The humeral head push-pull plate technique significantly diminishes secondary complications in the Treatment of Osteoporotic Varus Displaced Proximal Humeral Fractures

2021 ◽  
Vol 30 (7) ◽  
pp. e426-e427
Author(s):  
Guy Emile Putzeys
Author(s):  
Ryogo Furuhata ◽  
Noboru Matsumura ◽  
Ryosuke Tsujisaka ◽  
Satoshi Oki ◽  
Yusaku Kamata ◽  
...  

2017 ◽  
Vol 11 (1) ◽  
pp. 297-308
Author(s):  
Dominik Saul ◽  
Tobias Himmelmann ◽  
Klaus Dresing

Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS®plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.


2021 ◽  
Author(s):  
Zheng Xu ◽  
Ming Xiang ◽  
Jinsong Yang ◽  
Xu Gao ◽  
Yi Cao

Abstract Objective: To investigate the relationship between fracture line morphology, bone quality and fracture morphology of the posterior medial humeral calcar in proximal humeral fractures METHODS: CT data of patients with proximal humeral fractures diagnosed in our hospital from 06/2019 to 06/2021 were retrospectively analyzed to describe the map and coordinate analysis of the posterior medial humeral calcar fracture based on three-dimensional reconstruction, to create varus, valgus and normal groups according to the inclination angle of the humeral head, and to measure the bone mass of the posterior medial humeral calcar and perform statistical analysis.RESULTS: Sixty-two patients met the inclusion criteria, aged 15 to 72 years, there were 21 varus, 24 valgus and 17 normal types. Epiphyseal extension occurred most frequently posteriorly and medially, with the fracture line ending mostly posterior to the greater tuberosity. The thickness of the varus was (2.33 ± 0.47), valgus was (2.59 ± 0.33) and normal type was (2.69 ± 0.53). The T-test showed that the thickness of the bone in the varus was less than the other two types, and bone density and pinch angle were no statistically significant.CONCLUSION: There is no correlation between the trend of the posterior medial fracture line of the humeral calcar, bone density and internal, external rotation of the humeral head. The medial bone thickness after varus is less than that of valgus and normal fractures. The fracture line endpoint is mostly located posterior to the greater tuberosity.


Orthopedics ◽  
1998 ◽  
Vol 21 (1) ◽  
pp. 68-73
Author(s):  
William N Levine ◽  
Patrick M Connor ◽  
Ken Yamaguchi ◽  
Edward B Self ◽  
Julian S Arroyo ◽  
...  

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Mohammad Maddah ◽  
Wolf C. Prall ◽  
Lucas Geyer ◽  
Stefan Wirth ◽  
Wolf Mutschler ◽  
...  

The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (<em>vs</em> 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded.


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