scholarly journals Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures

2020 ◽  
Author(s):  
Lukas Dankl ◽  
Werner Schmoelz ◽  
Romed Hoermann ◽  
Simon Euler
Keyword(s):  
Humeral Head ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Test Group ◽  
The Elderly ◽  
Bending Test ◽  
Control Group ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Abstract Introduction Proximal humerus fractures are common injuries of the elderly. Different treatment options, depending on fracture complexity and stability, have been recommended in the literature. Particularly for varus displaced fractures with a lack of medial support, and patients suffering from osteoporosis, structural allografts can be used to enhance the stability of the construct. An individually shaped allograft has been suggested in the literature and investigated in a clinical setting. However, biomechanical properties have yet to be evaluated. Materials and methods Twenty-four fresh-frozen humeri and 12 femoral heads were obtained, and an unstable three-part fracture of the humeral head was simulated. Fracture fixation was achieved by using a locking plate in both groups. In the test group, a mushroom-shaped allograft was tailored out of a femoral head to individually fit the void inside the humeral head. Specimens were fitted with a 3D motion analysis system and cyclically loaded with a stepwise increasing load magnitude in a varus-valgus bending test until failure or up to a maximum of 10,000 load cycles. Results The mushroom group reached a significantly higher number of load cycles (8342; SD 1,902; CI 7133–9550) compared to the control group (3475; SD 1488; CI 2530–4420; p < 0.001). Additionally, the test group showed significantly higher stiffness values concerning all observational points (p < 0.001). Conclusion This mushroom-shaped allograft in combination with a locking plate significantly increased load to failure as well as stiffness of the construct when exposed to varus-valgus bending forces. Therefore, it might be a viable option for surgical treatment of unstable and varus displaced proximal humerus fractures to superiorly prevent loss of reduction and varus collapse.

scholarly journals Mechanical Quantification of Local Bone Quality in the Humeral Head: A Feasibility Study

2013 ◽  
Vol 7 (1) ◽  
pp. 172-176 ◽  
Author(s):  
Alexander Scola ◽  
Florian Gebhard ◽  
Sebastian Weckbach ◽  
Christoph Dehner ◽  
Ronald Schwyn ◽  
...  
Keyword(s):  
Bone Quality ◽  
Humeral Head ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Statistical Significance ◽  
Measurement Tool ◽  
Proximal Humerus Fractures ◽  
Local Bone ◽  
Breakaway Torque ◽  
Humerus Fractures

Objectives: Surgical treatment of proximal humerus fractures can be challenging due to osteoporosis. The weak bone stock makes stable implant anchorage difficult, which can result in low primary stability. Accordingly, significant failure rates, even with modern locking plates, are reported in the literature. Intraoperative knowledge of local bone quality could be helpful in improving results. This study evaluates the feasibility of local bone quality quantification using breakaway torque measurements. Materials and Methods: A torque measurement tool (DensiProbe™) was developed to determine local resistance to breakaway offered by the cancellous bone in the humeral head to quantify local bone quality. The tool was adapted to a standard locking plate (PHILOS, Synthes), allowing measurement in the positions of the six humeral head screws, as provided by the aiming device of the plate. Two hundred and seventy measurements were performed in 44 fresh cadaveric human humeri. Results: Handling of the tool was straight forward and provided reproducible results for the six different positions. The method allows discrimination between the respective positions with statistical significance, and thus provides reliable information on the local distribution of bone quality within the humeral head. Discussion: This study introduces a new method using breakaway torque to determine local bone quality within the humeral head in real time. Because DensiProbe is adapted to a standard locking plate, there is the potential for intraoperative application. The information provided could enable the surgeon to improve fixation of osteoporotic proximal humerus fractures.

scholarly journals A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Wang ◽  
Yan Wang ◽  
Jinye Dong ◽  
Yu He ◽  
Lianxin Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Shoulder Joint ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Anterolateral Approach ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

A systematic review of locking plate fixation of proximal humerus fractures

Injury ◽  
2011 ◽  
Vol 42 (4) ◽  
pp. 408-413 ◽  
Author(s):  
Robert C. Sproul ◽  
Jaicharan J. Iyengar ◽  
Zlatko Devcic ◽  
Brian T. Feeley
Keyword(s):  
Systematic Review ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

scholarly journals Treatment of proximal humerus fractures in the elderly

2015 ◽  
Vol 86 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Antti P Launonen ◽  
Vesa Lepola ◽  
Tapio Flinkkilä ◽  
Minna Laitinen ◽  
Mika Paavola ◽  
...  
Keyword(s):  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

TREATMENT OF PROXIMAL HUMERUS FRACTURES AND OUTCOME – A PROSPECTIVE STUDY

2021 ◽  
pp. 84-87
Author(s):  
S. Kishore Babu ◽  
S. Rajeswara Rao ◽  
Pamu.bala Avinash
Keyword(s):  
Closed Reduction ◽  
Evaluation Method ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Method Comparison ◽  
Fracture Pattern ◽  
Proximal Humerus Fractures ◽  
Chi Square ◽  
Study Results ◽  
Humerus Fractures

BACKGROUND: Proximal humerus fractures are commonest fractures account for about 4 – 5% of the fractures.Complicated fracture pattern in proximal humerus are increasing due to increase inincidence of high velocity trauma. Because of inconsistency in fracture classication, treatment and evaluation method,comparison of these fractures are impeded. This studydetermines and compare the results of different modalities of xations in proximal humerus fractures and outcome. MATERIALS AND METHODS: This study was done from August 2018 to February 2020 in king Georgehospital,Visakhapatnam. Total 32 patients with proximal humerus fractures were operatedwith different modalities depend on fracture pattern.The results were evaluated using the Neers Shoulder Scoring System. RESULTS:The results show that most Neer's two part fracture had excellent to satisfactory results (85%). Neer's three part fracture also had 73% excellent to satisfactory results. Neer's four part fracture which went into failure. This study results were compared with other studies by using chi square test. CONCLUSION: The management modality depended on the pattern of the fracture andthequality of the bone .The patient's goals with treatment options for these displaced fractures included closed reduction and percutaneous screws xation (13% cases), closed reduction and percutaneous k- wires xation (9% cases) ,open reduction and internal xation (78 % cases).

Pectoralis Major Insertional Ratio in Proximal Humerus Fractures: A Method to Reconstruct Humeral Head Height in Arthroplasty

Orthopedics ◽  
2009 ◽  
Vol 32 (10) ◽  
pp. 729-734 ◽  
Author(s):  
S. Ashfaq Hasan ◽  
Russell B. Rauls ◽  
Cari L. Cordell ◽  
Andrew D. Heinzelmann ◽  
Eric R. Siegel
Keyword(s):  
Humeral Head ◽  
Proximal Humerus ◽  
Pectoralis Major ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Head Height

Trends in Surgical Management and Costs for Operative Treatment of Proximal Humerus Fractures in the Elderly

Orthopedics ◽  
2017 ◽  
Vol 40 (4) ◽  
pp. e641-e647 ◽  
Author(s):  
Eddie K. Hasty ◽  
Edward W. Jernigan ◽  
Adrianne Soo ◽  
Dax T. Varkey ◽  
Ganesh V. Kamath
Keyword(s):  
Surgical Management ◽  
Operative Treatment ◽  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures
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