scholarly journals Study of Bone Quality and Fracture Line Morphology of the Posterior Medial Humeral Calcar in Proximal Humeral Fractures

2021 ◽  
Author(s):  
Zheng Xu ◽  
Ming Xiang ◽  
Jinsong Yang ◽  
Xu Gao ◽  
Yi Cao
Keyword(s):  
Bone Density ◽  
Bone Quality ◽  
Humeral Head ◽  
External Rotation ◽  
Three Dimensional ◽  
Fracture Morphology ◽  
Proximal Humeral Fractures ◽  
Fracture Line ◽  
Humeral Fractures ◽  
Greater Tuberosity

Abstract Objective: To investigate the relationship between fracture line morphology, bone quality and fracture morphology of the posterior medial humeral calcar in proximal humeral fractures METHODS: CT data of patients with proximal humeral fractures diagnosed in our hospital from 06/2019 to 06/2021 were retrospectively analyzed to describe the map and coordinate analysis of the posterior medial humeral calcar fracture based on three-dimensional reconstruction, to create varus, valgus and normal groups according to the inclination angle of the humeral head, and to measure the bone mass of the posterior medial humeral calcar and perform statistical analysis.RESULTS: Sixty-two patients met the inclusion criteria, aged 15 to 72 years, there were 21 varus, 24 valgus and 17 normal types. Epiphyseal extension occurred most frequently posteriorly and medially, with the fracture line ending mostly posterior to the greater tuberosity. The thickness of the varus was (2.33 ± 0.47), valgus was (2.59 ± 0.33) and normal type was (2.69 ± 0.53). The T-test showed that the thickness of the bone in the varus was less than the other two types, and bone density and pinch angle were no statistically significant.CONCLUSION: There is no correlation between the trend of the posterior medial fracture line of the humeral calcar, bone density and internal, external rotation of the humeral head. The medial bone thickness after varus is less than that of valgus and normal fractures. The fracture line endpoint is mostly located posterior to the greater tuberosity.

scholarly journals Risk Factors and Prognosis of Humeral Head Inferior Subluxation in Proximal Humeral Fractures after Osteosynthesis

2021 ◽  
Author(s):  
Ryogo Furuhata ◽  
Noboru Matsumura ◽  
Ryosuke Tsujisaka ◽  
Satoshi Oki ◽  
Yusaku Kamata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Humeral Head ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures

scholarly journals Anatomy and Biomechanic of the Shoulder

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Troydimas Panjaitan
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Central Component ◽  
Subscapularis Tendon ◽  
Glenoid Fossa ◽  
Greater Tuberosity ◽  
Glenohumeral Ligaments ◽  
Shoulder Complex

The shoulder is one of the most complex joints of the human body. Consequently, they are susceptible to injury and degeneration. Mechanical shoulder pathology typically results when overuse, extremes of motion, or excessive forces overwhelm intrinsic material properties of the shoulder complex resulting in tears of the rotator cuff, capsule, and labrum. The fundamental central component of the shoulder complex is the glenohumeral joint. It has a ball-and-socket configuration with a surface area ratio of the humeral head to glenoid fossa of about 3:1 with an appearance similar to a golf ball on a tee. Overall, there is minimal bony covering and limited contact areas that allow extensive translational and rotational ability in all three planes. The glenohumeral joint has 2 groups of stabilizers, which are static (passive) and dynamic (active) restrains. Static stabilizers include the concavity of the glenoid fossa, glenoid fossa retroversion and superior angulation, glenoid labrum, the joint capsule, and glenohumeral ligaments, and a vacuum effect from negative intra-articular pressure. Dynamic stabilization is merely the coordinated contraction of the rotator cuff muscles that create forces that compress the articular surfaces of the humeral head into the concave surface of the glenoid fossa. During upper extremity movement, the effects of static stabilizers are minimized and dynamic or active stabilizers become the dominant forces responsible for glenohumeral stability The simple act of arm elevation is a complex task that occurs via the combination of glenohumeral and scapulothoracic motion, together known as scapulohumeral rhythm. In the first 1200, glenohumeral arm abduction, the supraspinatus and deltoid work together and create a force couple that promotes stability, while raising the arm (deltoid contraction). In addition, the humerus must undergo 450 external rotation to not only clear the greater tuberosity posteriorly but also loosen the inferior glenohumeral ligament (IGHL) to allow maximum elevation. There are several anatomical updates regarding the rotator cuff and capsular footprint. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus. The superior-most insertion of the subscapularis tendon extends a thin tendinous slip, which attaches to the fovea capitis of the humerus. The teres minor muscle inserts to the lowest impression of the greater tuberosity of the humerus and additionally inserts to the posterior side of the surgical neck of the humerus.

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xueliang Cui ◽  
Hui Chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
External Rotation ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Head Height

Abstract Background Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001). Conclusion For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

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 How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures

2018 ◽  
Vol 27 (12) ◽  
pp. 2139-2144 ◽  
Author(s):  
Xavier Ohl ◽  
Nicolas Bonnevialle ◽  
David Gallinet ◽  
Nassima Ramdane ◽  
Philippe Valenti ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Greater Tuberosity
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