Rigid internal fixation of fractures of the proximal humerus in older patients

Hintermann, Beat; Trouillier, Hans; Schäfer, Doris

doi:10.1302/0301-620x.82b8.10330

Cited by 141 publications

(110 citation statements)

References 28 publications

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“…In fact, this scale is not only founded on the mobility but also on the strength and is finalized to the evaluation of young patients, able to lift 12 kg, while our patients were 68 years old on average. The mean Constant-Murley score was 70 points, comparable to that (73 points) of a recent study of elderly people [16].…”

Section: Displaced Fractures At Low Risk Of Osteonecrosis Insupporting

confidence: 81%

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Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications

Rosa¹,

Maccauro²,

Nizegorodcew³

et al. 2002

J Orthopaed Traumatol

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IntroductionFractures of the proximal humerus represent 4%-5% of all fractures. Although they can occur anytime after birth, their incidence increases progressively with age, particularly in women, because of postmenopausal osteoporosis, so that about 80% of affected people older than 50 years are women [1].The most used classification of these fractures was developed by Neer [2] in 1970 ( Fig. 1), starting from Codman's classification, based on the four constitutive fragments of the proximal humerus (head, tuberosities and diaphysis). Neer integrated it with notions of biomechanics, i.e. the analysis of muscular forces displacing fracture, and of physiopathology, i.e. the evaluation of possible vascular deficits of the humeral head (Fig. 2) [3] following trauma. Therefore, this classification allows one to determine the prognosis of the fracture, the risk of necrosis of the humeral head and the expectation of functional recovery of the shoulder, and consequently to choose among conservative treatment, osteosynthesis and prosthetic replacement. More complex, and therefore less used, is the AO/ASIF classification (Fig. 3) [4].In 85% of cases, the fractures are composed, so that they can be treated conservatively with simple immobilization [5]. In the remaining 15%, there is indication to the surgical treatment but, as it is known, there are controversies both on which classification to use (Neer versus AO/ASIF), because neither is entirely reliable [6], and on which surgical technique to choose, because neither is effective in all cases, either for technical difficulties or for insufficient functional results.We report the short-term results of the elastic osteosynthesis with percutaneous threads, a method that differs from the traditional static assemblage because it causes compression and not only an alignment at the focus of fracture.

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Section: Displaced Fractures At Low Risk Of Osteonecrosis Insupporting

confidence: 81%

“…16 This metaphyseal type III fracture (a) was accompanied by a diaphyseal fracture, which required a cerclage (b). This case is also interesting because of the lowering of the humerus in the postoperative period (c), which nevertheless was readily recovered after removing the wires (d, e) a b c d e…”

Section: Referencesmentioning

confidence: 99%

Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications

Rosa¹,

Maccauro²,

Nizegorodcew³

et al. 2002

J Orthopaed Traumatol

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“…Canbora et al [15] in their study has a total of 29 patients of which 9 were 2-part fracture, 15 were 3-part fractures and 5 were 4-part fractures. Hintermann et al [17] in their series had a total of 42 patients with proximal humerus fractures of which 34 were 3-part fractures and 8 were 4-part fractures. In our study we observed that 2-part proximal humerus fractures occurred in a greater frequency in the elderly compared to the other types.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

Int. J. Orthop. Sci.

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Proximal humerus fracture accounts to about 4-5% of all the fractures and is the third most common fracture in the elderly population. Though several modalities of treatment exist there are no clear guidelines or consensus to the optimal method of treatment of these fractures especially in the elderly population. This study was based in a tertiary hospital with the objectives to assess the functional outcome of surgical treatment of proximal humerus fractures in the elderly population. Patients with proximal humerus fracture aged above 51 years and fulfilling the inclusion criteria were included in the study. The fractures were classified using Neer's classification of proximal humerus fracture. Patients were treated surgically by [ORIF] and post-operatively limb is immobilized in arm pouch; mobilization was started at the second week as per patient's tolerance. Patients were then followed up at 3 months, 6months and 12 months. They were assessed for functional outcome using Constant scoring system [Pain, activities of daily living and range of motion]. A total of 37 patients were included in the study. The mean age of the patients was 65.2 years. The study included 18 2-part fracture, 11 3-part fractures and 8 4-part fracture. The mean Constant score at 12-month follow-up in 2-part fracture was 66.2, in 3-part fracture was 59 and in 4-part fracture was 51.4. The overall mean Constant score was 60.2. In conclusion we are of opinion that treatment of proximal humerus fractures in the elderly population is a challenge and one should not deny them a good functional outcome. Patients with 2-part fracture fared better and has a satisfactorily good functional outcome. Whereas in 3-part and 4-part fractures the outcomes do not vary significantly and patients with 4-part fracture had higher incidence of surgery related complication.

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“…Hintermann et al (12) descreveram bons resultados em fraturas fixadas com placa-lâmina. Porém, recentemente, Meier et al (13) relataram 33% de complicações com esse método; em 22% dos pacientes houve protrusão da placa-lâmina na articulação do ombro.…”

Section: Discussionunclassified