Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head

Resch, Herbert; Hübner, Clemens; Schwaiger, R.

doi:10.1016/s0020-1383(01)00058-4

Cited by 128 publications

(91 citation statements)

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“…All patients had informed and written consent obtained for the purpose of the study. The patients were informed about the benefits of external fixation and stabilization which included less invasiveness of the surgical procedure, minimal or less soft tissue dissection and almost no soft tissue stripping and the possible complications of external fixation which included loss of fracture reduction requiring more extensive surgery, pins migration and pin-tract infection; discomfort due to external fixator during the course of treatment [5,8,[16][17][18][19][20][21][22][23]. The present study was approved by ethical committee of institution.…”

Section: Methodsmentioning

confidence: 99%

“…There are very few reported studies in literature regarding external fixation of displaced proximal humeral fractures [5,[16][17][18][19][20][21][22][23]. Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Compared with open reduction and osteo-synthesis, external fixation techniques for displaced proximal humeral fractures avoid dissection and stripping of the soft tissues, leads to higher union rates, has a lower incidence of avascular necrosis, prevention of normal scapula humeral relation at its border and speedy rehabilitation [16,17]. There are however, conflicting reports from different studies regarding use of external fixation as treatment modality for displaced proximal humeral fractures [5,[17][18][19][20][21][22][23]. Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies in literature reports good or excellent results and less complication compared with open techniques [20][21][22][23], whereas some other studies reports state that external fixation and stabilization of proximal humeral fractures is technically demanding and can be used for two part 2-part proximal humeral fractures. External fixation also might lead to acceptance of less than optimal reduction as far as fracture stability is concerned, especially in elderly population with poor bone stock (osteoporosis) [5,[17][18][19]. In our study we aimed to analyse the results of closed reduction and external fixation for displaced three or four part fractures involving humeral head and associated with dislocated humeral head.…”

Section: Introductionmentioning

confidence: 99%

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Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

Nikose¹

2016

MOJOR

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Background: The complex fractures of the proximal humerus remain dilemmas far as treatment is concerned. Although better-quality techniques of internal fixation and prosthetic replacement are introduced effectively in the field of operative fracture care, management of complex fractures of the proximal humerus for head preserving modalities in injuries involving the humeral head remains to be a major factor concerning the trauma surgeon. Materials & Methods:Thirty nine patients with complex three or four part proximal fracture of humerus with dislocation of humeral head were treated and analyzed for results of percutaneous reduction and external fixation. All Patients were subjected to careful closed reduction under general anesthesia with optimal relaxation and fluoroscopic control followed by percutaneous external fixation of proximal humerus in optimal position. The patients were evaluated clinically and radiologically for a period till union or 10 months, whichever was earlier.One patient had an incomplete brachial plexus injury, which was yet to recover completely at the end of last follow up 10 months, with acceptable hand, elbow and shoulder function.Results: Percutaneous reduction & external fixation to treat complex fractures of the proximal humerus produces good results, if correct re-position and biological principles are respected. Most of the patients were pain-free and the shoulders functioned well despite the severity of shoulder injury. Conclusions:Percutaneous reduction and external fixation is a reasonable and logical approach to treat complex proximal humeral head fractures, rather than conservative treatment and before hemi-arthroplasty by prosthesis is considered, in view of the acceptable results obtained. Our study shows that complex fractures of the proximal humerus should be treated initially by head preserving procedures. The probable revascularization of the humeral head occurs by creeping substitution as the shoulder is non weight bearing joint.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

Nikose¹

2016

MOJOR

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“…Initially, the technique was applied to the management of two-part surgical neck fractures [7] where it was as successful as open methods. More recently, closed reduction and percutaneous fixation with pins and cannulated screws has been applied to the management of three-and even four-part proximal humerus fractures [8,9,10]. Although these approaches to more complex fractures are challenging, vascularity of the humeral head seems to be more reliably preserved than in open treatments that require soft-tissue dissection to place rigid fixation implants [11].…”

Section: Introduction:-mentioning

confidence: 99%

Percutaneous K-Wire Fixation for a Comminuted Proximal Humerus Fracture – A Case Report.

Khan¹,

Kumar²,

Haidry³

et al. 2017

IJAR

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Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

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Suture anchors and screws are commonly used for fixation of humeral greater tuberosity (GT) fractures in either arthroscopic or open surgeries, but no biomechanical studies have been performed to compare the strength of fixation constructs using these two implants. This cadaveric study aimed to compare the biomechanical strength of three different fixation constructs in the management of GT fractures: Double-Row Suture Anchor Fixation (DR); Suture-Bridge Technique using suture anchors and knotless suture anchors (SB); and Two-Screw Fixation (TS). The experimental procedure was designed to assess fracture displacement after cyclic loading, failure load, and failure mode of the fixation construct. Significant differences were found among the SB (321 N), DR (263 N), and TS (187 N) groups (SB > DR > TS, p < 0.05) in the mean force of cyclic loading to create 3 mm displacement. Regarding the mean force of cyclic loading to create 5 mm displacement and ultimate failure load, no significant difference was found between the DR (370 N, 480 N) and SB (399 N, 493 N) groups, but both groups achieved superior results compared with the TS group (249 N, 340 N) (p < 0.05). The results suggested that the suture anchor constructs would be stronger than the fixation construct using screws for the humeral GT fracture. Keywords: humeral greater tuberosity fracture; suture anchor; screw; double-row fixation; biomechanics Isolated greater tuberosity (GT) fractures of the humerus are common. The rate of incidence is $17% to 21% among proximal humeral fractures.1 GT fractures often occur in anterior shoulder dislocation or as the result of an impaction injury. Although the amount of displacement requiring operative reduction and fixation is disputed, the consequences of an untreated malunited GT fracture can be pain and limited motion.2 Current literature recommends surgical intervention in cases with >5 mm of displacement in the general population or >3 mm of displacement in active patients. 1,[3][4][5] Open surgeries or percutaneous techniques with the aid of fluoroscopy using suture anchors or screws are well accepted for the reduction and fixation of GT fractures. 1,6,7 However, the techniques continue to evolve, particularly minimally invasive and arthroscopic techniques that have the advantages of minimizing skin incision, soft tissue dissection, and associated morbidities. 8,9 The materials used for arthroscopic fixation include suture anchors 9-13 or percutaneous screws.14,15 Although both implants are commonly used for fixation in GT fractures, mechanical stability remains a major concern for early postoperative mobilization and optimal functional results. No biomechanical studies have been performed to compare the strength of fixation constructs using suture anchors or screws. Therefore, our purpose was to analyze the strength of three different fixation constructs, using suture anchors or screws, for the management of GT fractures. We hypothesized that the suture anchor configurations would provide more biomechanica...

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Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head

Cited by 128 publications

References 0 publications

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

Percutaneous K-Wire Fixation for a Comminuted Proximal Humerus Fracture – A Case Report.

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

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