Chapter 28 INTRAMEDULLARY CEMENT FIXATION OF PROXIMAL HUMERAL FRACTURES IN THE ELDERLY PATIENT

2002 ◽  
Keyword(s):  
Elderly Patient ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures

scholarly journals Humeral Head Replacement and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humerus Fracturesm

2017 ◽  
Vol 11 (1) ◽  
pp. 1108-1114 ◽  
Author(s):  
Aaron Andrew Frombach ◽  
Kendra Brett ◽  
Peter Lapner
Keyword(s):  
Shoulder Arthroplasty ◽  
New Technology ◽  
Reverse Shoulder Arthroplasty ◽  
Standard Of Care ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Current Evidence ◽  
Complication Rates ◽  
Surgical Fixation

Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain. While not conclusive, the evidence suggests that reverse shoulder arthroplasty yields more consistent results, with improved forward elevation and higher functional outcome scores. The primary advantages of hemiarthroplasty are improved shoulder rotation and shorter operative time. Complication rates do not vary significantly between the two options. Although higher quality trials are needed to further define the role of reverse shoulder arthroplasty, current evidence suggests that this is a reasonable option for surgeons who are highly familiar with its use.

scholarly journals Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications

2007 ◽  
Vol 33 (5) ◽  
pp. 512-519 ◽  
Author(s):  
Michael Dietrich ◽  
Christoph Meier ◽  
Daniela Zeller ◽  
Patrick Grueninger ◽  
Roger Berbig ◽  
...  
Keyword(s):  
Functional Outcome ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Social Implications

scholarly journals Clinico-radiological and functional outcome of Neer’s 2 part, 3 part and 4 part proximal humeral fractures in elderly treated by conservative management in a tertiary care centre of North India

2021 ◽  
Author(s):  
Pankaj Spolia ◽  
Abdul Ghani
Keyword(s):  
Elderly Patients ◽  
Prospective Study ◽  
Functional Outcome ◽  
Constant Score ◽  
Tertiary Care ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
North India ◽  
Excellent Outcome

<p><strong>Background:</strong> Treatment of proximal humeral fractures is challenging. Despite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for the elderly patients. The aim of this prospective study was to evaluate the radiological in terms of union and functional outcome in terms of pain, range of motion of conservatively managed proximal humeral fractures in elderly patients.</p><p><strong>Methods:</strong> This was an observational prospective study of 35 patients aged above 65 years with proximal humeral fractures including 2 part, 3 part and 4 part based on Neer’s classification, treated by conservative method. Functional outcome was assessed by using Constant score at follow up of 1 year.</p><p><strong>Results: </strong>Out of 35 patients, 21(60%) were female and 14 (40%) were male with mean age of 76.8 (range 65 to 91years). On the basis of Neer’s classification, majority of patients (15, 42.8%) had 3 part fracture. Radiological union was achieved within 13 to 24 weeks, with an average of 18.4 weeks. Out of 35, 5 (14.3%) had<strong> </strong>excellent outcome, 8 (22.8%) had good functional outcome, 16 (45.7%) had moderate outcome, 6 (17.14%) had poor outcome. The results were comparable with the existing literature.</p><p><strong>Conclusion: </strong>In the present study, our data shows that the proximal humeral fractures can be effectively managed conservatively in the elderly patients. Two part fractures have best functional outcome and four part fractures have highest rate of complications.</p>

scholarly journals Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont

2020 ◽  
Author(s):  
Federico A. Grassi ◽  
Riccardo Alberio ◽  
Chiara Ratti ◽  
Michele F. Surace ◽  
Piero Piazza ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Clinical Results ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
High Rate ◽  
Radiographic Findings ◽  
Functional Surgery ◽  
Reverse Total Shoulder

Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.

scholarly journals Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

2017 ◽  
Vol 11 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Ioannis Gigis ◽  
Alexandros Nenopoulos ◽  
Dimitrios Giannekas ◽  
Roderich Heikenfeld ◽  
Theodoros Beslikas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Humeral Fracture ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Long Term Results ◽  
Cochrane Library ◽  
Osteoporotic Bone ◽  
Reverse Prosthesis

Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

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