Effect of Osteoporosis on Proximal Humerus Fractures

Introduction: Proximal humerus fractures (PHF) constitute the majority of the most common osteoporotic fractures. Bone density measurements can affect treatment methods and outcomes. This study was aimed to investigate the effect of osteoporosis values, measured from direct radiographs, on fracture type, surgical outcomes. Methods: 248 patients over 50 years of age who presented to Mersin City Hospital between 2017 and 2020 with proximal humeral fractures were retrospectively evaluated. The age and gender of the patients and the fracture types were evaluated according to the AO classification system from the direct radiographs obtained at the time of admission were recorded. The Tingart cortical thickness and deltoid tuberosity index (DTI) measurements were used to assess osteoporosis status in all patients. Postoperative and follow-up radiographs of 45 patients, treated with fixed-angle proximal humeral locking plate, were evaluated for radiographic results and their correlations with osteoporosis measurements were examined. Results: According to the demographic characteristics of the patients, 171 patients were female and 77 patients were male (F/M: 3/1), and mean age was 69.2 ± 11.66 (50-95). Considering the bone quality parameters in all patients, the mean Tingart value was 5.8 ± 1.6 mm and the mean DTI was 1.43 ± 0.17, where there was a correlation between the Tingart value and DTI (r = 0.810 and p < 0.001). Although there was a statistically significant relationship between the osteoporosis parameters and age and gender (p < 0.001 and p = 0.023, respectively), main AO fracture types were not related to osteoporosis (p < 0.05). In the operated group (n = 48, 19%), 19 patients (42%) showed poor outcomes, which were not associated with age and osteoporosis parameters. Conclusion: This study was concluded that osteoporosis parameters differ between genders and age groups in patients with PHF, however osteoporosis is not the main factor affecting the fracture type and surgical outcomes.

Download Full-text

FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH A LOCKING COMPRESSION PLATE: A CROSS SECTIONAL STUDY

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1407 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3266-3269

Author(s):

Abhishek Patil

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Constant Score ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures ◽

The Mean

Proximal humerus fractures account for about 4% to 5% of all fractures. Following distal forearm fracture, proximal humeral fracture is the second most common upper extremity fracture. Kirschner (K)-Wires, external fixation, tension band wiring, and rush pins, intramedullary nails, ORIF with plates, and shoulder hemiarthroplasty have all been offered as therapeutic options. The purpose of this study was to assess the functional outcome and complication rates following internal fixation of proximal humerus fractures using a locking compression plate. Patients over the age of 18 with closed proximal humerus fractures or open proximal humerus fractures (Gustilo and Anderson type I, Type II) received open reduction and internal fixation with locking compression plate in the current study. The participants in this study were 60 people who had a proximal humerus fracture and were treated with open reduction and a proximal humerus locking compression plate. Patients ranged in age from 20 to 85 years old, with a mean age of 51.14 +/- 17.30 years. The age group 36–55 years (37 percent) was the most prevalent, followed by 56–75 years (30 %). The majority of patients (76.7 %) were men who had been in automobile accidents on the right side (83 %) (63 %). According to the Neer classification, the most prevalent type of fracture was a three-part fracture (53 %). The maximum union time observed in this study was 16 weeks, with a minimum of 10 weeks. The average time to union is 12.52 +/- 1.14 weeks. The mean flexion at the end of six months was 121.660 +/- 19.84. The mean internal rotation was 57.330 +/- 8.48, the mean external rotation was 530 +/- 11.98, and the mean abduction was 1180 +/- 19.36. 75.28 +/- 9.66 [Mean +/- SD] is the Mean Constant score. Pain 14.10, ADL 18.26, range of motion 22.46, and power 20 were the mean scores observed on Constant Score for its various aspects. According to the Constant score, the functional outcome of the 60 patients was as follows: 8 patients had excellent outcomes (13%), 34 patients had good outcomes (56.7%), 16 patients had moderate outcomes (26.7%), and two patients had poor outcomes (26.7%) and (3 %). Internal fixation of proximal humerus fractures with a locking compression plate results in anatomical reduction and secure fixation, resulting in a favorable functional outcome.

Download Full-text

Outcome of locking plate fixation for proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160712 ◽

2016 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Neil Rohra ◽

Jimmy Chokshi ◽

Rishi Sanghavi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Evaluation Criteria ◽

Proximal Humerus Fractures ◽

Age Group ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods: We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.Results: The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.Conclusions: PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.

Download Full-text

PROXIMAL HUMERUS FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.571 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1788-1793

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Avascular Necrosis ◽

Open Reduction ◽

Proximal Humerus ◽

Case Series ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

Download Full-text

Proximal Humerus Fractures in Children: Experience from a Central London Paediatric Orthopaedic Service

The Open Orthopaedics Journal ◽

10.2174/1874325001913010202 ◽

2019 ◽

Vol 13 (1) ◽

pp. 202-207

Author(s):

Woojin Chae ◽

Akib Khan ◽

Sarah Abbott ◽

Angelos Assiotis

Keyword(s):

Proximal Humerus ◽

Limb Length Discrepancy ◽

Operative Management ◽

Proximal Humerus Fractures ◽

Tertiary Referral Centre ◽

Correct Treatment ◽

Treatment Methods ◽

Fractures In Children ◽

Humerus Fractures ◽

The Mean

Objective: Proximal humeral fractures are commonly observed in children who sustain falls whilst running, or from heights. Appropriate and correct treatment is key in order to avoid limb length discrepancy and functional deficiencies. Current treatment methods include non-operative management such as collar and cuff immobilisation, and operative methods such as elastic stable intramedullary nails or Kirschner wires. This paper aims to present the demographics of this patient population and our experience in managing patients with proximal humerus fractures in an urban tertiary referral centre. Method: We assessed 41 cases across two sites in central London, identified via hospital electronic notes and our radiology digital system. We analysed patient demographics, mechanism of injury, time to discharge from orthopaedic services taking into account radiological and clinical union, and the treatment methods utilised. Results: The mean age of the cohort was 8.6 years old. 70% of the injuries were due to falls and 85% of cases were treated without an operation. The mean time to discharge from our service following radiological and clinical union was 46 days (9 – 161 days). Mean radiological and clinical union were 21.8 and 36.2 days respectively. Conclusion: These results support a non-operative approach, especially in cases with patients under 10 years of age. Surgery should only be undertaken in patients who have severe displacement and who have failed attempts at closed reduction. We would advocate a similar approach in institutions dealing with a comparable population of patients, as long as there are provisions for referral of more complex cases that require surgical stabilisation.

Download Full-text

Healing of the Greater Tuberosity in Acute Shoulder Hemiarthroplasty Using an Accelerated Rehabilitation Regime

Shoulder & Elbow ◽

10.1111/j.1758-5740.2010.00058.x ◽

2010 ◽

Vol 2 (2) ◽

pp. 131-135 ◽

Cited By ~ 1

Author(s):

Robert J. Macfarlane ◽

Zulfikar Ali ◽

Dipankar Datt ◽

Balachandran Venkateswaran

Keyword(s):

Proximal Humerus ◽

Early Mobilization ◽

Cerebrovascular Event ◽

Proximal Humerus Fractures ◽

Shoulder Hemiarthroplasty ◽

Accelerated Rehabilitation ◽

Average Maximum ◽

Humerus Fractures ◽

The Mean

Background Displaced three- and four-part proximal humerus fractures are common and are frequently treated by shoulder hemiarthroplasty. The present study sought to evaluate an accelerated rehabilitaton regime following hemiarthoplasty and assess its affect on healing of the greater tuberosities. Methods Twenty patients over a 2-year period treated with acute hemiarthroplasty were rehabilitated with an accelerated regime of passive movements on day 1, active movements from the second week, and strengthening from the fourth postoperative week. Clinical and radiological follow-up was at 12 months. Results At 6 months, the mean Constant functional shoulder score was 55.52 (range 14 to 78). The average maximum forward elevation was 98.47° (range 30° to 160°). The mean pain score at 6 months was 11.42 (range 0 to 15). Twenty-two of 23 patients went on to heal radiologically by 3 months, with one case undergoing resorption of the tuberosities as a result of falls and a cerebrovascular event affecting the limb. At 3 months, 20/23 patients had undergone tuberosity healing with less than 0.5 cm displacement (86.9% of patients). Discussion An accelerated rehabilitation regime does not adversely affect the rate of healing of the tuberosities following shoulder hemiarthroplasty for proximal humerus fractures. The use of an early mobilization regime is likely to allow an earlier return to normal activities of daily living.

Download Full-text

Effectiveness and Short Term Functional Results of Surgical Treatment with Locking Plate in Proximal Humerus Fractures

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2020.90958 ◽

2020 ◽

Author(s):

Tolgahan Kuru ◽

Onur YIlmaz

Keyword(s):

Locking Plate ◽

Proximal Humerus ◽

Late Complications ◽

Proximal Humerus Fractures ◽

Short Term ◽

Significant Difference ◽

Duration Of Hospitalization ◽

Humerus Fractures ◽

The Mean

INTRODUCTION: In this study, we aimed to investigate postoperative short term outcomes, union status, early and late complications and the relationship between them in patients treated with plate osteosynthesis due to proximal humerus fractures in our hospital. METHODS: A total of 34 patients aged between 18-92 years were included in the study. Patients’ age, gender, fracture pattern, time from hospitalization to the surgery, time from surgery to discharge and comorbidities were recorded and evaluated. RESULTS: The mean duration of hospitalization was found as 3.4±1.7 days. There was no significant difference between the patients with and without comorbidity in terms of the mean duration of hospitalization. There was no significant difference between the patients with and without complications in terms of the mean time from hospitalization to the surgery. According to Neer classification, postoperative late complications occurred in 40% of Neer Type 4 fractures, 29.4% of Neer Type 3 fractures and 8.3% of Neer Type 2 fractures. DISCUSSION AND CONCLUSION: Internal fixation with locking plate seems a reliable option in the treatment of proximal humerus fractures, especially in osteoporotic bones and Neer Type 2 fractures.

Download Full-text

Acromion-axillary Nerve Distance and Its Relation to the Humeral Length in the Prediction of the Axillary Nerve Position During the Anterolateral Deltoid-splitting Approach in the Treatment of Proximal Humerus Fractures: a Clinical Study

10.21203/rs.3.rs-1223482/v1 ◽

2022 ◽

Author(s):

mehmet demirel ◽

Cem Yıldırım ◽

Erhan Bayram ◽

Mehmet Ekinci ◽

Murat Yılmaz

Keyword(s):

Proximal Humerus ◽

Plate Fixation ◽

Anatomical Variation ◽

Axillary Nerve ◽

Proximal Humerus Fractures ◽

Lateral Epicondyle ◽

Anatomic Reduction ◽

Humerus Fractures ◽

The Mean ◽

Internal Plate Fixation

Abstract Background Because of the broad anatomical variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.Methods The present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range = 19 to 76) with displaced proximal humerus fractures who were treated by open reduction and internal fixation. After anatomic reduction and fixation was achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index.Results The mean AAND was 6 ± 0.36 cm (range = 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range = 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range = 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.Conclusion During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered as a safe zone for the prevention of possible axillary nerve injury.

Download Full-text

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.

Download Full-text

Difficulty in decision making in the treatment of displaced proximal humerus fractures: the effect of uncertainty on surgical outcomes

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.09.033 ◽

2018 ◽

Vol 27 (3) ◽

pp. 470-477 ◽

Cited By ~ 14

Author(s):

Joey LaMartina ◽

Kaitlyn N. Christmas ◽

Peter Simon ◽

Jonathan J. Streit ◽

Jesse W. Allert ◽

...

Keyword(s):

Decision Making ◽

Surgical Outcomes ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Download Full-text

Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163509 ◽

2016 ◽

Vol 2 (4) ◽

pp. 245

Author(s):

Lalith Mohan Chodavarapu ◽

Sreekanth Kashayi Chowdojirao ◽

Avinash Gonu ◽

Chandrasekhar Patnala ◽

Vijay Krishna Chilakamarri

Keyword(s):

Proximal Humerus ◽

Dash Score ◽

Proximal Humerus Fractures ◽

Independent Observer ◽

Constant Murley Score ◽

Fracture Dislocations ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.Methods: This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.Results: The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.Conclusions: Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome.

Download Full-text