Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Ong, Crispin C; Bechtel, Christopher; Walsh, Michael; Zuckerman, Joseph D.; Egol, Kenneth A.

doi:10.1007/s11999-011-1864-4

Cited by 18 publications

(8 citation statements)

References 25 publications

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“…3,30 This also explains why QoL is lower when impairment affects the lower extremity. 7,27,29 We were able to show the influence on all scores by the patients' age, sex, and time of follow-up, and by the different fracture types. Multivariate regression analysis showed that a patient's age influenced the score more than fracture type.…”

Section: Discussionmentioning

confidence: 78%

“…Values above the US norm 12 were also documented in recently published literature comparing 3-and 4-part PHF with conservative treatment of 1-part fractures in a US cohort. 7 Furthermore, while both genders were almost equally distributed in the youngest group (A), there was an increasing dominance of females with rising age, which makes an average difference of approximately 4 points related to the gender in group D. We were not able to adjust the SF-36 accordingly, while it was possible to adapt the CMS for age and gender. 22 Unfortunately, a corresponding European norm for such comparisons is unavailable.…”

Section: Limitationsmentioning

confidence: 91%

“…[3][4][5] Interestingly, information on different types of implants and techniques is widely available, but little is known about the quality of life (QoL) after PHF. [6][7][8][9][10] Most studies focus on radiological findings and pure functional outcome only, whereas studies on subjective outcome are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life After Osteosynthesis of Fractures of the Proximal Humerus

Inauen

Platz

Meier

et al. 2013

Journal of Orthopaedic Trauma

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Section: Discussionmentioning

confidence: 78%

Section: Limitationsmentioning

confidence: 91%

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Quality of Life After Osteosynthesis of Fractures of the Proximal Humerus

Inauen

Platz

Meier

et al. 2013

Journal of Orthopaedic Trauma

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“…Locking plates have been successfully introduced in the treatment of proximal humerus fractures. [19][20][21][22] However, failure rates of up to 14% highlight the fact that not all problems associated with the treatment of this demanding type of fracture have been fully solved. 2,23,24 In addition to the general presence of osteoporosis, the local distribution of BMD within the humeral head may have a significant effect on the primary stability of an osteosynthesis because it remains unclear in what quality of bone stock within the humeral head the screws of a locking plate purchase and whether the areas with good bone quality are even reached by the screws.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Assessment of Local Bone Quality to Predict Failure of Locked Plating in a Proximal Humerus Fracture Model

Röderer¹,

Brianza²,

Schiuma³

et al. 2013

Orthopedics

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The importance of osteoporosis in proximal humerus fractures is well recognized. However, the local distribution of bone quality in the humeral head may also have a significant effect because it remains unclear in what quality of bone screws of standard implants purchase. The goal of this study was to investigate whether the failure of proximal humerus locked plating can be predicted by the DensiProbe (ARI, Davos, Switzerland). A 2-part fracture with metaphyseal impaction was simulated in 12 fresh-frozen human cadaveric humeri. Using the DensiProbe, local bone quality was determined in the humeral head in the course of 6 proximal screws of a standard locking plate (Philos; Synthes GmbH, Solothurn, Switzerland). Cyclic mechanical testing with increasing axial loading until failure was performed. Bone mineral density (BMD) significantly correlated with cycles until failure. Head migration significantly increased between 1000 and 2000 loading cycles and significantly correlated with BMD after 3000 cycles. DensiProbe peak torque in all screw positions and their respective mean torque correlated significantly with the BMD values. In 3 positions, the peak torque significantly correlated with cycles to failure; here BMD significantly influenced mechanical stability. The validity of the DensiProbe was proven by the correlation between its peak torque measurements and BMD. The correlation between the peak torque and cycles to failure revealed the potential of the DensiProbe to predict the failure of locked plating in vitro. This method provides information about local bone quality, potentially making it suitable for intraoperative use by allowing the surgeon to take measures to improve stability.

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“…Proximal humeral fracture accounts for 4–5% of all bone fractures, with the growing elderly population, the frequency is still increasing [ 1 – 3 ]. Roughly 20% of these fractures exhibit an unstable fracture pattern, which should be treated by surgery [ 4 ]. Numerous operative techniques have been used for fixing unstable fractures, including Kirschner wires, tension band sutures, intramedullary nails, prosthetic replacement and locking plates.…”

Section: Introductionmentioning

confidence: 99%

Correlation between classification and secondary screw penetration in proximal humeral fractures

et al. 2017

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ObjectivesIn this study, we investigated the correlation between fracture classification and secondary screw penetration.MethodsWe retrospectively identified 189 patients with displaced proximal humeral fractures treated by ORIF at our hospital between June 2006 and June 2013. All fractures were classified radiographically before surgery and follow-up for least 2 years after surgery was recommended. At each follow-up, radiographs were taken in three orthogonal views to evaluate secondary screw penetration.ResultsThe study population consisted of 189 patients. Of these, 70 were male and 119 female, with a mean age of 59.1 years; the mean follow-up time was 28.5 months. Secondary screw penetration occurred in 26 patients. The risk of developing secondary screw penetration was 11.3-fold higher in four-part fractures than two-part fractures (P < 0.05), 8.6-fold higher for type C fractures than type A fractures (P < 0.05) and 11.0-fold higher for medial hinge disruption group than intact medial hinge group fractures (P < 0.05). However there was no difference between three-part fractures and two-part fractures (P = 0.374), and between type B and type A fractures (P = 0.195). Age, gender, time to surgery and the number of screw in humeral head had no influence on the secondary screw penetration rate (P > 0.05).ConclusionsPatients with four-part fractures, type C fractures and medial hinges disruption are vulnerable to secondary screw penetration. This allows additional precautions to be instituted and measures to be taken as needed.

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Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Cited by 18 publications

References 25 publications

Quality of Life After Osteosynthesis of Fractures of the Proximal Humerus

Quality of Life After Osteosynthesis of Fractures of the Proximal Humerus

Mechanical Assessment of Local Bone Quality to Predict Failure of Locked Plating in a Proximal Humerus Fracture Model

Correlation between classification and secondary screw penetration in proximal humeral fractures

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