Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception

Calvo, Emílio; Morcillo, Diana; Foruria, Antonio M.; Redondo-Santamaría, Enrique; Osorio-Picorne, Fernando; Caeiro, José Ramón

doi:10.1016/j.jse.2010.09.008

Cited by 107 publications

(68 citation statements)

References 31 publications

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“…This was a time-zero in vitro biomechanical model, which does not reflect the biological healing that occurs in vivo. Due to the increasing incidence of unstable proximal humeral fractures in elderly patients [22], osteoporotic humeri were used for this study. Therefore, comparable supportive characteristics of the PAP in younger humeri with potential higher BMD and stronger subchondral bone substance can only be assumed.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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Purpose Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this Bproximal anchoring point^(PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Methods Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Results Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20°abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). Conclusions The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the Bproximal anchoring point's^rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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“…Sixteen studies remained 207,[216][217][218][219][220][221][222][223][224][225][226][227][228][229][230] (summarised in 207,216,217,220,222,226,227,229,230 and two for shoulder fractures. 217,220 Of these, two studies used non-UK utility values 216,217 and two were of very specific patient cohorts, 217,218 making the results of these studies less relevant to the general population at risk of fragility fracture.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

“…217,220 Of these, two studies used non-UK utility values 216,217 and two were of very specific patient cohorts, 217,218 making the results of these studies less relevant to the general population at risk of fragility fracture. Cooper et al 218 focused on women with inadequate response to therapy and Ekström et al 219 focused on patients with subtrochanteric hip fractures only.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

Davis

James

Sanderson

et al. 2018

Health Technol Assess

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During the course of providing additional analyses for the National Institute for Health and Care Excellence Technology Appraisal Committee, two errors were identified in the data entered in the network meta-analysis that informed the cost-effectiveness analysis described in the original report. This corrigendum notice describes the errors identified and the impact of correcting these errors on the main analyses presented in the original report.

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“…Fractures of the proximal humerus are among the most common fractures encountered in clinical practice, particularly in patients with osteoporosis [3,2,9]. Classic teaching mandates that these injuries undergo a thorough and appropriate plain radiographic evaluation by means of the shoulder trauma series.…”

Section: Introductionmentioning

confidence: 99%

The Axillary View Typically Does Not Contribute to Decision Making in Care for Proximal Humeral Fractures

Berkes

Dines

Birnbaum

et al. 2015

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Convention dictates that an axillary view be obtained when evaluating proximal humerus fractures (PHF). However, the axillary view is frequently omitted because of pain and technical considerations. Furthermore, its diagnostic utility is unclear in this setting. Questions/Purposes: The purpose of this study was to (1) determine the rate of obtaining an adequate axillary X-ray and complete shoulder series at a level I trauma center, (2) understand the cost of ordering and attempting an axillary radiograph, and (3) determine if axillary radiographs influence the management of PHF. Patients and Methods: PHF treated between 2009 and 2011 that were ordered for an AP, scapular Y, and axillary view was identified. The types of radiographs actually obtained were recorded. The cost of obtaining three views and a single view of the shoulder with X-ray was determined. Lastly, three surgeons reviewed 42 PHF, both with and without an axillary view (AV), and treatment recommendations were compared. Results: 30% of PHF in this series had an adequate axillary view, and 14% received a complete trauma series. No factors could be identified that were associated with successfully obtaining an axillary view. Reviewers demonstrated substantial intraobserver reliability (κ=0.759-0.808) regarding treatment recommendations for PHF with and without the axillary view. The addition of the AV had minimal influence on treatment recommendations. Conclusion: Considering that the axillary view for PHF is painful, labor-intensive, costly, and does not appear to provide additional diagnostic value, orthopedic surgeons can consider foregoing the use of the axillary view when evaluating and treating PHF, particularly if other advanced imaging is utilized.

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Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception

Cited by 107 publications

References 31 publications

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

The Axillary View Typically Does Not Contribute to Decision Making in Care for Proximal Humeral Fractures

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