Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation

Lee, Churl Woo; Shin, Sang Jin

doi:10.1016/j.jse.2008.06.014

Cited by 138 publications

(90 citation statements)

References 26 publications

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“…Indeed, studies show that fractures treated with either anatomic reduction or screws in the inferomedial humeral head for which no medial column support was obtained had a high incidence of failure. 3,[9][10][11][12] An intramedullary fibular allograft used together with a locking plate fixation has been recently described in biomechanical studies to provide additional medial support and prevent varus malalignment. 13 The purpose of this study was to evaluate the clinical and radiographic outcomes of a locking plate with fibular allograft augmentation in unstable humeral fractures.…”

Section: Introductionmentioning

confidence: 99%

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Matassi

Angeloni

Carulli

et al. 2012

Injury

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Section: Introductionmentioning

confidence: 99%

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Matassi

Angeloni

Carulli

et al. 2012

Injury

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“…34 There is no general agreement on the optimal treatment for these fractures, and 1 of 9 patients treated with open reduction-internal fixation (ORIF) or hemiarthroplasty requires revision surgery 21 because of often serious complications. 6,9,25,29,37,41,45 An acceptable solution should take the osteoporotic bone especially of the greater tuberosity into account and ensure a predictable and rapid postoperative recovery of the ability to perform daily activities, independent of patient compliance and capability of postoperative rehabilitation. The use of a reverse total shoulder replacement (reverse total shoulder arthroplasty [RTSA]) as proposed by Grammont et al 19 is an alternative that addresses the additional fragility of the rotator cuff and has shown promising results in a few case series.…”

mentioning

confidence: 99%

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

122

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Due to the aging population with poor bone quality the frequency of complex proximal humerus fractures increases. An operative reconstruction and internal fixation is very challenging and is not always possible. Secondary impaction, screw perforations and humeral head necrosis is a common complication. The use of a Reverse Total Shoulder Arthroplasty in the elderly after trauma is a promising alternative. The present multicenter study retrospectively analyzes our long-term experience of reverse total shoulder arthroplasty as a primary treatment in this patient population regarding pain, range of shoulder motion, subjective shoulder value, the constant score, scapular notiching and signs of loosening. Background: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Methods: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). Results: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. Conclusion:The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Level of evidence: Level IV; Case Series; Treatment Study

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“…7) Previous investigators described the importance of anatomic reduction and mechanical support of medial calcar in proximal humerus fractures, reporting high failure rate or varus malunion without medial column support in cases of concomitant comminuted fracture at the medial calcar. [7][8][9][10][11][12] Since Walch et al 13) used the intramedullary bone peg technique in treating nonunion at the humeral surgical neck, Gardner et al 14) used a fibular strut allograft as an endosteal implant and support for proximal humerus fractures in small series [14][15][16][17][18] The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with a fibular strut allograft for unstable osteoporotic proximal humerus fractures. We hypothesized that the use of fibular strut allograft as an internal pillar may be a good option for preventing varus collapse and maintaining the initial reduction status.…”

Section: Introductionmentioning

confidence: 99%

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

Chun

Lee

2017

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. Methods: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in 20° external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in 20° external rotation view. Results: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was 138° ± 4°, and at one-year follow-up, the neck shaft angle was 137° ± 5°. There was no significant difference between the preoperative and postoperative values (p=0.105). Conclusions: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

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Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation

Cited by 138 publications

References 26 publications

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

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