The anterolateral approach to the proximal humerus for nonunions and delayed unions

Hettrich, Carolyn M.; Paul, Omesh; Neviaser, Andrew S.; Borsting, Emily Ann; Lorich, Dean G.

doi:10.4103/0973-6042.80466

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Our study has a female-predominant population (M:F=2:4) like most of the studies, e.g. : Badman et al (0:18), Hettrich et al (0:3), Ahrens et al (1:4), Allende and Allende (0:7), Gao et al (2:5), Quadlbauer et al (3:6) [ 16 , 17 , 21 - 24 ].…”

Section: Discussionmentioning

confidence: 76%

“…Badman et al treated 18 patients with fibular allograft and the fixed-angle device showed union in 17 patients [ 16 ]. However, the ideal treatment for this disabling condition remains unclear and largely depends on the judicious use of treatment methods and surgical expertise [ 17 ]. We have noticed scalloping of the humeral head, bone gap, and local (or generalized) osteoporosis in all the cases, probably due to late presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Different methods of osteosynthesis, implants, and arguments have been described with variable success rates, including inserting the shaft into the head, using an intramedullary cortical graft, blade plate, locking plate, and intramedullary nail including Polarus interlocking nail [ 10 - 13 ]. Functional outcome of PHN using a locking plate or blade plate with or without bone graft is comparable [ 14 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Mukhopadhaya,

Singh,

Gupta

et al. 2024

jocr

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Introduction: It can be challenging to treat proximal humeral non-union (PHN). The challenge gets compounded when they are presented either late or after previous surgery. The challenges are far greater due to small proximal fragments, scalloping of the head, medial bone defect, osteoporosis, soft tissue contractures, and problems related to the previous implants. Materials and Methods:In this retro-prospective study (2007–2020), we report on six cases of PHN which were presented to us more than 5 years after the original injury and managed using an intra-medullary autologous fibular strut graft (FSG) along with fixation with a proximal humeral locking plate and cancellous bone grafting. We quantified shoulder function based on constant score and disabilities of the arm, shoulder and hand (DASH) score. Results: The mean age of patients is found to be 54.3 years (range, 22–74 years) with females dominating our study. The mean pre-operative constant score is 26.33 which improved to 71.83 in the post-operative period. The mean DASH score is 77.98 preoperatively, which improved to 19.5 postoperatively. The paired sample t-test compared the difference in mean of the pre-operative and post-operative scores, which shows significant improvement in outcome. Conclusion: Even in very late PHN in poor-quality bone, the additional use of intramedullary strut grafts provides structural support to the fixation and further enhances the ability to withstand the load-start early motion and have a satisfactory functional outcome. Keywords: Non-union, proximal humerus non-union, proximal humerus fracture, proximal humerus internal locking system, locking plate, autogenous fibular strut graft.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Mukhopadhaya,

Singh,

Gupta

et al. 2024

jocr

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“…Other common treatments of intra-articular or distal humeral atrophic non-union include elbow arthrodesis, arthroplasty 16 , allografts 17e20 , open reduction and internal fixation 21 , prosthesis 22 or the Ilizarov technique 23 . From these options, we have chosen the posterior plate to reduce the distracting forces and used the opposing anterior bone splint to further increase stability at the fracture site 17e19, 24 . Besides stability, the osteo-inductive and osteo-formative abilities of the bone strut, bone chips and bone paste, provided a second mechanism to increase fracture healing and addition of mechanical load transfer 2,5,6,20,25 .…”

Section: Discussionmentioning

confidence: 99%

Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series

Rollo

Prkić

Pichierri

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Introduction: Non-union after humeral shaft fractures are seen frequently in clinical practice. The incidence is 2e10% after conservative management and up to 30% after surgical treatment. The purpose of this study is to evaluate the outcomes of plate-and-bone-strut-allograft technique with bone chip augmentation for aseptic non-unions of the distal third of the humerus. Materials and methods: 26 consecutive cases were treated using a trans-triceps approach. The non-union was fixed with a 4.5 mm Locking Compression Plate combined with a strut bone allograft at the anterior part of the humerus and bone chips. All patients underwent the same rehabilitation protocol of 12 weeks. Clinical evaluation took place 12 months after surgery with the Mayo elbow score and Oxford elbow score. Results: Complete bone healing without complications was achieved in all 26 patients. The average period of radiographic union was 106 days. The average range of flexion-extension was 108 (94 e180 ) and pro-supination was 159 (102 e180 ). Twelve months after surgery, average Mayo elbow score was 86 (68e100) and the Oxford elbow score was 83 (52e100). Conclusion:The plate-and-bone-strut-allograft technique with bone chip augmentation in distal humeral shaft for aseptic non-unions resulted in union of all cases. No adverse events related to the surgery or the materials used were documented.

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“…The senior author favors the anterolateral approach for ORIF of proximal humerus fractures, both in the acute setting and in cases of nonunion [40]. The incision is centered between the anterior and middle heads of the deltoid, with the proximal extent of the incision approximately one finger breadth proximal to the anterolateral border of the acromion [39•].…”

Section: Authors Preferred Technique: Surgical Approachmentioning

confidence: 99%

Open reduction internal fixation of proximal humerus fractures

Berkes

Little

Lorich

2013

Curr Rev Musculoskelet Med

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The treatment of proximal humerus fractures continues to evolve. While the many of these injuries can be managed nonoperatively, a certain percentage require operative treatment. Open reduction internal fixation can offer excellent outcomes when performed in the appropriate patient and utilizing proper techniques. This article reviews the most up-to-date literature regarding all phases of proximal humerus fracture osteosynthesis, including diagnosis, imaging, anatomic considerations, surgical indications, fixation, and surgical outcomes.

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The anterolateral approach to the proximal humerus for nonunions and delayed unions

Cited by 6 publications

References 22 publications

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Plate-and-bone-strut fixation of distal third humeral shaft aseptic non-unions: A consecutive case series

Open reduction internal fixation of proximal humerus fractures

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