scholarly journals Quantitative contrast enhanced dual energy CT to predict avascular necrosis: a feasibility study of proximal humerus fractures

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin B. Hoover ◽  
Alexandria O. Starks ◽  
Valentina Robila ◽  
Daniel L. Riddle
Keyword(s):  
Avascular Necrosis ◽  
Open Reduction ◽  
Proximal Humerus ◽  
Iodine Concentration ◽  
Dual Energy ◽  
Open Reduction Internal Fixation ◽  
Dual Energy Ct ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Abstract Background Avascular necrosis is a delayed complication of proximal humerus fractures that increases the likelihood of poor clinical outcomes. CT scans are routinely performed to guide proximal humerus fracture management. We hypothesized iodine concentration on post-contrast dual energy CT scans identifies subjects who develop avascular necrosis and ischemia due to compromised blood flow. Materials and methods 55 patients with proximal humerus fractures enrolled between 2014 and 2017 underwent clinical, radiographic and contrast enhanced dual energy CT assessment. Iodine densities of the humeral head and the glenoid (control) were measured on CT. Subjects managed with open reduction internal fixation or conservatively (non-surgical) were followed for up to two years for radiographic evidence of avascular necrosis. Arthroplasty subjects underwent histopathologic evaluation for ischemia of the resected humeral head. Results 17 of 55 subjects (30.9%) were treated conservatively, 21 (38.2%) underwent open reduction internal fixation and 17 of 55 (30.9%) underwent arthroplasty. Of the 38 subjects treated conservatively or with ORIF, 20 (52.6%) completed 12 months of follow up and 14 (36.8%) 24 months of follow up. At 12 months follow up, two of 20 subjects (10%) and at 24 months 3 of 14 subjects (21.4%) developed avascular necrosis. At 12 months, the mean humerus/glenoid iodine ratio was 1.05 (standard deviation 0.24) in subjects with AVN compared to 0.91 (0.24) in those who did not. At 24 months, subjects with avascular necrosis had a mean humerus/glenoid iodine concentration ratio of 1.06 (0.17) compared to 0.924 (0.21) in those who did not. Of 17 arthroplasty subjects, 2 had severe ischemia and an iodine ratio of 1.08 (0.30); 5 had focal ischemia and a ratio of 1.00 (0.36); and 8 no ischemia and a ratio of 0.83 (0.08). Conclusions Quantifying iodine using dual energy CT in subjects with proximal humerus fractures is technically feasible. Preliminary data suggest higher humeral head iodine concentration may increase risk of avascular necrosis; however, future studies must enroll and follow enough subjects managed with open reduction internal fixation or conservatively for two or more years to provide statistically significant results. Trial Registrations NCT02170545 registered June 23, 2014, ClinicalTrials.gov.

scholarly journals PROXIMAL HUMERUS FRACTURES;

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.

scholarly journals Surgical management of proximal humerus fracture treated with locking compression plate

2017 ◽  
Vol 3 (6) ◽  
pp. 1165
Author(s):  
Sivakumar Arumugam ◽  
Venkateshwara Arumugam ◽  
V. Raviraman
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Humerus ◽  
Early Mobilization ◽  
Open Reduction Internal Fixation ◽  
Locking Compression Plate ◽  
Proximal Humerus Fractures ◽  
Compression Plate ◽  
Comminuted Fractures ◽  
Humerus Fractures

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures accounts for about 4 to 5% of all fractures.  Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remain challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Various operative procedures are carried out, the recent trend in internal fixation has moved on to locking plates. The present study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by locking compression plate.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study comprising of 30 patients with fractures of proximal humerus were treated by open reduction and internal fixation with locking compression plate were evaluated at Velammal  Institute Of Medical  Sciences, Madurai from the period of April 2015 to December 2016. Clinical and radiological evaluation was done. Patients will undergo open reduction internal fixation with locking compression plate for the sustained fracture under general anesthesia.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our series, the majority of the patients were males, elderly aged, with RTA being the commonest mode of injury, involving 2 part, 3 part and 4 part fractures of the proximal humerus. Excellent and satisfactory results were found in 76.7% of patients with unsatisfactory results in 23.3 % according to Neer’s criteria. There were 100 % union rates and no failures.</p><p><strong>Conclusions:</strong> In conclusion locking Compression, the plate is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in Osteoporotic bones in elderly patients, thus allowing early mobilization.</p>

scholarly journals Outcome of locking plate fixation for proximal humerus fractures

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> 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 &lt;60 years and 8 patients in the age group of &gt;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.</span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> 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.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> 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.</span></p>

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