Proximal humerus fracture sequelae: are corrective osteotomies still a taboo? The role of three-dimensional preoperative planning and patient-specific surgical guides for proximal humerus corrective osteotomy in combination with reverse shoulder arthroplasty

Computed tomography improves the diagnostic accuracy but not the interobserver reliability of the Boileau classification of proximal humerus fracture sequelae

“…Previous authors recommended to distinguish types 1C, 1D, and 4 according to the position of the greater tuberosity as compared to the humeral head and the diaphysis. 7 The clinical relevance of this study was linked to the evidence that incorrect identification of the initial pattern of PHFS could lead to wrong intraoperative planning and to an increased number of complications. Indeed, the prosthetic treatment of type 1C, 1D, 3, and 4 PHFS is associated with a high rate of intraoperative and postoperative complications as showed by previous studies, with an intraoperative fracture rate ranging between 6.8% and 33%.…”

“…6,14,16,19 In a review including nine studies and 234 patients affected by PHFS (without any distinction about subtype), Holton et al 20 reported a 29% rate of severe complication (dislocation in 16.7%, infection in 6.8%, periprosthetic fracture in 3% and nerve injury in 2.6% of cases). On the other way, Cozzolino et al 7 reported no major complication in treating this type of deformity with a surgical plan based on preoperative CT scans. The fair intraobserver agreement observed in our study confirmed that CT scan deeply impacts on the deformity evaluation.…”

“…Previous authors recommended to distinguish types 1C, 1D, and 4 according to the position of the greater tuberosity as compared to the humeral head and the diaphysis. 7…”

“…A three-dimensional (3D) evaluation of PHFS has recently been proposed in order to better evaluate more complex deformities. 7,8 Indeed, all PHFS are 3D deformities which need to be corrected taking into account 6 degrees of freedom (three as rotations and three as translations), since evaluating a single rotation angle or a single plane diaphyseal realignment increases the risk to misinterpret the complexity of the lesion. Interestingly, the role of 3D diagnostic tools in the evaluation and in the classification of proximal humerus fractures has already been investigated.…”

The Role of 3D Custom Implants in Upper Extremity Surgery

“…These patient-specific instruments (PSIs) have demonstrated efficacy in upper extremity conditions such as proximal humerus malunions, cubitus varus, congenital radioulnar synostoses, and Madelung deformities. [12][13][14][15][16] With the ability to 3D plan, these complex deformities can be corrected with idealized osteotomies that are placed in anatomic locations selected by the surgeon. Surgeons can select osteotomy sites that allow for improved healing potential (such as metaphyseal bone) and for the creation of bony segments that allow for optimized fixation.…”