…Although reoperation rates varied, the mean rate was 35.6%, including a 10.7% rate of conversion to arthroplasty. Thus, surgeons should counsel patients with regard to the high likelihood of secondary intervention following ORIF 4 .…”

Section: Proximal Humerusmentioning

confidence: 99%