Mıd_term follow-up evaluation of plate osteosynthesis and hemiartroplasty results in multi-part fractures of teh proximal humerus

Çelik, Cem; Gümüştaş, Seyit Ali; Çeçen, Gültekin Sıtkı; Bulut, Güven; Bekler, Halil

doi:10.5505/tjtes.2016.90402

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Some trials comparing plates to nonoperative treatment in 3- and 4-part fractures have shown no difference in outcome, 55 and several studies have shown no difference between locking plates and hemiarthroplasty (HA). 56 , 57 When plating complex fractures, suture fixation of the tuberosities and medial augmentation with cement, bone graft, and calcar screws is suggested ( Figure 6 ). Fractures with valgus impaction have better outcomes than patients with varus impaction in both 3-and 4-part fractures, 58 - 60 so attention to medial support is important.…”

Section: Managementmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

140

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Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

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Section: Managementmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

140

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“…[27][28][29] Locked head screw holes in proximal part in different orientation for angular stability, increasing buttressing and provide high pull out strength. 27,30,31 LCP combiholes for the choice of two fixation techniques in one implant.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

Nishad

Shakeeb²,

Gijo³

2020

Int J Res Orthop

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Background: Proximal humerus fractures (PHFs) are common upper extremity fractures representing break in humerus bone. Incidences of PHFs increased in last few years due to life style changes and increased road accidents. Appropriate management strategy for PHFs is still uncertain. The aim of current study is to assess the functional outcome following open reduction and internal fixation of proximal humerus fractures using locking compression plates.Methods: Current study is a descriptive investigation conducted on 31 PHFs patients admitted to baby memorial hospital, calicut, between January 2013 to June 2014. Surgical management of PHFs was done by open reduction and internal fixation using locking compression plates and functional outcomes and complications of the employed treatment modality were investigated.Results: PHFs were observed to be common in 41-60 years age group, with 65% males being affected. Road accidents and domestic falls were observed to be the most common causes of PHFs in younger and elderly populations respectively. Three parts PHFs were observed to be more prevalent, followed by two and four parts fractures. Results of current study revealed that majority of PHFs united by 8-10 weeks duration with 22.58% cases with excellent and 41.93%, 16.12% and 19.35% cases with good, moderate and poor constant and Murley score respectively. Two patients reported post-operative complication of shoulder stiffness, while one patient each reported plate impingement, varus maluion, infection and varus malunion with intraarticular screw cut-out. Conclusions: Locking compression plates (PHILOS/PHLP) is an efficient treatment modality for proximal humerus fractures allowing early mobilization and good functional outcome.

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Is arthroplasty necessary for three and four-part proximal humerus fractures in elderly?

2022

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Background/Aim: Proximal humerus fractures are common in elderly patients. Treatment of three and four-part fractures is especially controversial in these patients. In recent years, surgical options have been widely used, especially among shoulder surgeons. The purpose of this study was to compare clinical results of conservative and arthroplasty methods. Methods: Between 2016 and 2020, 30 patients who were treated for Neer type 3 and type 4 proximal humeral fractures were included in the study. Patient data were evaluated retrospectively and then divided into three groups. Group 1 was treated conservatively, group 2 underwent hemiarthroplasty; and group 3 underwent reverse total shoulder arthroplasty. CONSTANT and visual analog scale (VAS) scores and radiological results at six months were evaluated retrospectively from patient records. At the last control they have been evaluated with CONSTANT, University of California/Los Angeles. (UCLA), and VAS scores. Results: Twenty-three (76.7%) of the patients included in the study were females. The mean age was 73.5 (5.7) years. The mean follow-up period was 33 (2.5) months. The mean follow-up periods in groups 1–3 were 33.3 (2.9), 32.8 (2), and 32.2 (2.9) months, respectively. When the CONSTANT scores of the patients were compared at the sixth month, they were observed to be better in the reverse total shoulder arthroplasty group (P = 0.001). Final control CONSTANT scores in the hemiarthroplasty group were lower than in the other groups (P = 0.001) and similar in the reverse shoulder prosthesis and conservative treatment group (P = 1). When the UCLA scores of all groups were compared, the mean UCLA scores were found to be significantly higher in groups 1 and 3 compared to group 2 (P = 0.001). When the VAS scores of the patients were compared, a significant difference between all groups was detected (P < 0.05). The highest VAS scores were observed in group 2, the second highest in group 1, and the lowest in group 3. Conclusion: For treatment of proximal humerus fractures in the elderly, patients should be evaluated according to activity levels and expectations, and surgical treatment should be suggested rather than ordered.

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Mıd_term follow-up evaluation of plate osteosynthesis and hemiartroplasty results in multi-part fractures of teh proximal humerus

Cited by 4 publications

References 18 publications

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

Is arthroplasty necessary for three and four-part proximal humerus fractures in elderly?

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