Open Reduction and Internal Fixation with a Locking Plate Via Deltopectoral Approach for the Treatment of Three and Four-Part and Proximal Humeral Fractures

Thompson, Jonathan Heath; Attum, Basem; Rodriguez-Buitrago, Andres; Yusi, Kurt; Cereijo, Cesar; Obremskey, William T.

doi:10.2106/jbjs.st.18.00003

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…Humeral head AVN has been reported in up to 33% of patients, and late surgery (>48 h) appears to be an important prognostic factor for ischemia [ 27 ]. However, while a history of dislocation associated with a proximal humerus fracture could be expected to lead to osteonecrosis from capsular injury and direct vascular damage, this is not fully supported in the literature [ 8 , 26 , 28 , 29 , 30 , 31 ]. Interestingly and antagonistically, Neviaser et al [ 29 ], in a series of 34 patients treated with open reduction and internal fixation of fractures of the proximal humerus, showed that the posteromedial hinge length was not an accurate parameter to predict the risk of osteonecrosis of the humeral head, although it has been shown to be useful for surgical planning, especially as it involves an important support region (calcar) for internal fixation, greatly reducing the incidence of cut-out and/or cut-through [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Tullio

Giordano²,

Belangero³

et al. 2022

Medicina

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Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are based solely on the use of radiographs, which can make interpretation extremely difficult due to several reasons, such as the overlapping fragments, severity of the injury, and noncompliant acute pain patients. The objectives of the study were to evaluate the role of computed tomography (CT) in the interpretation of the Hertel criteria and to evaluate the intra- and interobserver agreement of orthopedic surgeons, comparing their area of expertise. Materials and Methods: The radiographs and CT scans of 20 skeletally mature patients who had fractures of the proximal humerus were converted to jpeg and mov, respectively. All images were evaluated by eight orthopedic surgeons (four trauma surgeons and four shoulder surgeons) in two different occasions. The intra- and interobserver agreement was assessed by using the Kappa coefficient. The level of significance was 5%. Results: There was a weak-to-moderate intraobserver agreement (κ < 0.59) for all examiners. Only the medial metaphyseal hinge greater than 2 mm was identified by 87.5% of evaluators both in the radiographic and CT examinations in the two rounds of the study (p < 0.05). There was no significant interobserver agreement (κ < 0.19), as it occurred only in some moments of the second round of evaluation. Conclusions: The prognostic criteria for humeral head ischemia evaluated in this study showed weak intra- and interobserver agreement in both the radiographic and tomographic evaluation. CT did not help surgeons in the primary interpretation of Hertel prognostic criteria used in this study when compared to the radiographic examination.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Tullio

Giordano²,

Belangero³

et al. 2022

Medicina

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“…[7,8] Various methods have been proposed to treat displaced proximal humerus fractures, including conservative treatment, open reduction and internal fixation (ORIF), and shoulder arthroplasty. [9][10][11] With the use of locking plates, ORIF can achieve excellent fracture reduction, can allow early functional exercise, and is highly recommended by orthopedic surgeons, [7,12] particularly in patients aged younger than 65 years old. [11] The optimal surgical approach for proximal humeral fractures remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

Liu

Wang

et al. 2022

Medicine

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Background: The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach. Methods: This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score. Results: A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation ( P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups ( P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group ( P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group ( P = .049). Conclusion: The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.

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“…Proximal humeral fractures are the second most common fractures of the upper extremity in adults, ac counting for 24 -38 % of all upper limb fractures and with increase in incidence and complexity of the fracture with age [1] . Although a Majority of undisplaced proxima lhumeral fractures can be treated conservatively, th ereisan over whel ming need for osteosyn the sisin these fractures due to the change in the demographic pattern and more complex fractur epresentations with road traffic/ motor vehicl eaccidents on therise, demand fo rearly return to activities and problems of late collapse/ displacement with conservative measures [2] .…”

Section: Introductionmentioning

confidence: 99%

Outcome evaluation of proximal humerus fractures management by proximal humeral internal locking plates- A clinico- radiological study

Patil¹,

Deshmukh²,

Sawarkar³

et al. 2022

ijhs

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Introduction: Proximal humerus fractures are amongst the most common upper extremity fractures that are found in elderly as well as young age groups. Although majority of them are treated conservatively, due to the demand for early return to the daily activities and problems of late collapse/ displacement with conservative measures there arise a need for plate ostesynthesis. Amongst the various methods of fixation, Proximal humerus intrlocking plates designs promise an opportunity to minimize the common complicsations. However, a gap still exists between in vitro results and clinical outcomes. Addressing to the limitations and need to evaluate the efficacy of the currently available proximal humerual interlocking plates, the purpose of this study will be to evaluate the short and medium term functional resultys with fixation of proximal humerus fracture and review the common complications associated. Materials and methods: In this prospective observational study, conducted at a tertiary care centre, patients from 18-85 age group were selected according to the inclusion and exclusion criteria.

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Open Reduction and Internal Fixation with a Locking Plate Via Deltopectoral Approach for the Treatment of Three and Four-Part and Proximal Humeral Fractures

Abstract: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A225).

Cited by 5 publications

References 20 publications

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

Outcome evaluation of proximal humerus fractures management by proximal humeral internal locking plates- A clinico- radiological study

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