Proximale Humerusfraktur – was sagt die aktuelle Literatur?

Warnhoff, Mara; Lill, Helmut; Jensen, Gunnar; Ellwein, Alexander; Hazra, Rony-Orijit Dey

doi:10.1007/s11678-018-0496-7

Cited by 7 publications

(21 citation statements)

References 55 publications

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“…Principal innovations in therapy of proximal humerus fracture in recent years [10,11]: ▪ Polyaxial screw systems [12,13] ▪ Cement-augmented screws [14 -17, 43] ▪ Carbon fibre-reinforced plates made of PEEK polymer [18 -20, 44, 45] ▪ Double plate osteosynthesis in complex 4-part fractures [21,22,46] Cement augmentation was performed in our patient collective from 2014 to 2017 in 121 (39.4 %) of the cases with anchoring screws used in the humerus head. Various biometric studies have demonstrated superiority in terms of load-to-failure in axial rotation and in varus bending [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…An Innovationen für die proximale Humerusfraktur zeigten sich in den letzten Jahren vor allem 10 , 11 :…”

Section: Diskussionunclassified

“…Innovationen der letzten Jahre sind vor allem [10,11]: ▪ polyaxiale Schraubensysteme [12,13] ▪ zementaugmentierte Schrauben [14 -17] ▪ carbonfaserverstärkte Platten aus dem Kunststoff Polyetheretherketon (PEEK) [18 -20] ▪ Doppelplattenosteosynthese bei komplexen 4-Part-Frakturen [21 -24] Bei nicht rekonstruierbaren proximalen Humerusfrakturen geht bei den "fractures of the elderly" der Trend zu einer primären inversen Schulterprothese oder alternativ zu dem Belassen in der konservativen Heilbehandlung [25,26]. Innovationen bei der inversen Schulterprothetik der letzten Jahre sind vor allem [10]: ▪ Varisierung des glenohumeralen Inklinationswinkels ▪ inferiore Positionierung der "Baseplate" ▪ konsequente Refixation der Tubercula…”

Section: Zusammenfassungunclassified

“…The main innovations of recent years are [10,11]: ▪ Polyaxial screw systems [12,13] ▪ Cement-augmented screw [14 -17] ▪ Carbon fibre-reinforced plates made of the polymer polyetheretherketone (PEEK) [18 -20] ▪ Double plate osteosynthesis in complex 4-part fractures [21 -24] The trend in cases of non-reconstructable proximal humerus fractures in elderly patients is toward primary reverse shoulder arthroplasties or, alternatively, conservative therapy, i.e. nonoperative approach to fracture management [25,26].…”

Section: Introductionmentioning

confidence: 99%

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Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

et al. 2021

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Background The management of proximal humeral fracture (PHF) is not only complex but ever changing. Published epidemiological data are often dated and do not factor in demographic changes or the latest developments in implant material and surgical techniques. Aims The primary aim of this study was to evaluate changes in the epidemiology and actual treatment of PHF at a level-1 trauma centre, with a special focus on shoulder surgery. Hypotheses 1. Between 2009 to 2012 and 2014 to 2017, an increase in complex PHF entities can be observed. 2. In correlation with fracture complexity, an increasing number of comorbidities, especially osteoporosis, can be observed. Methods Between 2014 and 2017, a total of 589 patients (73% female; mean age: 68.96 ± 14.9 years) with 593 PHFs were treated. Patient records and imaging (XRs and CTs) of all patients were analysed. Fractures with ad latus displacement of a maximum of 0,5 cm and/or humeral head angulation of less than 20° were classified as non-displaced. Patients with displaced fractures were included in the analysis of the therapeutic algorithm. These results were compared to those of a cohort 2009 to 2012 (566 patients, 569 PHFs), which used the same inclusion criteria. Results The two cohorts showed comparable patient numbers, as well as gender and age distributions. Between 2009 to 2012 and 2014 to 2017, a decrease in 2-part fractures (13.9 to 8.6%) and a simultaneous increase in 4-part fractures (20.4 to 30%), and thus fracture complexity was observed. Further decreases were observed in conservative therapy (27.8 to 20.6%), nail osteosynthesis (10.7 to 2.7%) and anatomic shoulder arthroplasty (5,4 to 1%). Furthermore, there was an increase in the use of locking plate osteosynthesis (43.2 to 56.7%) and reverse shoulder arthroplasty (9 to 18.4%). The general trend shows an increase in surgical therapy between the years (72.2 to 79.4%), as well as an increase in osteoporosis incidence (13 to 20.6%). The greatest numbers of comorbidities were found in 3- and 4-part fractures. Conclusion There is an increase in both the complexity of fractures and the number of surgically treated fractures between 2009 and 2012. Furthermore, an increase in osteoporosis numbers can be observed. New implants (PEEK, fenestrated screws for cement augmentation) and new surgical techniques (double plating osteosynthesis) were used as a result of increasing fracture complexity. Moreover, reverse total shoulder arthroplasty was used more commonly.

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Section: Discussionmentioning

confidence: 99%

“…An Innovationen für die proximale Humerusfraktur zeigten sich in den letzten Jahren vor allem 10 , 11 :…”

Section: Diskussionunclassified

Section: Zusammenfassungunclassified

Section: Introductionmentioning

confidence: 99%

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Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

et al. 2021

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“…Functional limitations of the shoulder due to pain are one of the most common reasons patients seek medical attention and present to the emergency department [1,2]. While fractures of the proximal humerus and joint dislocation are the most frequent traumatic causes of shoulder pain [3,4], calcific tendinitis, characterized by calcium depots in the rotator cuffs, is among the most common atraumatic causes [5,6].…”

Section: Introductionmentioning

confidence: 99%

Deep learning for accurately recognizing common causes of shoulder pain on radiographs

et al. 2021

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Objective Training a convolutional neural network (CNN) to detect the most common causes of shoulder pain on plain radiographs and to assess its potential value in serving as an assistive device to physicians. Materials and methods We used a CNN of the ResNet-50 architecture which was trained on 2700 shoulder radiographs from clinical practice of multiple institutions. All radiographs were reviewed and labeled for six findings: proximal humeral fractures, joint dislocation, periarticular calcification, osteoarthritis, osteosynthesis, and joint endoprosthesis. The trained model was then evaluated on a separate test dataset, which was previously annotated by three independent expert radiologists. Both the training and the test datasets included radiographs of highly variable image quality to reflect the clinical situation and to foster robustness of the CNN. Performance of the model was evaluated using receiver operating characteristic (ROC) curves, the thereof derived AUC as well as sensitivity and specificity. Results The developed CNN demonstrated a high accuracy with an area under the curve (AUC) of 0.871 for detecting fractures, 0.896 for joint dislocation, 0.945 for osteoarthritis, and 0.800 for periarticular calcifications. It also detected osteosynthesis and endoprosthesis with near perfect accuracy (AUC 0.998 and 1.0, respectively). Sensitivity and specificity were 0.75 and 0.86 for fractures, 0.95 and 0.65 for joint dislocation, 0.90 and 0.86 for osteoarthrosis, and 0.60 and 0.89 for calcification. Conclusion CNNs have the potential to serve as an assistive device by providing clinicians a means to prioritize worklists or providing additional safety in situations of increased workload.

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Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

Schmalzl

Jessen

Holschen³

et al. 2020

Eur J Orthop Surg Traumatol

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Proximale Humerusfraktur – was sagt die aktuelle Literatur?

Cited by 7 publications

References 55 publications

Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery

Deep learning for accurately recognizing common causes of shoulder pain on radiographs

Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis

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