scholarly journals Analysis of the subcapital two-part humerus fracture by fluoroscopy: objective criteria for classification and decision making

2021 ◽  
Author(s):  
Nicolas Bless ◽  
Nicola Keller ◽  
Amir Steinitz ◽  
Thibaut Klein ◽  
Daniel Rikli
Keyword(s):  
Decision Making ◽  
Proximal Humerus ◽  
Image Intensifier ◽  
Anatomical Landmarks ◽  
Proximal Point ◽  
Level Of Evidence ◽  
Lesser Tuberosity ◽  
Varus Angulation ◽  
Exact Degree ◽  
Humerus Fractures

Abstract Background Surgical decision making in the treatment of proximal humerus fractures (PHFx) is primarily based on fracture classification using standard radiographs. Due to the lack of objective criteria, this classification process is associated with high interobserver variation. In this study, we investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semi-quantitative determination of distinct angulation patterns of the proximal humerus as they appear in the image intensifier. Methods Using a saw bone model, defined subcapital 2-part fracture configurations were generated and assessed radiographically. Anatomical landmarks—including the greater and lesser tuberosity as well as anatomical neck—were identified using an image converter, and the exact degree of fracture displacement with 10° up to 70° (in 10° increments) of posterior, varus or combined posterior-varus angulation was compared to nondisplaced controls. From the resultant series of radiographs, the appearance of these angulations in anteroposterior (AP) and scapular Y-views were also visualized and defined. Results An angulation of 50° or more of any given 2-part fracture through the surgical neck is present when the greater tuberosity becomes the most proximal point in AP view (varus and combined posterior-varus angulation) or a bimodal form is found for the superior contour of the head with the lesser tuberosity being the most proximal point in the Y-view (posterior angulation). Conclusion The radiological appearance of various PHFx constellations can be well visualized using the saw bone shoulder model. The presence of angulation in accordance with the Neer classification for group III fractures can be adequately determined by analyzing the relative position of the greater or lesser tuberosity to the humeral head calotte. This can assist the surgeon’s decision on whether to operate or opt for a conservative approach. Level of evidence Basic Science, Anatomy Study, Imaging.

scholarly journals Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alejandro Garcia-Reza ◽  
Diego Matias Dominguez-Prado ◽  
Constantino Iglesias-Nuñez ◽  
Lucia Alvarez-Alvarez ◽  
Beatriz Hernandez-Gonzalez ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Proximal Humerus ◽  
Cox Regression ◽  
Survival Rates ◽  
Osteoporotic Fractures ◽  
Fundamental Parameter ◽  
Proximal Humerus Fractures ◽  
Level Of Evidence ◽  
Humerus Fractures

Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR  = 3.83; p  < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR  = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR  = 3.64; p  < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.

Epidemiology and Risk Factors of Humerus Fractures among Skiers and Snowboarders

2008 ◽  
Vol 36 (10) ◽  
pp. 1880-1888 ◽  
Author(s):  
Benjamin T. Bissell ◽  
Robert J. Johnson ◽  
Adam B. Shafritz ◽  
Derek C. Chase ◽  
Carl F. Ettlinger
Keyword(s):  
Risk Factors ◽  
Proximal Humerus ◽  
Similar Rate ◽  
Level Of Evidence ◽  
Helmet Use ◽  
Increased Risk ◽  
Humerus Fractures ◽  
And Gender ◽  
Left Humerus ◽  
Control Study

Background The incidence of humerus fractures while participating in snowboarding and skiing is undefined. Very little is known about the risk factors associated with these fractures. Hypothesis Snowboarders are at increased risk for sustaining humerus fractures when compared with skiers. In addition, the types of fractures, laterality, and risk factors differ between the 2 groups. Study Design Case-control study; Level of evidence, 3. Methods At a major ski area clinic, 318 humerus fractures were evaluated over 34 seasons. Radiographs were classified according to the AO and Neer systems. Patient data were analyzed and compared with that of a control population of uninjured skiers and snowboarders to determine incidence and risk factors. Results The incidence of humerus fractures among snowboarders (0.062 per 1000 snowboarder days) was significantly higher than that of skiers (0.041 per 1000, P < .05). Skiers were more likely to sustain proximal fractures, and snowboarders were relatively more likely to sustain diaphyseal and distal fractures ( P < .05). Of glenohumeral dislocations, 6.56% were associated with proximal humerus fractures among skiers (1.7% among snowboarders). Snowboarders who lead with their left foot were more likely to fracture their left humerus ( P = .023). Helmet use and gender were not risk factors for humerus fractures among either skiers or snowboarders. Jumping was involved in 28.3% of humerus fractures among snowboarders and in 5.4% among skiers. Skiers with humerus fractures were more skilled, older, and fell less frequently than controls. Snowboarders were less skilled, younger, and fell at a similar rate compared with controls. Conclusion Snowboarders are at significantly higher risk of sustaining humerus fractures than skiers. In skiers, humerus fractures show no laterality and most often involve the proximal humerus. In contrast, snowboarders more often fracture the left humerus at the diaphysis.

scholarly journals Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures—A Retrospective, Observational Study

2021 ◽  
Vol 10 (2) ◽  
pp. 175
Author(s):  
Jan-Philipp Imiolczyk ◽  
Philipp Moroder ◽  
Markus Scheibel
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Bone Ingrowth ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Proximal Humerus Fractures ◽  
Stem Design ◽  
Lesser Tuberosity ◽  
Scapular Notching ◽  
Humerus Fractures

Tuberosity healing and stem design can be outcome-dependent parameters in hemiarthroplasty for proximal humerus fractures (PHF). The relevance of fracture-specific stem design in reverse shoulder arthroplasty (RSA) is still a matter of debate. This retrospective study evaluates tuberosity healing and function for fracture specific stems (A) compared to conventional stems (B) in RSA for complex PHF in 26 patients (w = 21, mean age 73.5 years). Clinically, range of motion (ROM), Constant-Murley-Score (CS), Subjective Shoulder Value (SSV), and external rotation lag signs (ERLS) were evaluated. Healing of greater tuberosity (GT) and lesser tuberosity (LT), scapular notching, and loosening were examined radiologically. There were no statistical significant differences with regards to CS (A: 73 ± 11; B: 77 ± 9 points), SSV (A: 78% ± 11%; B: 84% ± 11%), external rotation (A: 18° ± 20°; B: 24° ± 19°), or internal rotation (A: 5.7 ± 2.2; B: 6.7 ± 2.8 CS-points) (p > 0.05). Mean forward flexion was superior for group A (p = 0.036). Consolidation of GT (82%) and LT (73%) was similar in both groups. Anatomical healing was slightly higher in group B (p > 0.05). Scapular notching was found in 27% (A) and 55% (B) (p > 0.05). RSA for PHF provides good to excellent clinical results. The quantitative and qualitative union rate for both cohorts was similar, indicating that fracture stems with open metaphyseal designs to allow for bone ingrowth do not improve tuberosity healing. ERLS correlates with a worse function in CS and ROM in all planes.

Difficulty in decision making in the treatment of displaced proximal humerus fractures: the effect of uncertainty on surgical outcomes

2018 ◽  
Vol 27 (3) ◽  
pp. 470-477 ◽  
Author(s):  
Joey LaMartina ◽  
Kaitlyn N. Christmas ◽  
Peter Simon ◽  
Jonathan J. Streit ◽  
Jesse W. Allert ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Outcomes ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Decision Making for the Treatment of Proximal Humerus Fractures

2002 ◽  
Vol 3 (4) ◽  
pp. 234-250 ◽  
Author(s):  
STUART J. ELKOWITZ ◽  
KENNETH J. KOVAL ◽  
JOSEPH D. ZUCKERMAN
Keyword(s):  
Decision Making ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Comorbidities, substance abuse, weight and age are independent risk factors for postoperative complications following operation for proximal humerus fractures: a retrospective analysis of 1109 patients

2021 ◽  
Author(s):  
Ralf Henkelmann ◽  
Jan Theopold ◽  
Jonas Kitsche ◽  
Paul-Vincent Link ◽  
Meinhard Mende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Abuse ◽  
Body Weight ◽  
Postoperative Complications ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Level Of Evidence ◽  
Operative Revision ◽  
Independent Risk Factors ◽  
Humerus Fractures

Abstract Introduction This study aimed to investigate the influence of epidemiologic parameters on complications that needed operative revision of operatively treated proximal humerus fractures. Methods We performed a retrospective single-center study in a level 1 trauma center. We included all patients with operatively treated proximal humerus fractures from January 1 2005 to December 31 2015. We characterized our cohort and subgroup using descriptive statistics. The primary outcome was postoperative complications. For this purpose, postoperative complications were defined in advance, an operative revision was necessary on a general rule. The secondary outcome was a model of the risk factors for complications created with multiple logistic regression. Results We included 1109 patients. The average age was 67.2 years (± 16.4), and 71.4% of the fractures occurred in women. A total of 644 patients (58.1%) had between one to three comorbidities, and 27.8% had four or more. The fracture morphology was as follows: 3 part 41.8%, 4 part 26.9%, 2 part 24.3%, and dislocation fracture 6.7%. Complications occurred in 150 patients (13.5%). The number of comorbidities [odds ratio (OR) 2.85, p < 0.01], body weight (OR 1.15, p = 0.02), and substance abuse (OR 1.82, p = 0.04) significantly correlated with the risk of complications. We achieved a sensitivity of 48% and a specificity of 74% for the variables body weight, substance abuse, age, and comorbidities Conclusion The epidemiologic parameters, comorbidities, substance abuse, weight, and age are independent risk factors for complications. If these factors are present, one can predict a postoperative complication requiring surgical revision with low sensitivity and moderate specificity. Therefore, concerning the high number of multi-morbid patients with proximal humerus fractures, an increased postoperative complication rate can be expected. Level of evidence Level of evidence IV

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