scholarly journals High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

2020 ◽  
Vol 11 ◽  
pp. 215145932097156
Author(s):  
Jordan M. Walters ◽  
Shahryar Ahmadi
Keyword(s):  
Bone Quality ◽  
Geriatric Patients ◽  
Proximal Humerus ◽  
Nonoperative Management ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
High Energy ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Trauma Teams

High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.

TREATMENT OF PROXIMAL HUMERUS FRACTURES AND OUTCOME – A PROSPECTIVE STUDY

2021 ◽  
pp. 84-87
Author(s):  
S. Kishore Babu ◽  
S. Rajeswara Rao ◽  
Pamu.bala Avinash
Keyword(s):  
Closed Reduction ◽  
Evaluation Method ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Method Comparison ◽  
Fracture Pattern ◽  
Proximal Humerus Fractures ◽  
Chi Square ◽  
Study Results ◽  
Humerus Fractures

BACKGROUND: Proximal humerus fractures are commonest fractures account for about 4 – 5% of the fractures.Complicated fracture pattern in proximal humerus are increasing due to increase inincidence of high velocity trauma. Because of inconsistency in fracture classication, treatment and evaluation method,comparison of these fractures are impeded. This studydetermines and compare the results of different modalities of xations in proximal humerus fractures and outcome. MATERIALS AND METHODS: This study was done from August 2018 to February 2020 in king Georgehospital,Visakhapatnam. Total 32 patients with proximal humerus fractures were operatedwith different modalities depend on fracture pattern.The results were evaluated using the Neers Shoulder Scoring System. RESULTS:The results show that most Neer's two part fracture had excellent to satisfactory results (85%). Neer's three part fracture also had 73% excellent to satisfactory results. Neer's four part fracture which went into failure. This study results were compared with other studies by using chi square test. CONCLUSION: The management modality depended on the pattern of the fracture andthequality of the bone .The patient's goals with treatment options for these displaced fractures included closed reduction and percutaneous screws xation (13% cases), closed reduction and percutaneous k- wires xation (9% cases) ,open reduction and internal xation (78 % cases).

Increasing Use of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures in Elderly Patients

Orthopedics ◽  
2017 ◽  
Vol 40 (6) ◽  
pp. e982-e989 ◽  
Author(s):  
Sean S. Rajaee ◽  
Dheeraj Yalamanchili ◽  
Naudereh Noori ◽  
Eytan Debbi ◽  
James Mirocha ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

Is serial radiological evaluation of one-part proximal humeral fractures necessary?

2019 ◽  
Vol 101-B (10) ◽  
pp. 1307-1312
Author(s):  
Matthijs Jacxsens ◽  
Jeremias Schmid ◽  
Vilijam Zdravkovic ◽  
Bernhard Jost ◽  
Christian Spross
Keyword(s):  
Bone Quality ◽  
Proximal Humerus ◽  
Constant Score ◽  
Nonoperative Treatment ◽  
Proximal Humerus Fractures ◽  
Radiological Evaluation ◽  
Fracture Configuration ◽  
Secondary Displacement ◽  
Humerus Fractures

Aims In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. Patients and Methods Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. Results In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients’ age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. Conclusion Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307–1312

scholarly journals Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

2020 ◽  
Vol 4 ◽  
pp. 247154922094973
Author(s):  
Patrick A Nelson ◽  
Changyow C Kwan ◽  
Vehniah K Tjong ◽  
Michael A Terry ◽  
Ujash Sheth
Keyword(s):  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Salvage Procedure ◽  
Proximal Humerus Fractures ◽  
Patient Reported ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

Background There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. Methods A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. Results Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. Conclusions Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.

The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures

Injury ◽  
2019 ◽  
Vol 50 (3) ◽  
pp. 676-680 ◽  
Author(s):  
Mark T. Dillon ◽  
Heather A. Prentice ◽  
William E. Burfeind ◽  
Priscilla H. Chan ◽  
Ronald A. Navarro
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

scholarly journals Incidence, risk factors, and clinical impact of non-home discharge following surgical management of proximal humerus fractures

2018 ◽  
Vol 11 (6) ◽  
pp. 430-439
Author(s):  
Azeem T Malik ◽  
Jonathan D Barlow ◽  
Nikhil Jain ◽  
Safdar N Khan
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Open Reduction Internal Fixation ◽  
Clinical Impact ◽  
Proximal Humerus Fractures ◽  
Factors Associated ◽  
Discharge Disposition ◽  
Humerus Fractures

Introduction There has been a reported increase in the number of proximal humerus fractures being surgically managed. In an attempt to manage increasing costs associated with increasing volume, there is a need for identification of factors associated with discharge destinations. Methods The 2012–2016 American College of Surgeons—National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes for open reduction internal fixation, hemiarthroplasty, and total shoulder arthroplasty being performed for proximal humerus fractures. Results Five hundred and seventy-six (21.5%) patients had nonhome discharge disposition. Following adjusted analysis, age > 65 years (p < 0.001), partially dependent functional health status prior to surgery(p = 0.027), inpatient surgery (p = 0.010), American Society of Anesthesiologists (ASA) grade>II (p < 0.001), transfer from nursing home/chronic care facility (p < 0.001), undergoing a total shoulder arthroplasty versus open reduction internal fixation (p = 0.012), length of stay > 2 days (p < 0.001), and the occurrence of any predischarge complication (p < 0.001) were significant predictors associated with a nonhome discharge disposition. Conclusion The study identifies significant risk factors associated with a nonhome discharge and assesses clinical impact of nonhome discharge destination on postdischarge outcomes. Providers can utilize these data to preoperatively risk stratify those at an increased risk of a nonhome discharge, counsel patients on discharge expectations, and tailor a more appropriate postoperative course of care.

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