scholarly journals 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

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.

scholarly journals Strut Support with Tricortical Iliac Allografts in Unstable Proximal Humerus Fractures: Surgical Indication and New Definition of Poor Medial Column Support

2019 ◽  
Vol 22 (1) ◽  
pp. 29-36
Author(s):  
Seung-Jin Lee ◽  
Yoon-Suk Hyun ◽  
Seung-Ha Baek
Keyword(s):  
Open Reduction ◽  
Proximal Humerus ◽  
Constant Score ◽  
Plate Fixation ◽  
Assessment Method ◽  
Proximal Humerus Fractures ◽  
Neck Shaft Angle ◽  
Significant Difference ◽  
Humerus Fractures ◽  
The Mean

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs.Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters.Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was 148°. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support).Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

scholarly journals A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Wang ◽  
Yan Wang ◽  
Jinye Dong ◽  
Yu He ◽  
Lianxin Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Shoulder Joint ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Anterolateral Approach ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

scholarly journals Effect of Osteoporosis on Proximal Humerus Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932098539
Author(s):  
Anil Taskesen ◽  
Ali Göçer ◽  
Kadir Uzel ◽  
Yüksel Uğur Yaradılmış
Keyword(s):  
Surgical Outcomes ◽  
Proximal Humerus ◽  
City Hospital ◽  
Proximal Humerus Fractures ◽  
Fracture Type ◽  
Age And Gender ◽  
Humerus Fractures ◽  
The Mean ◽  
And Gender ◽  
Fracture Types

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.

A systematic review of locking plate fixation of proximal humerus fractures

Injury ◽  
2011 ◽  
Vol 42 (4) ◽  
pp. 408-413 ◽  
Author(s):  
Robert C. Sproul ◽  
Jaicharan J. Iyengar ◽  
Zlatko Devcic ◽  
Brian T. Feeley
Keyword(s):  
Systematic Review ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

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

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.

Locked Plate Fixation and Intramedullary Nailing for Proximal Humerus Fractures: A Biomechanical Evaluation

2005 ◽  
Vol 58 (6) ◽  
pp. 1194-1201 ◽  
Author(s):  
Martin Henri Hessmann ◽  
Werner Sternstein Matthias Hansen ◽  
Frank Krummenauer ◽  
Tamara Fischer Pol ◽  
Maria Rommens
Keyword(s):  
Intramedullary Nailing ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Proximal Humerus Fractures ◽  
Locked Plate ◽  
Biomechanical Evaluation ◽  
Humerus Fractures

scholarly journals Review of philos plate fixation in proximal humerus fractures

Injury Extra ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 96
Author(s):  
A.C. King ◽  
F. Brooks ◽  
R. Williams
Keyword(s):  
Proximal Humerus ◽  
Plate Fixation ◽  
Proximal Humerus Fractures ◽  
Philos Plate ◽  
Humerus Fractures

Is the Axillary Nerve at Risk During a Deltoid-Splitting Approach for Proximal Humerus Fractures?

2016 ◽  
Vol 30 (5) ◽  
pp. 240-244 ◽  
Author(s):  
Jessica L. Traver ◽  
Miguel A. Guzman ◽  
Lisa K. Cannada ◽  
Scott G. Kaar
Keyword(s):  
At Risk ◽  
Proximal Humerus ◽  
Axillary Nerve ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Efficacy of Hemiarthroplasty vs. Locking Plate Fixation for Proximal Humerus Fractures: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiali Deng ◽  
Shuai Zhang ◽  
Yuanyuan Yu ◽  
Li Zhang ◽  
Li Zhang ◽  
...  
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Short Form ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Cochrane Library ◽  
Proximal Humerus Fractures ◽  
Randomized Controlled Studies ◽  
Humerus Fractures

Background: Proximal humerus fractures are common in a clinic and account for ~6% of all adult fractures. Hemiarthroplasty (HA) or locking plate (LP) fixation is currently recommended for the treatment of complex proximal humerus fractures (PHFs); however, there is no uniform standard for optimal surgical treatment or functional recovery. We conducted a meta-analysis to compare the efficacy of LP and HA in the treatment of PHFs.Methods: Relative studies associated with HA and LP were searched in December 2020 in the PubMed, Embase, Cochrane Library, and OVID databases. The quality of the studies, functional outcomes (including the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Short Form Health Survey (SF-12v2), complications, and reoperation rate were extracted and analyzed with the Stata 14.0 software.Results: A total of 958 patients from 12 studies were included in the meta-analysis, which showed that patients treated with LP had a significantly lower reoperation rate, a higher complication rate, and a higher CMS score than those treated with HA. There were no significant differences in ASES, SST, or SF-12v2 scores between treatment groups.Conclusions: Compared with HA, LP exhibited better clinical efficacy in some aspects. However, large sample and randomized, controlled studies are needed for further validation.

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