Risk Factors and Prognosis of Humeral Head Inferior Subluxation in Proximal Humeral Fractures after Osteosynthesis

Proximal humerus presents the second most frequent site of posttraumatic osteonecrosis. This complication is usually related to poor functional outcomes. The aim of this study is to identify and analyze the risk factors for posttraumatic humeral head osteonecrosis in surgically treated patients. Ninety-one patients with 92 acute proximal humeral fractures were operated on for a period of 39 months. Operative methods include open reduction and internal fixation and closed reduction and percutaneous fixation. Fractures were classified according to Neer, AO and LEGO classifications. The mean age of patients was 60.9 years. From 91 operated patients for follow-up were available 82. The mean follow-up period was 15 months. Patient data was collected prospectively. Functional results are present using age and gender adjusted Constant score. In 41 patients, the result is excellent, in 28-good, in 11-fair and in 3 poor. Bone union was evident in all cases. No deep wound infections, nerve injuries, vascular injuries and implant failure were observed. Osteonecrosis was seen in 5 (6.1%) patients. Patients with posttraumatic osteonecrosis had significant lower Constant results. Analyzing the pre- and intraoperative factors in patients with osteonecrosis, we find that the most significant factors for this complication are increasing fracture severity and а combination of short medial metaphyseal extension and disrupted medial hinge.

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Risk factors for secondary displacement in conservatively treated proximal humeral fractures

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2020-0045.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 881-889

Author(s):

Florian A. Frank ◽

Richard Niehaus ◽

Paul Borbas ◽

Karim Eid

Keyword(s):

Risk Factors ◽

Alcohol Abuse ◽

Conservative Treatment ◽

Humeral Head ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Secondary Fracture ◽

Secondary Displacement ◽

The Mean

Aims Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making. Methods A total of 163 shoulders in 162 patients with conservatively treated isolated proximal humeral fractures were included. The fractures occurred between January 2015 and May 2018. The mean age of the patients was 69 years (26 to 100) and the mean follow-up was 144 days (42 to 779). The fractures were classified according to Neer. Scores for osteoporosis (Tingart, Deltoid Tuberosity Index (DTI)) and osteoarthritis (OA) of the glenohumeral joint were assessed. Translation of the head on follow-up radiographs of more than 10 mm was defined as displacement. Eccentric head index (EHI) describes the offset of the humeral head centre in relation to the diaphyseal axis. The ratio was estimated on anteroposterior (AP) and Neer views. Medial hinge was considered intact if the medial cortex proximal and distal to the fracture was in line on AP view. Results Secondary fracture displacement occurred in 41 patients (25.2%). Clinical risk factors were alcohol abuse (odds ratio (OR) 6.8; 95% confidence interval (CI) 1.3 to 36; p = 0.025) and previously diagnosed osteoporosis (OR 4.6; 95% CI 0.6 to 34; p = 0.136). Age (OR 1.1; 95% CI 1.0 to 1.1; p = 0.003) and sex (OR 0.9; 95% CI 0.3 to 2.8; p = 0.867) were not independent factors. Radiological risk factors were OA grade 3 (OR 16.4; 95% CI 0.25 to 37.6; p = 0.107) and osteoporosis with the DTI (OR 10; 95% CI 0.8 to 250; p = 0.031) being more predictive than the Tingart score (OR 2.3; 95% CI 0.8 to 4.7; p = 0.041). A high EHI (AP/Neer > 0.4, OR 18.9; 95% CI 2.1 to 30.9/3.0; 95% CI 1.1 to 8.0; p = 0.002/p = 0.033) and a disrupted medial hinge (OR 3.7; 95% CI 1.1 to 12.6; p = 0.039) increased the risk of secondary displacement significantly. Neer classification had no influence. Conclusion During conservative treatment, a quarter of patients showed secondary fracture displacement of at least 10 mm. Patients with alcohol abuse, severe OA, and osteoporosis are at risk. Newly defined EHI and disrupted medial hinge are relevant predictors for secondary displacement. Cite this article: Bone Joint J 2020;102-B(7):881–889.

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Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures

Injury ◽

10.1016/j.injury.2015.10.001 ◽

2016 ◽

Vol 47 (2) ◽

pp. 350-355 ◽

Cited By ~ 22

Author(s):

Sandra Boesmueller ◽

Margit Wech ◽

Markus Gregori ◽

Florian Domaszewski ◽

Adam Bukaty ◽

...

Keyword(s):

Risk Factors ◽

Humeral Head ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Non Union ◽

Humeral Head Necrosis

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Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.75b1.8421010 ◽

1993 ◽

Vol 75-B (1) ◽

pp. 132-136 ◽

Cited By ~ 161

Author(s):

CH Brooks ◽

WJ Revell ◽

FW Heatley

Keyword(s):

Humeral Head ◽

Cadaver Study ◽

Proximal Humeral Fractures ◽

Humeral Fractures

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

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.03.025 ◽

2021 ◽

Vol 30 (7) ◽

pp. e426-e427

Author(s):

Guy Emile Putzeys

Keyword(s):

Humeral Head ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Secondary Complications ◽

Plate Technique

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Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation ? introduction of a new treatment concept

Langenbeck s Archives of Surgery ◽

10.1007/s00423-002-0286-x ◽

2002 ◽

Vol 387 (3-4) ◽

pp. 153-160 ◽

Cited By ~ 14

Author(s):

Cyrus Khodadadyan-Klostermann ◽

Michael Raschke ◽

Roger Fontes ◽

Ingo Melcher ◽

Allen Sossan ◽

...

Keyword(s):

Minimally Invasive ◽

Humeral Head ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Treatment Concept ◽

Wire Fixation ◽

New Treatment ◽

Complex Proximal Humeral Fractures ◽

Minimally Invasive Fixation

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Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001711010297 ◽

2017 ◽

Vol 11 (1) ◽

pp. 297-308

Author(s):

Dominik Saul ◽

Tobias Himmelmann ◽

Klaus Dresing

Keyword(s):

Predictive Factors ◽

Humeral Head ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Anatomic Reconstruction ◽

Daily Routine ◽

X Rays ◽

Tip Apex Distance ◽

Over Time

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.

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Study of Bone Quality and Fracture Line Morphology of the Posterior Medial Humeral Calcar in Proximal Humeral Fractures

10.21203/rs.3.rs-934274/v1 ◽

2021 ◽

Author(s):

Zheng Xu ◽

Ming Xiang ◽

Jinsong Yang ◽

Xu Gao ◽

Yi Cao

Keyword(s):

Bone Density ◽

Bone Quality ◽

Humeral Head ◽

External Rotation ◽

Three Dimensional ◽

Fracture Morphology ◽

Proximal Humeral Fractures ◽

Fracture Line ◽

Humeral Fractures ◽

Greater Tuberosity

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.

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