scholarly journals Modified percutaneous Kirschner wire with mutual linking technique in proximal humeral fracture: a technique note and preliminary results

2019 ◽  
Author(s):  
Hao-Ming Chang ◽  
Pei-Yuan Lee ◽  
Wei-Ren Su ◽  
Cheng-Li Lin
Keyword(s):  
Proximal Humeral Fracture ◽  
Glenohumeral Joint ◽  
Kirschner Wire ◽  
Humeral Fracture ◽  
Deep Infection ◽  
Bony Union ◽  
Invasive Approach ◽  
Kirschner Wire Fixation ◽  
Minimal Invasive Approach

Abstract Background: The percutaneous pinning technique (PPT) with multiple Kirschner wires (K-wires) is one of common surgical options in proximal humeral fractures. However, complications including pin migration and loss of reduction have been re-ported. We aimed to describe a novel technique employing modified percutaneous pin-ning with mutual linking for the treatment of proximal humerus fractures, which may decrease such complications. Methods: 6 patients (5 female, 1male ; mean age 60.1 years) received close reduction and the modified percutaneous Kirschner wire fixation with mutual linking technique. All wires were removed about 6 weeks postoperatively followed by progressive reha-bilitation. We used following radiograph to evaluate bony union, wires migration, and fragment displacement. Clinical outcomes were evaluated using range of motion of af-fected glenohumeral joint, a 1-10 visual analog score (VAS), UCLA shoulder rating score (UCLA), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES). Outcomes were evaluated during the 2-month follow up and at the final follow up. Results: All cases were followed-up after an average of 12.6 months (range, 12-13.5 months). The mean of anterior forward flexion of the injured shoulder were 152.5 degrees (range, 145-160 degrees) during the 2-month follow up and 166.7 degrees (range, 150-180 degree) at the final follow up respectively. The means of the VAS, UCLA score, and the ASES of the injured shoulders were 0.3 (range, 0-1), 31.8 (range, 27-34), and 92.4 (range, 82-100) respectively. No wire migrations or fracture displacements were noted in our cases. There were also no deep infection, nonunion, implant failure, or avascular necrosis of the humeral head observed during the follow-ups. Conclusions:With this modified percutaneous Kirschner wire mutual linking technique, minimal invasive approach could be achieved and additional stability was provided by mutually linking the wires to reduce pin migration and fracture displacement in proximal humeral fracture.

Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

2018 ◽  
Vol 100-B (6) ◽  
pp. 761-766 ◽  
Author(s):  
M. Holschen ◽  
M-K. Siemes ◽  
K-A. Witt ◽  
J. Steinbeck
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humeral Fracture ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Operating Time ◽  
Humeral Fracture ◽  
Reverse Total Shoulder Arthroplasty ◽  
The Mean ◽  
Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

Prospective comparison of functional outcomes of primary reverse shoulder arthroplasty for acute fractures versus rotator cuff deficiencies

2020 ◽  
Vol 102-B (11) ◽  
pp. 1555-1559
Author(s):  
Emilio Sebastia-Forcada ◽  
Alejandro Lizaur-Utrilla ◽  
Gerard Mahiques-Segura ◽  
Matias Ruiz-Lozano ◽  
Fernando Anacleto Lopez-Prats ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Proximal Humeral Fracture ◽  
Revision Rate ◽  
Reverse Shoulder Arthroplasty ◽  
Humeral Fracture ◽  
Fracture Group ◽  
Rotator Cuff Deficiency

Aims The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years. Methods This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed. Results Mean follow-up was 8.4 years (5 to 11). There were no significant differences in mean absolute (p = 0.125) or adjusted (p = 0.569) Constant, UCLA (p = 0.088), QuickDASH (p = 0.135), VAS-pain (p = 0.062), or range of movement at the final follow-up. However, patient satisfaction was significantly lower in the fracture group (p = 0.002). The complication rate was 1.5% (one patient) versus 9.3% (six patients), and the revision rate was 1.5% (one patient) versus 7.8% (five patients) in the fracture and arthropathy groups, respectively. The ten-year arthroplasty survival was not significantly different (p = 0.221). Conclusion RSA may be used not only for patients with irreparable rotator cuff deficiencies, but also for those with acute complex proximal humeral fractures. We found that RSA provided similar functional outcomes and a low revision rate for both indications at long-term. However, satisfaction is lower in patients with an acute fracture. Cite this article: Bone Joint J 2020;102-B(11):1555–1559.

Four-corner arthrodesis employing the native scaphoid as the principal donor graft for advanced collapse deformity of the wrist: technique and outcomes

2016 ◽  
Vol 42 (3) ◽  
pp. 246-252 ◽  
Author(s):  
S. M. Koehler ◽  
C. P. Melone
Keyword(s):  
Revision Surgery ◽  
Work Performance ◽  
Kirschner Wire ◽  
En Bloc ◽  
Level Of Evidence ◽  
Kirschner Wire Fixation ◽  
Donor Graft ◽  
Carpal Height ◽  
Progressive Stage

The purpose of this study was to determine the functional, radiographic, and subjective outcome of the authors’ technique of four-corner arthrodesis using the en bloc excised scaphoid as the principal donor bone graft coupled with Kirschner wire fixation. The study comprised 40 consecutive patients with progressive Stage II and III scapholunate advanced collapse or scaphoid nonunion advanced collapse deformities. Preoperative and postoperative range of motion, grip strength, carpal height, and Michigan Hand Outcomes Questionnaire responses were assessed with a mean follow-up of 4.4 years. At an average of 7 weeks, all patients demonstrated radiographic fusion. Moreover, postoperatively, improvement in the Michigan Hand Outcomes Questionnaire domains of overall function, activities of daily living, work performance, pain, and satisfaction were statistically significant. Complications were few and no patient required revision surgery. In this study, the authors’ technique results in a reliable four-corner arthrodesis with a low expectation of complications or revision surgery. Level of evidence: IV

scholarly journals Assessment of the restriction of arm elevation after intramedullary fixation for proximal humeral fractures

2017 ◽  
Vol 9 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Hiroaki Inui ◽  
Katsuya Nobuhara
Keyword(s):  
Glenohumeral Joint ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Bony Union ◽  
Greater Tuberosity ◽  
Zero Position ◽  
Maximum Elevation ◽  
Entry Points ◽  
Arm Elevation

Background Nail protrusion is suspected as a reason for the restriction of arm elevation after antegrade nailing of proximal humeral fractures, although assessment of the restriction of the glenohumeral joint during arm elevation has been insufficient. Methods In this retrospective study, 30 shoulders with proximal humeral fractures in 29 cases were treated with Polarus short nails (Acumed, Beaverton, OR, USA). At a mean final follow-up of 14 months, clinical outcomes, bony union, alignment including retroversion of the head and entry points of the nails were evaluated. The ability of a subject to achieve maximum elevation above the zero position was also evaluated. Results Constant and Japanese Shoulder Association scores were a mean (SD) of 54 (12) and 71 (8.9) points, respectively. Even though all cases achieved bony union without mal-alignment of the head and greater tuberosity height or protrusion of the nail at its entry point, only six subjects could achieve maximum elevation above the zero position. Conclusions Based on these findings, treatment of proximal humeral fractures with an antegrade humeral nail inserted from the top of the humeral head results in restricted arm elevation, even in patients without nail protrusion or fragment malalignment.

scholarly journals Closed reduction and percutaneous k-wire fixation for distal end radius fractures

2020 ◽  
Vol 8 (7) ◽  
pp. 2400
Author(s):  
Tanveer Ali ◽  
Mohmmad Sikander Baketh ◽  
Maneer Ahmad Mir
Keyword(s):  
Functional Outcome ◽  
Distal Radius ◽  
Kirschner Wire ◽  
Mayo Score ◽  
Kirschner Wire Fixation ◽  
Anatomic Reduction ◽  
Wire Fixation ◽  
Inexpensive Procedure ◽  
Anatomical Restoration

Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical  restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that  provides anatomic  reduction,  fracture  fixation,  and maintenance  of  reduction  with  an  adequate method of  immobilization.

scholarly journals The Short Term Clinical Follow-up Study for Hemiarthroplasty in Proximal Humeral Fracture

2007 ◽  
Vol 10 (1) ◽  
pp. 92-98
Author(s):  
Chang-Meen Sung ◽  
Se-Hyun Cho ◽  
Soon-Taek Jung ◽  
Sun-Chul Hwang ◽  
Hyung-Bin Park
Keyword(s):  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Short Term ◽  
Follow Up Study

Treatment of nonunions of the distal phalanx with olecranon bone graft

2009 ◽  
Vol 34 (5) ◽  
pp. 638-642 ◽  
Author(s):  
İ. B. ÖZÇELIK ◽  
F. KABAKAS ◽  
B. MERSA ◽  
H. PURISA ◽  
İ. SEZER ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Kirschner Wire ◽  
Distal Phalanx ◽  
Kirschner Wire Fixation ◽  
Clinical Pain ◽  
Initial Injury ◽  
Phalangeal Fractures ◽  
Radiological Union

Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx. The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability) and radiological signs of nonunion more than 4 months after the initial injury. Three patients had developed infection and four of them had bone resorption after their initial treatments, which probably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation was done in all patients. The mean follow up was 7 months (range 5–18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one. There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.

The Treatment of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint by Closed Reduction and Kirschner Wire Fixation: A 16-Year Follow Up

2001 ◽  
Vol 26 (6) ◽  
pp. 537-540 ◽  
Author(s):  
D. P. NEWINGTON ◽  
T. R. C. DAVIS ◽  
N. J. BARTON
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 81 at the proximal interphalangeal joint, which had a mean arc of movement of 851. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.

scholarly journals Proximal humerus fracture–dislocation managed by mini-open reduction and percutaneous screw fixation

2018 ◽  
Vol 11 (5) ◽  
pp. 353-358
Author(s):  
NA Johnson ◽  
R Pandey
Keyword(s):  
Open Reduction ◽  
Proximal Humeral Fracture ◽  
Soft Tissues ◽  
Humeral Fracture ◽  
Fracture Dislocation ◽  
Oxford Shoulder Score ◽  
Fracture Dislocations ◽  
Mini Open ◽  
Shoulder Score

BackgroundWe describe a minimally open reduction and percutaneous fixation technique for three- and four-part proximal humeral fracture–dislocations which preserves soft tissues.MethodsEleven consecutive patients with three-and four-part proximal humeral fracture–dislocations (eight anterior, three posterior dislocations) were treated this way. The dislocation is reduced using a mini-open deltopectoral approach with a horizontal split in subscapularis. Fracture fragments are fixed with percutaneous screws. Constant and Oxford Shoulder Score were collected prospectively.ResultsMean age was 51 years (range 32–65). Mean follow-up was 36 months (range 24–72 months). At last follow-up mean Constant score was 75 (range 64–86) compared to 88 (range 85–92) for the uninjured shoulder. Mean Oxford shoulder score was 41 (range 34–46). One patient developed avascular necrosis. Screw back out was seen in three patients. These were removed under local anaesthesia. There were no screw penetrations of articular surface. One patient suffered a radial nerve neuropraxia which resolved.ConclusionThese results are promising and comparable to published literature with other means of fixation for this complex problem. Due to minimal soft tissue dissection the complications rate is low.

Sign in / Sign up

Export Citation Format

Share Document