How do surgical and non-surgical treatments compare for proximal humeral fractures in adults?

2016 ◽  
Keyword(s):  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Surgical Treatments

scholarly journals Inter-rater agreement among shoulder surgeons on treatment options for proximal humeral fractures among shoulder surgeons

2022 ◽  
Author(s):  
Hyojune Kim ◽  
Si-Jung Song ◽  
In-Ho Jeon ◽  
Kyoung Hwan Koh
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Clinical Information ◽  
Fracture Pattern ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Rater Agreement ◽  
Neer Classification ◽  
Conservative And Surgical Treatment ◽  
Surgical Treatments

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures.Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomograms of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed.Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity.Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

scholarly journals Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 635
Author(s):  
Florian Freislederer ◽  
Susanne Bensler ◽  
Thomas Specht ◽  
Olaf Magerkurth ◽  
Karim Eid
Keyword(s):  
Closed Reduction ◽  
Biceps Tendon ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Constant Murley Score ◽  
Fractures In Children ◽  
Initial Surgery ◽  
Conjoint Tendon

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.

scholarly journals Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiantao Li ◽  
Yuan Gao ◽  
Caixia Yin ◽  
Hao Zhang ◽  
Shaobo Nie ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Humeral Fracture ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Dash Score ◽  
Peek Cage ◽  
Polyether Ether Ketone ◽  
Stable Osteosynthesis ◽  
Long Term Follow Up

Abstract Background The treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP). Methods A total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up. Results The average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients. Conclusion The use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

scholarly journals Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0206349 ◽  
Author(s):  
Jan Theopold ◽  
Stefan Schleifenbaum ◽  
Mirijam Müller ◽  
Michael Werner ◽  
Niels Hammer ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Biomechanical Evaluation

Cemented vs Uncemented Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures

2021 ◽  
Author(s):  
Luciano A. Rossi ◽  
Bruchmann Maria Guillermina ◽  
Martin Buljubasich ◽  
Nicolás Atala ◽  
Ignacio Tanoira ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures
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