Surgical treatment of proximal humeral fracture with external fixator

Zhang, Jingwei; Ebraheim, Nabil A.; Lausé, Gregory E.

doi:10.1016/j.jse.2011.07.005

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…The average age of the patients was 65 years (range 45–90 years), 14 (70%) were female. Seventeen patients underwent a reduction and fixation using an external fixator, two a reverse total shoulder arthroplasty and one hemiarthroplasty . For descriptive purpose, patients were divided into two subgroups according to the delay of surgery.…”

Section: Resultsmentioning

confidence: 99%

Effect of surgical delay on bacterial colonization in proximal humeral fractures

Blonna

Prun

Bellato

et al. 2015

Journal Orthopaedic Research

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Postoperative infection is a severe complication after proximal humeral fracture surgical treatment. The aim of this study was to determine if the surgical delay could modify the number and type of bacteria on the surgical site. A two stages study was set up. In the first stage the effect of delay was simulated in 20 patients affected by proximal humeral fracture treated conservatively. In a second stage, the effect of delay was measured in 20 patients that underwent surgery. In stage 1, three skin culture swabs were taken in correspondence of the deltopectoral approach, the day of the fracture (day 0), the day after (day 1), and five days after fracture (day 5). In stage 2, skin swab cultures were taken the day of trauma and immediately before surgery and cultured on various media suitable for aerobic and anaerobic bacteria. The number of bacteria increased over the course of the study, from day 0 to day 5, both considering the total number of colony-forming units and individual species of pathogen bacteria. The second stage of the study confirmed these data. An increasing number of bacteria was observed in patients that underwent surgery later than 2 days from trauma. The delay of surgery increased bacterial colonization of the skin in the deltopectoral approach area including common pathogenic bacteria such as Staphylococcus aureus, coagulase-negative staphylococci and Propionibacterium acnes. This might justify the correlation between delay to surgery and risk of infection.

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Section: Resultsmentioning

confidence: 99%

Effect of surgical delay on bacterial colonization in proximal humeral fractures

Blonna

Prun

Bellato

et al. 2015

Journal Orthopaedic Research

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“…It is hypothesized that the main causes of this issue were the isolation and the fear of contagion in hospital environment [10] (Figure 1). considered, but in the end it was discarded because of the high risk of avascular necrosis of the fragments [13]. To minimize the intraoperative jeopardy to the blood supply of the humeral head and avoid the complications of ORIF (blood loss, operating times, hardware migration requiring a second operation) [14], a minimally invasive first treatment was chosen.…”

Section: Discussionmentioning

confidence: 99%

"How COVID-19 Pandemic Indirectly Affected Orthopedic Patients: A Case Report of a Rescue Treatment For a Proximal Humerus Nonunion"

Rm¹,

Reina²,

Nesta

et al. 2021

BJSTR

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The management of proximal humerus fracture is often challenging for orthopedic surgeons. Most of these fractures, in fact, occurs in old women with poor bone quality. Risk of loosening or nonunion and risk of avascular necrosis of humeral head is high, especially in four-parts fractures. We present a case of a 69-year-old woman with proximal humeral nonunion associated with a humeral head osteonecrosis. The peculiarity of this case is that the patient had no follow-up for 7 months because of the Covid-19 pandemic and the restrictions that resulted. We intend to describe how this social situation forced us to change our strategy of treatment and to discuss how to face the possible consequences in orthopedic practice.

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“…4 El tratamiento con tutor externo puede indicarse a pacientes con fracturas expuestas con pérdida ósea segmentaria, lesión neurovascular abierta, falta de consolidación infectada y a politraumatizados. 7 El uso del tutor externo tiene las siguientes ventajas: se logra una mayor estabilidad del sistema y permite realizar la compresión del foco, lo que hace posible la movilidad precoz y tasas de consolidación más altas, a diferencia de los tutores modulares AO, que tienen mayor inestabilidad y alta tasa de aflojamiento de los clavos. 7 Las complicaciones más frecuentes son: la infección de los tornillos de Schanz (12-50%), las molestias y el aspecto estético por el dispositivo.…”

Section: Caso Clínicounclassified

“…7 El uso del tutor externo tiene las siguientes ventajas: se logra una mayor estabilidad del sistema y permite realizar la compresión del foco, lo que hace posible la movilidad precoz y tasas de consolidación más altas, a diferencia de los tutores modulares AO, que tienen mayor inestabilidad y alta tasa de aflojamiento de los clavos. 7 Las complicaciones más frecuentes son: la infección de los tornillos de Schanz (12-50%), las molestias y el aspecto estético por el dispositivo. 7 En pacientes con fracturas expuestas de húmero por arma de fuego y lesiones del nervio radial, la conducta debe ser quirúrgica, con una exploración inicial para evaluar la indemnidad del nervio y la posibilidad de realizar una reparación primaria.…”

Section: Caso Clínicounclassified

“…7 Las complicaciones más frecuentes son: la infección de los tornillos de Schanz (12-50%), las molestias y el aspecto estético por el dispositivo. 7 En pacientes con fracturas expuestas de húmero por arma de fuego y lesiones del nervio radial, la conducta debe ser quirúrgica, con una exploración inicial para evaluar la indemnidad del nervio y la posibilidad de realizar una reparación primaria. 8,9 Ante lesiones complejas del nervio periférico, existen alternativas terapéuticas para restaurar el balance y la funcionalidad de la extremidad, como neurotización, aloinjertos y transferencias tendinosas.…”

Section: Caso Clínicounclassified

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Extremidad superior gravemente lesionada. Reporte de un caso clínico. [Mangled upper extremity. Case report]

Villanueva

Villalobos

Núñez

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Se presenta un paciente con una extremidad superior gravemente lesionada por arma de fuego. Inicialmente fue tratado con múltiples limpiezas quirúrgicas y colocación de tutor externo AO. El tratamiento definitivo consistió en tutor externo monolateral, además de injerto estructural de cresta ilíaca. Durante el manejo inicial, se detecta lesión del nervio radial, con nervio en continuidad. Dado el proceso cicatricial y la infección de partes blandas, no se logra manejar en la etapa aguda. Posteriormente se realizan transferencias tendinosas para nervio radial. La evolución fue favorable y la función de la extremidad superior resultó satisfactoria. Se comunica este caso debido a su complejo manejo a causa de las lesiones óseas, neurovasculares, cutáneas y de partes blandas. AbstractWe present a patient with a severely injured upper extremity due to a shotgun. Patient was initially managed with multiple surgical debridements and an AO external fixator.Final treatment was performed with a monolateral external fixator, in addition to an iliac crest structural bone graft. During initial management, a radial nerve injury was observed;the nerve was intact, though devitalized. Given the scarring process and soft tissue infection, treatment was performed in the acute phase. Subsequently, tendon transfers were made to treat a radial nerve injury. Patient evolved favorably and regained adequate function of the upper extremity.This case is presented due to its complex management due to bone, neurovascular, skin, and soft tissue involvement.

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Surgical treatment of proximal humeral fracture with external fixator

Cited by 16 publications

References 20 publications

Effect of surgical delay on bacterial colonization in proximal humeral fractures

Effect of surgical delay on bacterial colonization in proximal humeral fractures

"How COVID-19 Pandemic Indirectly Affected Orthopedic Patients: A Case Report of a Rescue Treatment For a Proximal Humerus Nonunion"

Extremidad superior gravemente lesionada. Reporte de un caso clínico. [Mangled upper extremity. Case report]

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