Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures

Boesmueller, Sandra; Wech, Margit; Gregori, Markus; Domaszewski, Florian; Bukaty, Adam; Fialka, Christian; Albrecht, Christian

doi:10.1016/j.injury.2015.10.001

Cited by 60 publications

(47 citation statements)

References 33 publications

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“…Most surgeons are reluctant to use antegrade IM nailing for the treatment of displaced 2-part surgical neck fractures of the proximal humerus and still prefer to use locking plate and screw fixation, although many complications related to this option have been reported throughout the literature. 2,27 For many surgeons, substantial barriers to adoption of antegrade IM nailing are the reported high rates of unexpected hardware complications (up to 50%) and unplanned reoperations (up to 16%) with first-and second-generation humeral nails. With the goal to avoid opening and plating these displaced surgical neck fractures and avoid or minimize complications reported with existing IMNs, we have designed a thirdgeneration (straight design, locked, low-profile, tuberositybased fixation) humeral IMN.…”

Section: Discussionmentioning

confidence: 99%

“…Complications associated with locking plates and an open approach for the treatment of proximal humeral fractures include humeral head necrosis (up to 35%), screw cutout (up to 57%) with potential glenoid erosion, and fracture nonunion (up to 13%). 2,8,18,27,41 Antegrade intramedullary (IM) nailing for 2-part surgical neck fractures of the proximal humerus could be an alternative treatment option to locking plates. A recent prospective randomized trial comparing locking intramedullary nails (IMNs) and locking plates for the treatment of 2-part surgical neck fractures has shown that the complication rate was much higher for the locking plate group (31%) than the locking nail group (4%).…”

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confidence: 99%

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Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Boileau

D’ollonne

Bessière³

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background: The high rates of complications and reoperations observed with the early designs of firstgeneration (unlocked) and second-generation (bent design) humeral intramedullary nail (IMNs) have discouraged their use by most surgeons. The purpose of this study was to report the results of a thirdgeneration (straight, locking, low-profile, tuberosity-based fixation) IMN, inserted through a percutaneous approach, for the treatment of displaced 2-part surgical neck fractures. Methods: We performed a retrospective review of 41 patients who underwent placement of a thirdgeneration IMN to treat a displaced 2-part surgical neck fracture (AO/OTA type 11A3). The mean age at surgery was 57 years (range, 17-84 years). After percutaneous insertion through the humeral head, the IMN was used as a reduction tool. Static locking fixation was achieved after axial fracture compression ("back-slap" hammering technique). Patients were reviewed and underwent radiography with a minimum of 1 year of follow-up; the mean follow-up period was 26 months (range, 12-53 months). Results: Preoperatively, 3 types of surgical neck fractures were observed: with valgus head deformity (Type A = 8 cases), shaft translation without head deformity (Type B = 19 cases), or with varus head deformity (Type C = 14 cases). At final follow-up, all fractures went on to union, and the mean humeral neck-shaft angle was 132°± 5°. We observed 2 malunions and 1 case of partial humeral head avascular necrosis. No cases underwent screw migration or intra-articular penetration. At last review, mean active forward elevation was 146°(range, 90°-180°) and mean external rotation was 50°(range, 20°-80°). The mean Constant-Murley score and Subjective Shoulder Value were 71 (range, 43-95) and 80% (range, 50%-100%), respectively. Conclusions: Antegrade insertion of a third-generation IMN through a percutaneous approach provides a high rate of fracture healing, excellent clinical outcome scores, and a low rate of complications. No morbidity related to the passage of the nail through the supraspinatus muscle and the cartilage was observed. The proposed A, B, and C classification allows choosing the optimal entry point for intramedullary nailing. The study was approved by the Institutional Review Board of Institut Universitaire Locomoteur et du Sport (No. 2016-02).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Boileau

D’ollonne

Bessière³

et al. 2019

Journal of Shoulder and Elbow Surgery

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“…Therefore, we summarized and analyzed the data of these two complications. Boesmueller et al reported the follow-up results of 286 patients with PHF treated with PHILOS plate in 2016, among which 60 patients had postoperative complications, with a complication rate of 39% [37] A detailed analysis of the complications would help us to further guide the clinical work, Klug et al performed RSA or open reduction and internal xation with locking plate in 125 elderly with complicated PHF. Statistical analysis demonstrated that the incidence of postoperative complications in locking plate group was signi cantly higher than that in RSA group (15.8%).…”

Section: Discussionmentioning

confidence: 99%

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Gong¹,

Lin²,

Xu³

et al. 2020

Preprint

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Background: Previous studies had compared the effectiveness of surgical and conservative treatment in proximal humeral fracture (PHF), suggesting that both treatments were effective for displaced fractures. However, which treatment is more effective, especially in the elderly patient population, remains controversial to date. This study aims to evaluate the efficacy of the two treatment methods, including functional outcome scores, complications, etc.Methods: We searched four databases (MEDLINE, Web of Science, EMBASE, Cochrane Library) from the inception of the databases to March 2020. Within the scope of the search, the publication time and language of the relevant literatures were not limited. The meta-analysis directly compared the results and complications of the two groups and subgroups. Results: We included 11 comparative studies into our meta-analysis. The contents of the study included 7 randomized controlled trials (RCTs) and 4 non-randomized controlled trials (nRCTs). The pooled data demonstrated that there was no significant difference in postoperative Constant score between surgical and conservative treatment in the RCT subgroup, but there were differences among the nRCT and prosthesis subgroup. Although there was no significant difference between the surgery and conversation group in the major postoperative complications, the subgroup analysis showed fewer complications in the joint prosthesis replacement group. Conclusion: Both treatments could provide better clinical results for patients. The joint prosthesis replacement may offer additional benefits in terms of reduced complications and postoperative function. Furthermore, due to the increasing number of prosthesis replacements and the advent of the aging age, we should consider the individual differences between patients and enrich the clinical efficacy through the personal experience of surgeons before choosing treatment options.

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“…La aparición de esta complicación es más frecuente en pacientes mayores, fumadores o patrones de fractura más complejos. (23)(24) Es importante plantear estudios con un seguimiento superior a un año para no infravalorar la aparición de esta complicación. En nuestro estudio, planteamos un seguimiento mínimo de 2 años con el objetivo de detectar esta complicación, sobre en todo en casos que no muestren sintomatología.…”

Section: Discussionunclassified

Valoración cuantitativa de la pérdida de funcionalidad asociada a la aparición de complicaciones en osteosíntesis de fracturas de húmero proximal

Fernández

Albero

Gómez-Blasco

et al. 2019

Rev Fac Cien Med Univ Nac Cordoba

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OBJETIVO: Evaluar la relación entre la incidencia de complicaciones y los resultados clínico-funcionales, tras el tratamiento de las fracturas de húmero proximal mediante osteosíntesis con placa bloqueada.MATERIAL Y MÉTODO: Nuestro estudio revisa 47 pacientes intervenidos mediante osteosíntesis con placa en un periodo de 5 años. Presentamos los resultados clínico-funcionales con las escalas de Constant-Murley y Quick Dash, y con un análisis cinemático. Análisis estadístico de las relaciones complicación-resultados funcionales y reintervención-resultados funcionales.RESULTADOS: Al final del seguimiento, fueron recogidos un total de 47 pacientes, con una edad media de 74,85 años. 11 pacientes (23,4%) tuvieron complicaciones, de los cuales 6 pacientes (12,7%) precisaron ser reintervenidos. La aparición de complicaciones se asoció a una pérdida de 65,41º de flexión, 14,49º de extensión, 36,71º de abducción, 8,84º de aducción, 5,47º de rotación externa y 30,82º de rotación interna. Además, se encontró relación estadísticamente significativa entre el desarrollo de complicaciones y las escalas Constant-Murley y Quick Dash.CONCLUSIÓN: Existe un porcentaje elevado de pacientes que desarrollan complicaciones tras RAFI con placa, los cuales ven disminuida su funcionalidad de forma notable. Nuestro estudio cuantifica de forma exacta ésta pérdida y, de esta manera, predice la situación funcional, según las eventuales complicaciones que puedan aparecer.

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Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures

Cited by 60 publications

References 33 publications

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Valoración cuantitativa de la pérdida de funcionalidad asociada a la aparición de complicaciones en osteosíntesis de fracturas de húmero proximal

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