No incidence of glenohumeral joint dislocation in a review of 220 paediatric proximal humerus fractures

Purpose Proximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation. Methods We retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation. Results Average patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation. Conclusion No paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern. Level of Evidence Level III Diagnostic

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Skin Entrapment in an Un-displaced Proximal Humerus Fracture Treated with Closed Reduction; A Case Report

The Open Orthopaedics Journal ◽

10.2174/1874325001610010120 ◽

2016 ◽

Vol 10 (1) ◽

pp. 120-124

Author(s):

Michael Hughes ◽

Antonio Frasquet-Garcia ◽

Mobeen Ismail ◽

Mohammad Waseem

Keyword(s):

Closed Reduction ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Rare Complication ◽

Low Energy ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

The United Kingdom ◽

Literature Searches ◽

Humerus Fractures

Background: Proximal humerus fractures are a common presentation to Orthopaedic services in the United Kingdom, and the incidence is increasing. Proximal humerus fractures are usually associated with low energy trauma in elderly patients. There is a sub-set of younger patients who suffer low energy fractures due to underlying osteopenia, commonly associated with alcohol excess. Skin puckering or dimpling has been described as a very rare complication of proximal humerus fracture. Based on the few previously published reports of this complication, skin entrapment in proximal humerus fracture is usually predictive of failure of closed reduction, and need for open surgery. Methods: Literature searches were carried out for relevant keywords. Articles were then critically appraised before being included in the literature review. Results: The Authors were only able to identify three previous reports of this rare complication. Conclusion: The authors describe a rare case of skin interposition in an un-displaced proximal humerus fracture, outline a technique for closed reduction, and review the current literature surrounding this rare complication.

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A prospective study to analyze the outcome of proximal humerus fracture managed with proximal humerus locking plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163491 ◽

2016 ◽

Vol 2 (4) ◽

pp. 215

Author(s):

Biju R. ◽

Kumar Babu B.L.S. ◽

Viswanath Gautham M.

Keyword(s):

Prospective Study ◽

Proximal Humerus Fracture ◽

Locking Plate ◽

Proximal Humerus ◽

High Energy ◽

Humerus Fracture ◽

Common Mechanism ◽

Minor Trauma ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Background: The incidence of proximal humerus fractures has increased in last few years due to changes in life style and increase in road traffic accidents. Hence, the challenge of the modern day treatment was to get accurate reductions anatomically, fast healing and early restoration of function. Proximal humerus locking plate revolutionized the treatment without compromising fracture union. The present study aimed to evaluate the functional and radiological outcome of proximal humerus fracture managed with proximal humerus locking plate.Methods: This prospective study was conducted at Narayana Medical College Hospital for a period of two years from December 2014 to June 2016. 30 cases of proximal humerus fractures in adults after meeting inclusion criteria were participated and treated surgically with proximal humerus locking plate technique. Consent form was taken from all the patients. The final functional outcome was assessed by radiography and DASH scoring system.Results: Proximal humerus fractures were found to have high incidence in the 40 to 45 age group which had 37% of the study population. Males predominated over females in our study. Ratio of males to female was 2:1. Right sided fractures are more in the present study in both the sexes. The most common mechanism of injury was fall on the outstretched hand from a standing height or less with minor trauma seen in 34% of patients. High energy trauma was more frequently involved in younger patients (30%). According to Neer’s classification two part fractures constituted the most common type 16 (54%) in this study. The collected data was analyzed using SPSS software version 23.0. A ‘p’ value less than 0.05 was considered significant.Conclusions: The proximal humerus locking plate method for proximal humerus fracture emerges to be safe, effective, reliable fixation with minimal complications.

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Cost-effectiveness of Open Reduction and Internal Fixation Compared With Hemiarthroplasty in the Management of Complex Proximal Humerus Fractures

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549217751453 ◽

2018 ◽

Vol 2 ◽

pp. 247154921775145

Author(s):

Robert J Thorsness ◽

James C Iannuzzi ◽

Edward J Shields ◽

Katia Noyes ◽

Ilya Voloshin

Keyword(s):

Cost Effectiveness ◽

Internal Fixation ◽

Open Reduction ◽

Retrospective Cohort ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Cost Effective ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Objectives To determine if open reduction and internal fixation (ORIF) is more cost-effective than hemiarthroplasty (HA) in the management of proximal humerus fracture. Design Retrospective cohort study with cost-effectiveness analysis. Setting Tertiary referral center in Rochester, NY. Patients/participants The records of 459 consecutive patients in whom a proximal humerus fracture was treated surgically at our institution between the years 2002 and 2012 were studied retrospectively. We identified 30 consecutive patients with a mean follow-up of 60.3 months (13.6–134.5 months) of which 15 patients underwent primary ORIF and another 15 underwent primary HA for the management of head-splitting fracture or fracture-dislocation of the proximal humerus. Intervention HA or ORIF for the management of proximal humerus fracture. Main outcome measurements SF-36 scores were converted to utility weights, and a cost-effectiveness model was designed to evaluated ORIF and HA. Results Given the baseline assumptions, ORIF was slightly more costly but also more effective (0.75 quality-adjusted life years [QALY] vs 0.67 QALY) than HA. The incremental cost-effectiveness ratio (ICER) was $5319/QALY for ORIF compared to HA, which is less than the cost-effectiveness standard utilized based on a willingness to pay of $50,000/QALY. Conclusions Compared to HA, ORIF is the more cost-effective approach for the surgical management of complex proximal humerus fractures. These data are limited by patient selection which would impact the relative utility scores. These results suggest that ORIF should be considered the preferable surgical approach given payer and patient perspectives. Level of Evidence: This is a Level III retrospective, cohort therapeutic study.

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Fracture Dislocation of Shoulder

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i2.9529 ◽

2014 ◽

Vol 3 (2) ◽

pp. 44-45

Author(s):

Hemanta Kumar Manandhar ◽

Pramod Devkota ◽

Padam Bahadur Khadka ◽

Chakra Raj Randey

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Shoulder Dislocation ◽

Open Reduction ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Humerus Fracture ◽

Fracture Dislocation ◽

Good Range

Simultaneous dislocation of shoulder with fracture of the ipsilateral humerus is extremely rare and very little reported in the literature. We report a case of forty three year old man who got right shoulder dislocation with proximal humerus fracture. The patient was treated with open reduction and internal fixation by three 4.5mm screws. The operation went uneventful and has good range of motion of the shoulder after six months of follow up. DOI: http://dx.doi.org/10.3126/noaj.v3i2.9529 NOAJ July-December 2013, Vol 3, Issue 2, 44-45

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Primary Hemiarthroplasty Following Severe Proximal Humerus Fracture Dislocations with Irretrievable Humeral Head in Young Patients

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1171 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Lim Chia Hua ◽

Khairul Nizam Siron

Keyword(s):

Humeral Head ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Young Patients ◽

Humerus Fracture ◽

Fracture Dislocation ◽

Proximal Humerus Fractures ◽

Range Of Movement ◽

Humerus Fractures ◽

Good Range

Neer first popularised the use of primary hemiarthroplasty to treat complex proximal humerus fractures, especially when the humeral head is nonviable or not reconstructable with internal fixations, and with younger patients. A 16-year-old boy had a motor vehicle accident and sustained a closed right proximal humerus fracture dislocation without neurovascular injury. Intraoperatively, due to difficulty retrieving the humeral head which dislocated and positioned behind the clavicle, hemiarthroplasty was done to avoid injuring the brachial plexus, vessels and lung. Mr Y, a 34-year-old man similarly sustained closed left proximal humerus fracture dislocation with an irretrievable head. He too underwent hemiarthroplasty. Both patients were followed up for a year with no pain and fairly good range of movement and muscle power. In complex proximal humerus fractures, there is still debate regarding primary hemiarthroplasty. There are risks of secondary displacement of fracture fragments and head necrosis after internal fixation. Neer and Cofield reported over 90% patients had relief of pain and 66% patients had free range of movement post hemiarthroplasty. Other authors described primary malposition and subsequent migration or deficient osseous integration as a complication after prosthesis. In a thirteen-year observational cohort study of 163 patients with hemiarthroplasty, the overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. Of the factors that were assessed, the age is most important due to factors such as degenerative changes in the rotator cuff, osteoporosis, and motivation to achieve a good range of motion. Successful treatment of acute proximal humerus fractures with prosthetic replacement is challenging to orthopaedic surgeons as it requires proper patient evaluation, good surgical technique, especially in soft-tissue tensioning and stability, and meticulous rehabilitation. In young patients with good bone quality and irretrievable head, hemiarthroplasty is a choice.

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MANAGEMENT AND OUTCOME ANALYSIS OF PROXIMAL HUMERUS FRACTURES BY PHILOS - A PROSPECTIVE STUDY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1273 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Mukka Naveen ◽

D. Narsimlu

Keyword(s):

Prospective Study ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Early Recovery ◽

Systemic Complications ◽

Post Surgery ◽

Humerus Fractures ◽

A Prospective Study

Introduction: Proximal humerus fracture is considered as one of the commonest fractures in clinical practice. Most of these fractures occur as a result of osteoporosis. Proximal humerus fractures are often nondisplaced or minimally displaced fractures with two parts, which can be managed conservatively. Surgical interventions include closed reduction and percutaneous pinning (CRPP). It also involves trans-osseous suture fixation, Open Reduction Internal Fixation (ORIF) with either conventional or Proximal Humerus Interlocking Osteosynthesis System (PHILOS) or hemiarthroplasty. Good clinical outcomes have been achieved by the PHILOS as they stabilize the proximal humeral fractures with steady fixation in osteoporotic bone and assisted aged patients in early functional exercises which resulted in early recovery. Aim: To analyse the functional results and complications associated with management of proximal humerus fractures treated with PHILOS. Materials and Methods: This is a prospective study conducted at Department of Orthopaedics, Prathima Institute Of Medical Sciences, Nagunur, Karimnagar, from July 2017 to January 2019. 58 patients were taken into study with two-part, three-part, four-part fracture of the proximal humerus in adults >18 years of age. In all patients PHILOS plating was done and surgical events and surgical difficulties faced, post-surgery local or systemic complications, time needed for fracture union and time taken to return to pre-fracture activity were documented. They were followed up till there were signs of union on radiographs or for at least a period of 1 year. Results: The results were assessed with Constant Murley Score at 6 months post-surgery and Visual Analogue Scale at 6 weekly intervals. The mean Constant score for two-part fractures was 88.1, for Three-part 82.5, for Four-part 72.7. The patients with two-part and three-part fractures had a significantly better VAS than patients with four-part fractures till 18 months of surgery. After 18 months the VAS was similar for all 3 groups. 6.9% developed shoulder stiffness, 2 patients from four-part fracture group developed Varus angulation. Conclusion: we conclude that the PHILOS is safe, effective and provides stable fixation for proximal humerus fractures and in patients with indigent bone quality. Keywords: PHILOS, Proximal Humerus Fracture

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Assessment of Functional and Radiological Outcome in Patients of Proximal Humerus Fractures Managed by Proximal Humerus Locking Compression Plate - A Longitudinal Observational Study from Moradabad, Uttar Pradesh

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/267 ◽

2021 ◽

Vol 8 (19) ◽

pp. 1403-1408

Author(s):

Amit Saraf ◽

Ashish Maurya ◽

Ajay Pant

Keyword(s):

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Locking Compression Plate ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Radiological Outcome ◽

X Ray ◽

Longitudinal Observational Study ◽

Compression Plate ◽

Humerus Fractures

BACKGROUND The proximal humerus fractures are mostly undisplaced fractures. Various complications which were encountered with the closed treatment included: subacromial impingement, malunion, shoulder pain, avascular necrosis, stiffness secondary to osteoarthritis and the rotator cuff deficiency. In order to overcome these complications, trend has shifted towards surgical management. The present study was conducted to assess the functional and radiological outcome in patients with proximal humerus fracture managed by proximal humerus locking compression plate. METHODS This was a longitudinal observational study (combination of retrospective and prospective design) conducted in the Department of Orthopaedics in Teerthanker Mahaveer Medical College and Research Centre, Moradabad. All patients with proximal humerus fractures under Neer’s classification who fulfilled our inclusion criteria were included. The radiological assessment was done by union, complication or any failure on x-ray and functional outcome was assessed by University of California at Los Angeles (UCLA) score. Surgery was performed under general/brachial anaesthesia in beach chair position. Delto-pectoral approach was used. Injectable antibiotics (3 rd generation cephalosporin) and analgesic (paracetamol/tramadol) were given for 3 days after surgery. Post op. X- ray of shoulder with arm antero-posterior and lateral view were taken on 2nd day of surgery RESULTS A total of 34 patients were included in the study who were followed up for a minimum of one year. At the end of the follow up, 25 patients showed union except for 3 non-union, 1 delayed union, 2 valgus and 2 varus deformity, 2 avascular necrosis (AVN) and 2 infections. The functional outcomes were excellent in 5 patients, good in 14 patients, fair in 9 patients and poor in 6 patients. CONCLUSIONS Proximal humerus locking compression plate is a safe and effective procedure for the management of proximal humerus fracture for young as well as older age group individuals with good functional outcome. The complications are acceptable and can occur in any hospital with any experienced surgeon. KEYWORDS Proximal Humerus, Fracture, Compression Plate

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Outcomes of Percutaneous Pinning Technique in the Management of Two-Part and Three-Part Proximal Humerus Fracture in Adults

Diyala Journal of Medicine ◽

10.26505/djm.19025380517 ◽

2020 ◽

Vol 19 (2) ◽

pp. 129-139

Author(s):

Abdulkadr Muhammed Sleman Alany ◽

◽

Hasan Mazin Shekheel Mercalose ◽

Thaqaf Alauldeen Fadhil Al-Bayati

Keyword(s):

Functional Outcome ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Trauma Surgery ◽

Case Series ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Percutaneous Pinning ◽

Neck Shaft Angle ◽

Humerus Fractures

Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal end of the humerus oftentimes represent a management dilemma with the multiple surgical options available to deal with them. Objective: To evaluate the functional and radiographic outcomes of the percutaneous pinning techniques in the management of two-part and three-part proximal humerus fracture. Patients and Methods: A case series of 25 patients, functional outcome was determined by ASES and Constant scores and multiple radiographic views were taken to assess the fracture union, mal-union, and the presence of avascular necrosis. Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04. Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle <=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint. Conclusion: This study supports that the percutaneous close reduction and pinning technique is an effective and reliable surgical technique in the management of closed two-part and three-part proximal humerus fractures in adults. Appropriate preoperative planning is important to achieve a successful surgical result, and regular postoperative follow-up and rehabilitation are essential to get an optimum functional outcome. Keywords: Proximal humerus fracture, percutaneous pinning, upper extremity surgery, trauma surgery, Clinical outcomes, Percutaneous fracture fixation

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Bilateral Proximal Humerus Fracture – a Rare Combination with a High Complication Rate after Surgery

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0619-6400 ◽

2018 ◽

Vol 156 (06) ◽

pp. 646-652 ◽

Cited By ~ 1

Author(s):

Matthias Königshausen ◽

Valentin Rausch ◽

Eileen Mempel ◽

Alexander von Glinski ◽

Christopher Ull ◽

...

Keyword(s):

Complication Rate ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Loss Of Reduction ◽

Angle Stable ◽

Humerus Fractures ◽

Angle Stable Plate

Abstract Introduction Bilateral acute proximal humerus fractures are rare. There are no data available about these bilateral injuries. The aim of the study was to analyse bilateral proximal humerus fractures retrospectively in terms of incidence, complications and revisions. Methods All bilateral proximal humerus fractures were evaluated retrospectively using the institutionʼs database, with the focus on cause of the injury, fracture severity and the clinical course compared to published information on monolateral proximal humerus fractures. Bilateral posterior dislocation fractures were excluded, because these fractures are a separate entity. Results Between 2005 and 2016, n = 17 patients were primarily treated within our hospital for an acute proximal humerus fracture on both sides (n = 12 female, n = 5 male, average age: 68 years; overall 34 proximal humerus fractures). The general trauma mechanism was a fall on both arms (82% [18% polytrauma]). There were 65% displaced 3-/4-part proximal humerus fractures. Angle-stable plate osteosynthesis was performed predominantly (64%), followed by fracture prosthesis (18%; tension wiring: 3%; non-operatively: 15%). Overall, n = 10 patients (59%) or n = 18 (53%) proximal humerus fractures developed a complication, primarily with loss of reduction or implant loosening (44%). In n = 14 (78%) of the complications further operations were necessary. Alcohol abuse was increasingly found in 29% of the cases within the bilateral patient cohort compared to patients with monolateral fractures. Conclusion Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.

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Study of functional outcome of surgical management of proximal humerus fracture by various modalities: a two-year study at a tertiary care hospital

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200003 ◽

2020 ◽

Vol 6 (2) ◽

pp. 242

Author(s):

Addanki Vijayanand ◽

Narreddy Jayasomeswar

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Tertiary Care ◽

Humerus Fracture ◽

Significant Heterogeneity ◽

Care Hospital ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Background: Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.Methods: A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.Results: 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).Conclusions: Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.

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