Predicting failure after surgical fixation of proximal humerus fractures

Krappinger, Dietmar; Bizzotto, Nicola; Riedmann, Stephan; Kammerlander, Christian; Hengg, Clemens; Kralinger, Franz

doi:10.1016/j.injury.2011.01.017

Cited by 304 publications

(216 citation statements)

References 26 publications

Supporting

Mentioning

199

Contrasting

Unclassified

Order By: Relevance

“…For example Fankhauser et al [7] found low BMD to negatively affect the stability of ORIF of the proximal humerus in their cadaver study. However Krappinger et al [13] found low BMD to be a predictor for later failure of ORIF in their clinical study. Thus they agree with other authors that bone quality should be part of the preoperative assessment [7,10,13,19,20].…”

Section: Introductionmentioning

confidence: 87%

“…However Krappinger et al [13] found low BMD to be a predictor for later failure of ORIF in their clinical study. Thus they agree with other authors that bone quality should be part of the preoperative assessment [7,10,13,19,20]. Dual-energy x-ray absorptiometry (DXA) is the gold standard for assessing osteoporosis in patients, however it is valid only for specific anatomic sites which do not include the proximal humerus.…”

Section: Introductionmentioning

confidence: 87%

“…The influence of local bone mineral density (BMD) on the outcome of proximal humerus fractures is controversial and not sufficiently addressed in the literature [7,12,13]. However, several studies have shown that osteoporosis may negatively affect surgical fixation or healing of proximal humerus fractures after open reduction and internal fixation (ORIF).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Spross

Kaestle

Benninger

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs. Questions/purposes We asked: (1) How do the deltoid tuberosity index and Tingart measurement correlate with each other, with patient age, and local bone mineral density (BMD) of the humeral head, measured by pQCT? (2) Which threshold values for the deltoid tuberosity index and Tingart measurement optimally discriminate poor local bone quality of the proximal humerus? (3) Are the deltoid tuberosity index and Tingart measurement clinically applicable and reproducible in patients with proximal humerus fractures? Methods The deltoid tuberosity index was measured immediately above the upper end of the deltoid tuberosity. At this position, where the outer cortical borders become parallel, the deltoid tuberosity index equals the ratio between the outer cortical and inner endosteal diameter. In the first part of our study, we retrospectively measured the deltoid tuberosity index on 31 patients (16 women, 15 men; mean age, 65 years; range, 22-83 years) who were scheduled for elective surgery other than fracture repair. Inclusion criteria were available native pQCT scans, AP shoulder radiographs taken in internal rotation, and no previous shoulder surgery. The deltoid tuberosity index and the Tingart measurement were measured on the preoperative internal rotation AP radiograph. The second part of our study was performed by reviewing 40 radiographs of patients with proximal humerus fractures (31 women, nine men; median age, 65 years; range, 22-88 years). Interrater (two surgeons) and intrarater (two readings) reliabilities, applicability, and diagnostic accuracy were assessed. Results The correlations between radiograph measurements and local BMD (pQCT) were strong for the deltoid tuberosity index (r = 0.80; 95% CI, 0.63-0.90; p \ 0.001) and moderate for the Tingart measurement (r = 0.67; 95% CI, 0.42-0.83; p \ 0.001). There was moderate correlation between patient age and the deltoid tuberosity index (r = 0.65; p \ 0.001), patient age and the Tingart measurement (r = 0.69; p \ 0.001), and patient age and pQCT (r = 0.73; p \ 0.001). The correlation between the deltoid tuberosity index and the Tingart measurement was strong (r = 0.84; p \ 0.001). We determined the cutoff value for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Inte...

show abstract

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Spross

Kaestle

Benninger

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Potential complications include avascular necrosis (AVN) of the humeral head, displaced tuberosity fragments, malunion or non-union, rotator cuff impingement, implant failure, painful frozen shoulder, neurovascular problems and arthritis [5,6]. Complexity of the fracture, severity of soft tissue injury, patient's age, male sex, preexisting comorbidities and bone density have been reported as influential factors for failure and complication after surgery [7,8].…”

Section: Introductionmentioning

confidence: 99%

A Report on Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

Azizian¹

2017

MOJCSR

View full text Add to dashboard Cite

Background: Proximal humeral fractures are among prevalent types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three-vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods:In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. Constant score was evaluated 6 months later in follow-up. P-value <0.05 was considered significant.Results: Four-part fractures were mainly caused by a trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P-value=0.010). Open fractures were only observed in patients with four-part fracture (P-value=0.018). No significant differences were noticed regarding gender, cause and side of fracture. Presence of other fractures, fracture of implant, reduction loss, avascular necrosis (AVN) of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. Constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P-value=0.006). Conclusion:Open reduction and internal fixation with Philos® plate yields acceptable results in both types of fractures, however prognosis of this intervention is poorer four-part fractures.

show abstract

“…Many studies have reported successful outcomes when fixation is performed with a recently developed fixed-angle implant. [1][2][3][4] The proximal humeral locking plate (PHLP) is widely preferred for fixation when compared with other implant designs. However, even with the use of the PHLP, many complications still occur after fixation, including avascular necrosis of the humeral articular fragment, malreduction (particularly varus malalignment), and screw penetration.…”

mentioning

confidence: 99%

Surgical Technique for Open Reduction–Internal Fixation of an Unstable Displaced 3-Part Proximal Humeral Fracture Using a Proximal Humeral Locking Plate

Kanchanatawan

Suppauksorn

Chobpenthai

et al. 2017

Arthroscopy Techniques

View full text Add to dashboard Cite

Abstract:The proximal humeral locking plate (PHLP) is a recently developed fixed-angle implant that is an option for open reductioneinternal fixation of an unstable displaced proximal humeral fracture. Various articles have reported successful outcomes using the PHLP when compared with other implant designs. However, many complications still occur with use of the PHLP, such as avascular necrosis of the humeral articular fragment, malreduction (particularly varus malalignment), and screw penetration. These complications are related to the difficulty in fixation of this particular type of fracture, as well as ineffective surgical technique. We have therefore proposed a step-by-step surgical technique for open reductioneinternal fixation of an unstable displaced 3-part proximal humeral fracture using a PHLP. This technique focuses on the precise placement of the PHLP according to the plate design, as well as an effective intraoperative assessment, to improve surgical outcomes and prevent the various complications of proximal humeral fractures.O pen reductioneinternal fixation (ORIF) of an unstable displaced proximal humeral fracture is a difficult procedure for general orthopaedic surgeons. The difficulty arises from the fact that it involves fixation of a comminuted fracture in an unfamiliar skeletal area, and the fixation can be particularly difficult when the patient has osteoporosis. Many studies have reported successful outcomes when fixation is performed with a recently developed fixed-angle implant. [1][2][3][4] The proximal humeral locking plate (PHLP) is widely preferred for fixation when compared with other implant designs. However, even with the use of the PHLP, many complications still occur after fixation, including avascular necrosis of the humeral articular fragment, malreduction (particularly varus malalignment), and screw penetration. [3][4][5][6] To our knowledge, only a few studies in the literature have described the surgical technique in detail, and these studies are still lacking in certain key points that will enable the surgeon to avoid the complications previously described. Therefore, we propose a surgical technique for the fixation of a 3-part proximal humeral fracture using the PHLP. This technique mainly focuses on the precise placement of the plate according to the plate design. This technique is a synergism of anatomic knowledge, traumatology, and sports medicine. It enable the surgeon to achieve adequate surgical fixation as well as adequate intraoperative assessment for avoidance of complications. Surgical TechniqueThe key to achieve successful reduction of an unstable displaced 3-part proximal humeral fracture is to attempt to convert a 3-part fracture into a 2-part fracture by converting the 2 parts at the humeral head (the humeral articular part with the attached lesser tuberosity and greater tuberosity) into 1 part, with the humeral shaft as the second part (Fig 1A).

show abstract

Predicting failure after surgical fixation of proximal humerus fractures

Cited by 304 publications

References 26 publications

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

A Report on Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

Surgical Technique for Open Reduction–Internal Fixation of an Unstable Displaced 3-Part Proximal Humeral Fracture Using a Proximal Humeral Locking Plate

Contact Info

Product

Resources

About