Surgical Neck Fractures of the Proximal Humerus

Koval, Kenneth J.; Blair, Benjamin; Takei, Robert; Kummer, Frederick J.; Zuckerman, Joseph D.

doi:10.1097/00005373-199605000-00017

Cited by 128 publications

(10 citation statements)

References 21 publications

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“…Biomechanical tests are currently being used in studies of fracture fixation [11]–[14]. In the current study, biomechanical tests showed that medial support from cortical bone in the proximal humerus provided the best stability when locking plates were used to treat proximal humerus fractures.…”

Section: Discussionmentioning

confidence: 65%

“…Using a plate attached to the mechanical tester, axial compression was applied with a vertical load at the apex of the humeral head using displacement control (max deflection = 0.5 mm; load rate = 5 mm/min [11]; preload = 50 N). The maximum load was recorded, and the slope of the load-deflection curve was used to compute the axial baseline stiffness.…”

Section: Methodsmentioning

confidence: 99%

“…Each humerus was mounted distally in a vice with the shaft axis in 20° of abduction(Fig.3c) as recommended by Koval et al in order to simulate the shear loading across a proximal fracture site experienced when rising out of a chair or crutch weight bearing [11].The same test procedure as that with axial stiffness testing was performed, except that maximum displacement was 1.0 mm. Load levels were chosen to prevent permanent damage to the specimens.…”

Section: Methodsmentioning

confidence: 99%

“…The force was applied until catastrophic failure of the implant occurred. The highest peak load was determined to indicate significant structural collapse [11]. Catastrophic fracture patterns of the bone and implant were examined and recorded.…”

Section: Methodsmentioning

confidence: 99%

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The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

et al. 2014

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BackgroundThe purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures.MethodsThirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed.ResultsConstructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001). When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P≤0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture.ConclusionsAnatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.

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Section: Discussionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

et al. 2014

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“…Presence of comminution offers difficulty in internal fixation while external fixation works on principal of ligamentotaxis. Internal fixation has been reported to have increased complication rates in these patients due to hardware loosening and pullout of the screws 13–15. Additionally, the use of internal fixation device prolongs the operative time, increases intraoperative bleeding, and increases the risk of avascular necrosis of humeral head because of the disruption of the residual vascularity 1415.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome of closed fractures of proximal humerus managed by Joshi’s external stabilizing system

Gupta

Sengar

et al. 2012

IJOO

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Background:Proximal humeral fractures account for 4–5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3-5. We evaluated the functional results of closed Neer's 2- and 3-part proximal humerus fractures treated by Joshi's external stabilizing system.Materials and Methods:Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi's stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer's classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6–8 weeks). Pain was evaluated by visual analogue scale (VAS) and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks.Results:Mean followup was of 20.5 months (range 9-30 months). Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average followup of 6 months. Mean duration for union was 6.5 (±1.18) weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted.Conclusion:External fixation by JESS is an alternative option to treat Neer's 2 and 3 part proximal humerus fractures with good results.

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Age‐ and sex‐related changes of humeral head microarchitecture: Histomorphometric analysis of 60 human specimens

Barvencik

Gebauer

Beil

et al. 2009

Journal Orthopaedic Research

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Fractures of the humeral head are frequent and will further increase due to demographic changes. Prior to operative fracture treatment, the regional differences of bone quality, especially of elderly people, have to be carefully considered to assure stable implant fixation. However, conclusive data concerning the variation of histomorphometric parameters are still lacking. Consequently, the purpose of this study was to analyze the age-and sex-related changes in bone microarchitecture. For that reason, 60 proximal humeri were harvested from patients at autopsy. Twelve regions of interest (ROI) were defined for each centered coronar humeral head slice and the specimens were subjected to radiographic, histological, and histomorphometric analyses. We could demonstrate that in contrast to men, women over 60 years of age had a significant age-related decrease in bone mass. The most prominent decrease was observed in the region of the greater tuberosity, which represents an osteoporotic fracture site. The most superior and medially located part of the centered coronar humeral head slice showed, independent from age and sex, the highest bone mass and can therefore be considered as the best location for subchondral screw placement. Taken together, our study revealed distinct sex-related changes of the humeral head bone microarchitecture with aging, which should be considered in implant positioning. ß

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Surgical Neck Fractures of the Proximal Humerus

Cited by 128 publications

References 21 publications

The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

Functional outcome of closed fractures of proximal humerus managed by Joshi’s external stabilizing system

Age‐ and sex‐related changes of humeral head microarchitecture: Histomorphometric analysis of 60 human specimens

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