New trends in fixation of proximal humeral fractures: A review

Karataglis, Dimitrios; Stavridis, Stavros I.; Petsatodis, George; Papadopoulos, Pericles; Christodoulou, Anastasios

doi:10.1016/j.injury.2010.10.016

Cited by 53 publications

(44 citation statements)

References 108 publications

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Section: Introductionmentioning

confidence: 99%

“…The deltopectoral approach requires extensive soft tissue dissection and muscle retraction to gain adequate exposure to the lateral aspect of the humerus [10,11,14,16,18-20]. This can cause further devascularization of fracture fragments during dissection and plating, leading to the disruption of critical blood supplies to the humeral head [10,18-20]. The deltoid splitting approach, which is an alternative method, provides good visualization of the posterolateral aspect of the shoulder without extensive soft tissue dissection or forcible retraction; however, there is an increased risk of injuring the axillar nerve as compared to the conventional deltopectoral approach [16,21,22].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, MIPO allows for the visualization of the axillary nerve [12,14,16,22]. Thus, MIPO is a safe and effective method for the treatment of proximal humerus fractures [14,19,20,22]. …”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Lin

Xiao

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or open reduction and internal fixation (ORIF) in patients with proximal humerus fractures.MethodsA matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score.ResultsThe MIPO technique required less surgery time and caused less blood loss compared to ORIF (p < 0.01). In addition, MIPO required a smaller incision, resulted in less scarring, and was cosmetically more appealing and acceptable to female patients than ORIF. Following MIPO, patients had better functional results at 3 and 6 months, with better outcomes, less pain, higher satisfaction in activities of daily living, and a higher range of motion when compared to ORIF (p < 0.05). Fracture configuration, according to the AO/ASIF(Association for the Study of Internal Fixation) fracture classification, did not significantly influence the functional results. The complication rate was comparable between both groups.ConclusionThe use of MIPO with a locking compression plate in the management of proximal humerus fractures is a safe and superior option compared to ORIF.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Lin

Xiao

et al. 2014

BMC Musculoskelet Disord

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“…Various modalities like percutaneous pinning, intra medullary nail, transosseous sutures, locking plate fixation and arthroplasty have been advocated for tratment of displaced proximal humerus fractures, which make up about 15-20% of the proximal humeral fractures. 2,3 According to Neer, displacement is defined as more than 1 cm of translation or more than 45 degrees of angulation between the fragments. 4 He classified these fractures according to the number of fragments, as two, three and four part fractures.…”

Section: Introductionmentioning

confidence: 99%

Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases

et al. 2018

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Background: The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.Methods: 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.Results: In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA <130 (p<0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.Conclusions: Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.

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“…Recently, several reports have been published on IM nail fixation techniques for proximal humerus fractures using devices that provide screw stabilization of the humeral head and tuberosity. They provide rigid fixation without extensive soft-tissue dissection 1213). In our patients, we applied an IM nailing technique, interlocking IM nailing with additional augmentation of the skeletal defect with bone cement, for pathological fractures of the proximal humerus.…”

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confidence: 99%

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

et al. 2016

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BackgroundEndoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes.MethodsWe reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes.ResultsThe mean follow-up period was 14.2 months. The mean Musculoskeletal Tumor Society functional score and Karnofsky performance status scale score were 27.7 and 75.6, respectively. Improvement of pain assessed using the visual analogue scale was 6.2 on average. Thirty-one patients (97%) experienced no pain after surgery. The mean ranges of forward flexion and abduction were 115° and 112.6°, respectively. All patients achieved stability and had no local recurrence without failure of fixation until the last follow-up.ConclusionsProximal interlocking IM nailing with cement augmentation appears to be a reliable treatment option for pathological or impending fractures of the proximal humerus in selected patients with metastatic tumors, even with extensive bone destruction.

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New trends in fixation of proximal humeral fractures: A review

Cited by 53 publications

References 108 publications

Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus

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