How to treat stiffness after proximal humeral fractures?

Abstract

Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system. Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas. Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others. Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required. Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case.

Cyclic Stability of Locking Plate Augmented with Intramedullary Polymethyl Methacrylate (PMMA) Strut Fixation for Osteoporotic Humeral Fractures: A Biomechanical Study

“…This finding highlights the ability of the intramedullary PMMA strut to provide additional support within the medullary canal, thus decreasing the load on the locked screw and minimising the risk of humeral head varus and screw cut-out. Our results are consistent with previous biomechanical studies and support the potential clinical benefits of using PMMA struts in this context [17][18][19][20][21][22].…”

“…Few clinical reports exist on the results of locking plate fixation of proximal humeral fractures, and short-term functional outcomes and complications, such as humeral head varus collapse or intra-articular screw penetration have been variable in patients with osteoporosis [7][8][9]. In vitro studies indicated that these complications arise from locking plates without medial column support [10][11][12][13][14][15][16][17]. Biomechanical studies show that locking plates with intramedullary fibular allograft fixation can enhance the stability of the construct and reduce the humeral head migration compared to locking plate fixation alone [18][19][20][21][22][23].…”

Arthroscopic Assisted Versus Open Reduction and Internal Fixation of Greater Tuberosity Fractures of the Proximal Humerus

“…A review was conducted in PubMed, Embase, and Scopus databases to identify relevant studies reporting complication rates in surgically managed greater tuberosity fractures [2,[43][44][45][46][47][48][49][50][51][52]. Outcomes were variable between series, with heterogeneous reports and data, and limited studies with high level of evidence were obtained.…”

Factors influencing shoulder stiffness after open reduction and internal fixation of proximal humeral fractures

“…Shoulder stiffness is a frequent complication after proximal humeral fractures treated with surgery. [ 9 ] Accordingly, it is crucial to prevent shoulder stiffness in the treatment of proximal humeral fractures. Currently, there is no consensus on the diagnostic criteria for shoulder stiffness, which is often diagnosed based on limited active and passive movement of the shoulder, including forward flexion, lateral rotation, and posterior internal rotation.…”