Reduction and Fixation of Proximal Humeral Fracture With Severe Medial Instability Using a Small Locking Plate

Abstract Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

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Evaluation of open reduction and internal fixation of proximal humerus fractures using a locking plate with smooth pegs – A retrospective study

Shoulder & Elbow ◽

10.1177/1758573218791166 ◽

2018 ◽

Vol 11 (6) ◽

pp. 411-418

Author(s):

Frida Hansson ◽

Magdalena Riddar ◽

Anders Ekelund

Keyword(s):

Quality Of Life ◽

Retrospective Study ◽

Internal Fixation ◽

Avascular Necrosis ◽

Open Reduction ◽

Locking Plate ◽

Constant Score ◽

Humeral Fracture ◽

The Mean

Background Optimal treatment of displaced proximal humeral fractures is controversial. This retrospective study aims to identify complications and clinical outcomes using a locking plate with smooth pegs instead of screws (S3 plate). Method Eighty-two patients with displaced proximal humeral fracture classified with 2–4 fragments (Neer’s classification) treated with open reduction and internal fixation (ORIF) with S3 plate were studied retrospectively. Clinical outcome according to constant score; Single Shoulder Value; Disabilities of Arm, Shoulder and Hand; and European Quality of life-5 dimensions and complication rate defined radiologically including peg penetration, avascular necrosis, and loss of reduction was assessed minimum 2.5 years after surgery. Results A total of 11 peg penetrations were identified (13.6%). Avascular necrosis was seen in 8.5% (n = 7). Mean constant score at follow-up was 64.4 with a relative constant score of 87% (standard deviation 18%) compared to the contralateral uninjured side. The mean Disabilities of Arm, Shoulder and Hand score was 12.7 and mean European Quality of life-5 dimensions score 0.83. The mean Single Shoulder Value was 78.3. No cases of deep infection were seen. Conclusions Fixation with S3 plate shows a proper osteosynthesis and the functional outcome is good. Symptomatic peg penetrations are rare and the incidence is lower compared to what has been reported with locked screws.

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Assessment of the Efficacy of the Far Cortical Locking Technique in Proximal Humeral Fractures: A Comparison with the Conventional Bi-cortical Locking Technique

10.21203/rs.2.22352/v4 ◽

2020 ◽

Author(s):

joongbae seo ◽

Yoenjun Kim ◽

Kyubeom Kim ◽

Jae-Sung Yoo

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Callus Formation ◽

Constant Score ◽

Plate Fixation ◽

Treatment Strategies ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Union Rate ◽

Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

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Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

10.21203/rs.2.14214/v2 ◽

2019 ◽

Author(s):

Won Chul Shin ◽

Suk-Woong Kang ◽

Seung Min Son ◽

Hyuk Bae

Keyword(s):

Surgical Treatment ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Bone Union ◽

Neck Shaft Angle ◽

Radiological Results ◽

Comminuted Fracture ◽

Shaft Angle ◽

The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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RISK FACTORS FOR HUMERAL HEAD OSTEONECROSIS IN PATIENTS WITH PROXIMAL HUMERAL FRACTURES TREATED OPERATIVELY

Journal of IMAB - Annual Proceeding (Scientific Papers) ◽

10.5272/jimab.2021274.4072 ◽

2021 ◽

Vol 27 (4) ◽

pp. 4072-4076

Author(s):

Konstantin Totev ◽

◽

Georgi Dimitrov ◽

Lyubomira Toteva ◽

Svilen Todorov ◽

...

Keyword(s):

Risk Factors ◽

Humeral Head ◽

Constant Score ◽

Functional Results ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Frequent Site ◽

The Mean ◽

And Gender

Proximal humerus presents the second most frequent site of posttraumatic osteonecrosis. This complication is usually related to poor functional outcomes. The aim of this study is to identify and analyze the risk factors for posttraumatic humeral head osteonecrosis in surgically treated patients. Ninety-one patients with 92 acute proximal humeral fractures were operated on for a period of 39 months. Operative methods include open reduction and internal fixation and closed reduction and percutaneous fixation. Fractures were classified according to Neer, AO and LEGO classifications. The mean age of patients was 60.9 years. From 91 operated patients for follow-up were available 82. The mean follow-up period was 15 months. Patient data was collected prospectively. Functional results are present using age and gender adjusted Constant score. In 41 patients, the result is excellent, in 28-good, in 11-fair and in 3 poor. Bone union was evident in all cases. No deep wound infections, nerve injuries, vascular injuries and implant failure were observed. Osteonecrosis was seen in 5 (6.1%) patients. Patients with posttraumatic osteonecrosis had significant lower Constant results. Analyzing the pre- and intraoperative factors in patients with osteonecrosis, we find that the most significant factors for this complication are increasing fracture severity and а combination of short medial metaphyseal extension and disrupted medial hinge.

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Mid-term results after proximal humeral fractures following angular stable plate fixation in elderly patients—which scores can be evaluated by a telephone-based assessment?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1536-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Patrick Ziegler ◽

Kim Stierand ◽

Christian Bahrs ◽

Marc-Daniel Ahrend

Keyword(s):

Elderly Patients ◽

Constant Score ◽

Plate Fixation ◽

Humeral Fracture ◽

Weighted Kappa ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Cross Tabulation ◽

Mid Term Results

Abstract Background The aim was to evaluate postsurgical outcome in elderly patients (> 70 years) after open reduction and internal fixation (ORIF) of proximal humeral fractures and compare the test-retest agreement of scores which are frequently used to assess the outcome of upper extremity disorders. Methods Ninety patients (78.1 ± 5.2 years) with a minimum follow-up of 2 years (3.7 ± 0.9 years) following angular stable plate fixation of a proximal humeral fracture (2-part: 34, 3-part: 41, 4-part: 12) were enrolled. Two telephone-based interviews assessed Disabilities of the Arm, Shoulder and Hand Score (DASH), Oxford Shoulder Score (OSS), and Constant Score adjusted for interview assessment (CS) by two independent interviewers. Correlations, Bland-Altman analyses, Cross tabulation, and weighted Kappa measure of agreement (k) were calculated to assess differences and the test-retest agreement between the categories of each score. Results In the first and second interview, we could state fair outcomes: CS 91 (range 40–100) and 65.5 (23–86), DASH 12.5 (0–64.2) and 18.3 (0–66.7), and OSS 58 (33–60) and 55 (25–60) points. The test-retest correlations were r = 0.67, r = 0.77, and r = 0.71 for CS, DASH, and OSS. Bland-Altman analyses showed absolute mean individual score differences of − 22.3, 4.9, and − 3.0 for CS, DASH, and OSS. Limits of agreement represented possible differences of 21.6%, 15.5%, and 9.0% of CS, DASH, and OSS. The category agreements were medium to high: CS 55.9% (k = 0.08), DASH 87.2% (k = 0.62), and OSS 99.3% (k = 0.74). Conclusion Patients showed good subjective outcomes. The test-retest agreement of the interview-adjusted CS was low, but telephone-based assessment of OSS and DASH present as an alternative to collect outcomes in elderly patients. Trial registration (250/2011BO2).

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Assessment of the Efficacy of the Far Cortical Locking Technique in Proximal Humeral Fractures: A Comparison with the Conventional Bi-cortical Locking Technique

10.21203/rs.2.22352/v3 ◽

2020 ◽

Author(s):

joongbae seo ◽

Yoenjun Kim ◽

Kyubeom Kim ◽

Jae-Sung Yoo

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Callus Formation ◽

Constant Score ◽

Plate Fixation ◽

Treatment Strategies ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Union Rate ◽

Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.Level of evidence: Level III-2, Retrospective study

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Assessment of the Efficacy of the Far Cortical Locking Technique for Proximal Humeral Fractures: A Comparison with the Conventional Bicortical Locking Technique

10.21203/rs.2.22352/v1 ◽

2020 ◽

Author(s):

Joong-bae Seo ◽

Sunghyun Yoon ◽

Hyung-Seok Yi ◽

Jun-Kyom Kim ◽

Kyu-Beom Kim ◽

...

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Callus Formation ◽

Constant Score ◽

Plate Fixation ◽

Treatment Strategies ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Union Rate ◽

Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL allows axial motion and promotes uniform callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique. Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA). Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups. Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

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Review of Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals.

10.21203/rs.3.rs-568751/v1 ◽

2021 ◽

Author(s):

R M Chandak ◽

Mohit Sharma ◽

Amrit Jha

Keyword(s):

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Radiological Outcome ◽

Neck Shaft Angle ◽

Clinical And Radiological Outcome ◽

Shaft Angle ◽

Pin Site ◽

The Mean

Abstract Introduction: Proximal humeral fracture is 3rd most common fracture in elderly population.Selection of appropriate implant is always challenging to get optimum results in theseosteoporotic bones. Though locking plates are gold standard, major complications range from9% to 36%. Many percutaneous fixation techniques described in the literature are associated with pin site infections, pin backout and loss of reduction.Objective: To study clinical and radiological outcome of J nail technique for Neer’s three orfour part proximal humeral fractures in patients more than 60 years age.Materials and Method: We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, >60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip L (Lambrinudi) wires. At final follow-up, clinical outcome was assessed using Constant Score and radiological evaluation was done according to the Bahr criteria. Statistical analysis was performed.Results: The mean Constant Score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up upto 2 yrs.Conclusions: Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections. This surgical technique can be considered as one of the effective technique for fixation of proximal humeral fractures in elderly osteoporotics.

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Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

The Open Orthopaedics Journal ◽

10.2174/1874325001004010087 ◽

2010 ◽

Vol 4 (1) ◽

pp. 87-92 ◽

Cited By ~ 9

Author(s):

Dennis den Hartog ◽

Jeroen de Haan ◽

Niels W. Schep ◽

Wim E. Tuinebreijer

Keyword(s):

Conservative Treatment ◽

Outcome Measure ◽

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Conservative Group ◽

Electronic Search ◽

The Mean ◽

The Difference

The objective was to identify whether arthroplasty or conservative treatment is the best available treatment for three- and four-part proximal humeral fractures by analyzing the outcome measure of the Constant score. We conducted an electronic search. The systematic review included 33 studies encompassing 1096 patients with three- or four-part proximal humeral fractures that used the Constant score as outcome measure. The mean Constant score in the conservative group was 66.5 and in the arthroplasty group was 55.5. The difference could be attributed to selection bias, unreliable classification of the fractures and inter-observer differences in the assessment of the Constant score.

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