Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

Abstract Objective To investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures. Design Uncontrolled, blinded, comparative behavioural analysis. Setting Germany and United States. Participants 10 blinded experts in the field of orthopaedic trauma surgery ( Homo chirurgicus accidentus ), with special focus on upper extremity surgery from Germany and the US, and five Barbary macaques ( Macaca sylvanus ) from a semi-free range enclosure. Main outcome measures The reliability of agreement between raters assessed with Fleiss’ ĸ. Results Barbary macaques seem to have inferior inter-rater reliability in comparison with experts for choice of treatment (non-surgical v surgical), but for the geriatric age group most frequently affected by proximal humeral fractures, they performed similarly to the experts in their choices of treatment and choice of surgical procedure. Agreement about predicted outcome was poor among the macaques and slight among the experts. All experts almost always predicted the outcome incorrectly and tended to underestimate it. While only 4 (4.4%) of 90 experts’ predictions were correct, 13 (28.9%) of 45 macaques’ predictions were correct. Conclusions Consensus on treatment and expected outcomes of proximal humeral fractures is lacking even beyond the human species. Although Barbary macaques tend to predict the clinical outcome more accurately, their reliability to assist surgeons in making a consistent decision is limited. Future high quality research is needed to guide surgeons’ decision making on the optimal treatment of this common injury.

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Proximal Humerus Fractures: up to date

Journal of Orthopaedic Surgery and Traumatology ◽

10.36438/jost00000002 ◽

2017 ◽

Author(s):

Joan Ferràs-Tarragó

Keyword(s):

Proximal Humerus ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Surgical Indication ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Multifactorial Approach

Humeral fractures requiere a multifactorial approach, and it's difficult to stablish lot of times the surgical indication. That's why we need to understand why and when complications related with proximal humeral fractures happens, and this is the aim of this up to date: to understand why we must do the things that we do.

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Outcome analysis of patients with proximal humerus fractures treated with locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171578 ◽

2017 ◽

Vol 3 (3) ◽

pp. 401

Author(s):

Ritesh Kumar ◽

S. Natarajan ◽

Sanjeev Kumar ◽

R. Kalanithi

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

High Energy ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Humerus Fractures

Background: Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure.Methods: This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.Results: Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome. Conclusions: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome.

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The Humelock Hemiarthoplasty Device for Both Primary and Failed Management of Proximal Humerus Fractures: A Case Series

The Open Orthopaedics Journal ◽

10.2174/1874325001509010001 ◽

2015 ◽

Vol 9 (1) ◽

pp. 1-6

Author(s):

Ikram A ◽

Singh J ◽

Jagarnauth S ◽

Khan W.S ◽

Hambidge J

Keyword(s):

Proximal Humerus ◽

Hospital Setting ◽

Case Series ◽

Early Mobilization ◽

District General Hospital ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Complex Case ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Fractures of the proximal humerus account for 4-5% of all fractures. Managing proximal humerus fractures operatively and non-operatively have their respective complications both short- and long-term. We present our experience using the Humelock hemiarthoplasty device for both primary and failed management of proximal humeral fractures. We present four different examples from ten cases that include a failure of internal fixation, a failure of intramedullary nailing, a complex case in a patient with multiple co-morbidities, and a failure of nonoperative management. The patients in our series had multiple injuries and the device allowed early mobilization and produced good results. We suggest that this device has a role in the failure of primary and secondary management of proximal humeral fractures in a district general hospital setting.

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Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures: A Retrospective Study Describing Principles and Advantages of the Technique

Advances in Orthopedics ◽

10.1155/2018/5904028 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Riccardo Luigi Alberio ◽

Matteo Del Re ◽

Federico Alberto Grassi

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humeral Fractures ◽

Radiographic Evaluation ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Greater Tuberosity ◽

Humerus Fractures ◽

The Mean

Background. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Materials and Methods. From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48–80) were surgically treated with the MIPO technique for proximal humeral fractures. According to Neer classification, there were 12 two-part, 24 three-part, and 2 four-part fractures and 1 two-part fracture-dislocation; the AO/OTA system was also used to categorize the fractures. The Constant-Murley (CMS) and the Oxford Shoulder (OSS) Scores were used to evaluate shoulder function. Results. Thirty-four patients were available for clinical and radiographic evaluation at a mean follow-up of 31.8 months (range: 12–54 months). All fractures healed and no postoperative complications occurred. Full recovery of pretrauma activities was reported by 27 patients, while 7 patients presented mild functional limitations. The mean absolute CMS was 75.2 (range: 55–95), the mean normalized CMS was 90.5 (range: 69–107), and the mean OSS was 43.7 (range: 31–48). The only statistically significant correlation was found between the female gender and lower absolute CMS and OSS. Radiographic evaluation revealed varus malunion in 4 cases and valgus malunion in 1 case, while incomplete greater tuberosity reduction was detected in 4 cases. All malunions were related to inadequate reduction at time of surgery and not to secondary displacement. Conclusions. MIPO for proximal humeral fractures is an effective and safe surgical procedure. The limited tissue dissection allows minimizing the incidence of nonunion, avascular necrosis, and infection. The technique is not easy, requires experience to achieve mastery, and should be reserved for selected fracture patterns. In our experience, the main advantage of this approach consists in the direct access to the greater tuberosity, thus facilitating its anatomic reduction and fixation.

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