The Humelock Hemiarthoplasty Device for Both Primary and Failed Management of Proximal Humerus Fractures: A Case Series

Fractures of the proximal humerus account for 4-5% of all fractures. Managing proximal humerus fractures operatively and non-operatively have their respective complications both short- and long-term. We present our experience using the Humelock hemiarthoplasty device for both primary and failed management of proximal humeral fractures. We present four different examples from ten cases that include a failure of internal fixation, a failure of intramedullary nailing, a complex case in a patient with multiple co-morbidities, and a failure of nonoperative management. The patients in our series had multiple injuries and the device allowed early mobilization and produced good results. We suggest that this device has a role in the failure of primary and secondary management of proximal humeral fractures in a district general hospital setting.

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Proximal Humerus Fractures: up to date

Journal of Orthopaedic Surgery and Traumatology ◽

10.36438/jost00000002 ◽

2017 ◽

Author(s):

Joan Ferràs-Tarragó

Keyword(s):

Proximal Humerus ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Surgical Indication ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Multifactorial Approach

Humeral fractures requiere a multifactorial approach, and it's difficult to stablish lot of times the surgical indication. That's why we need to understand why and when complications related with proximal humeral fractures happens, and this is the aim of this up to date: to understand why we must do the things that we do.

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Outcome analysis of patients with proximal humerus fractures treated with locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171578 ◽

2017 ◽

Vol 3 (3) ◽

pp. 401

Author(s):

Ritesh Kumar ◽

S. Natarajan ◽

Sanjeev Kumar ◽

R. Kalanithi

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

High Energy ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Humerus Fractures

Background: Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure.Methods: This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.Results: Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome. Conclusions: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome.

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Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

BMJ ◽

10.1136/bmj.m4429 ◽

2020 ◽

pp. m4429

Author(s):

Sam Razaeian ◽

Birgitt Wiese ◽

Dafang Zhang ◽

Afif Harb ◽

Christian Krettek ◽

...

Keyword(s):

Proximal Humerus ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Proximal Humerus Fractures ◽

Macaca Sylvanus ◽

Rater Reliability ◽

Barbary Macaques ◽

Behavioural Analysis ◽

Choice Of Treatment ◽

Humerus Fractures

Abstract Objective To investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures. Design Uncontrolled, blinded, comparative behavioural analysis. Setting Germany and United States. Participants 10 blinded experts in the field of orthopaedic trauma surgery ( Homo chirurgicus accidentus ), with special focus on upper extremity surgery from Germany and the US, and five Barbary macaques ( Macaca sylvanus ) from a semi-free range enclosure. Main outcome measures The reliability of agreement between raters assessed with Fleiss’ ĸ. Results Barbary macaques seem to have inferior inter-rater reliability in comparison with experts for choice of treatment (non-surgical v surgical), but for the geriatric age group most frequently affected by proximal humeral fractures, they performed similarly to the experts in their choices of treatment and choice of surgical procedure. Agreement about predicted outcome was poor among the macaques and slight among the experts. All experts almost always predicted the outcome incorrectly and tended to underestimate it. While only 4 (4.4%) of 90 experts’ predictions were correct, 13 (28.9%) of 45 macaques’ predictions were correct. Conclusions Consensus on treatment and expected outcomes of proximal humeral fractures is lacking even beyond the human species. Although Barbary macaques tend to predict the clinical outcome more accurately, their reliability to assist surgeons in making a consistent decision is limited. Future high quality research is needed to guide surgeons’ decision making on the optimal treatment of this common injury.

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Surgical management of proximal humerus fracture treated with locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174707 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1165

Author(s):

Sivakumar Arumugam ◽

Venkateshwara Arumugam ◽

V. Raviraman

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Early Mobilization ◽

Open Reduction Internal Fixation ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Comminuted Fractures ◽

Humerus Fractures

Background: Proximal humerus fractures accounts for about 4 to 5% of all fractures. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remain challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Various operative procedures are carried out, the recent trend in internal fixation has moved on to locking plates. The present study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by locking compression plate.Methods: This is a prospective study comprising of 30 patients with fractures of proximal humerus were treated by open reduction and internal fixation with locking compression plate were evaluated at Velammal Institute Of Medical Sciences, Madurai from the period of April 2015 to December 2016. Clinical and radiological evaluation was done. Patients will undergo open reduction internal fixation with locking compression plate for the sustained fracture under general anesthesia.Results: In our series, the majority of the patients were males, elderly aged, with RTA being the commonest mode of injury, involving 2 part, 3 part and 4 part fractures of the proximal humerus. Excellent and satisfactory results were found in 76.7% of patients with unsatisfactory results in 23.3 % according to Neer’s criteria. There were 100 % union rates and no failures.Conclusions: In conclusion locking Compression, the plate is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in Osteoporotic bones in elderly patients, thus allowing early mobilization.

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Clinical Outcomes Following Reverse Total Shoulder Arthroplasty with Tuberosity Excision for Treatment of Proximal Humerus Fractures: A Case Series.

JSES Reviews, Reports, and Techniques ◽

10.1016/j.xrrt.2021.10.003 ◽

2021 ◽

Author(s):

Taylor A. VanHelmond ◽

Hari Iyer ◽

Brandon Lung ◽

Kevin Kashanchi ◽

Matthew Pearl ◽

...

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Total Shoulder Arthroplasty ◽

Case Series ◽

Reverse Total Shoulder Arthroplasty ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Reverse Total Shoulder

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PROXIMAL HUMERUS FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.571 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1788-1793

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Avascular Necrosis ◽

Open Reduction ◽

Proximal Humerus ◽

Case Series ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

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Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures

The Journal of Medical Sciences ◽

10.5005/jp-journals-10045-0024 ◽

2016 ◽

Vol 2 (1) ◽

pp. 1-8

Author(s):

KV Ramesh ◽

G Mahesh ◽

KC Kiran ◽

Roshan Kumar

Keyword(s):

Functional Outcome ◽

Traffic Accidents ◽

Proximal Humerus ◽

Road Traffic ◽

Early Mobilization ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Comminuted Fractures ◽

Humerus Fractures

ABSTRACT Introduction Proximal fractures of the humerus account for about 4 to 5% of all fractures. They are the most common fractures in elderly population. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Objectives The present study is undertaken to evaluate the functional outcome of proximal humerus fractures treated by locking compression plate in 20 patients. Materials and methods Prospective study was done involving 20 adult patients with proximal humerus fractures admitted from October 2012 to December 2013 treated by open reduction and internal fixation (ORIF) with locking compression plate. The functional follow-up was done for a minimum period of 3 months and the patients were evaluated by Constant Murley scoring (CMS). Results In our series, the majority of the patients were middle-aged males, with road traffic accidents (RTAs) being the most common cause of injury, involving 2-part, 3-part, and 4-part fractures of the proximal humerus. The fractures were united in 19 patients and 1 patient had avascular necrosis (AVN). Excellent results were seen in 15% of patients, good results in 55%, moderate results in 15%, and poor results in 15% according to CMS. There were 95% union rates, 5% of AVN, and no failures. Conclusion In conclusion, locking compression plate is an advantageous implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones of elderly patients, which allows their early mobilization. How to cite this article Mahesh G, Kiran KC, Ramesh KV, Kumar R. Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures. J Med Sci 2016;2(1):1-8.

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Healing of the Greater Tuberosity in Acute Shoulder Hemiarthroplasty Using an Accelerated Rehabilitation Regime

Shoulder & Elbow ◽

10.1111/j.1758-5740.2010.00058.x ◽

2010 ◽

Vol 2 (2) ◽

pp. 131-135 ◽

Cited By ~ 1

Author(s):

Robert J. Macfarlane ◽

Zulfikar Ali ◽

Dipankar Datt ◽

Balachandran Venkateswaran

Keyword(s):

Proximal Humerus ◽

Early Mobilization ◽

Cerebrovascular Event ◽

Proximal Humerus Fractures ◽

Shoulder Hemiarthroplasty ◽

Accelerated Rehabilitation ◽

Average Maximum ◽

Humerus Fractures ◽

The Mean

Background Displaced three- and four-part proximal humerus fractures are common and are frequently treated by shoulder hemiarthroplasty. The present study sought to evaluate an accelerated rehabilitaton regime following hemiarthoplasty and assess its affect on healing of the greater tuberosities. Methods Twenty patients over a 2-year period treated with acute hemiarthroplasty were rehabilitated with an accelerated regime of passive movements on day 1, active movements from the second week, and strengthening from the fourth postoperative week. Clinical and radiological follow-up was at 12 months. Results At 6 months, the mean Constant functional shoulder score was 55.52 (range 14 to 78). The average maximum forward elevation was 98.47° (range 30° to 160°). The mean pain score at 6 months was 11.42 (range 0 to 15). Twenty-two of 23 patients went on to heal radiologically by 3 months, with one case undergoing resorption of the tuberosities as a result of falls and a cerebrovascular event affecting the limb. At 3 months, 20/23 patients had undergone tuberosity healing with less than 0.5 cm displacement (86.9% of patients). Discussion An accelerated rehabilitation regime does not adversely affect the rate of healing of the tuberosities following shoulder hemiarthroplasty for proximal humerus fractures. The use of an early mobilization regime is likely to allow an earlier return to normal activities of daily living.

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Reverse Shoulder Arthroplasty for Failed Proximal Humerus Osteosynthesis With Intramedullary Allograft: A Case Series

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549220925464 ◽

2020 ◽

Vol 4 ◽

pp. 247154922092546

Author(s):

Teja Polisetty ◽

Paul DeVito ◽

Hyrum Judd ◽

Andrew Malarkey ◽

Jonathan C Levy

Keyword(s):

Pain Relief ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Intraoperative Complications ◽

Reverse Shoulder Arthroplasty ◽

Case Series ◽

Proximal Humerus Fractures ◽

Surgical Time ◽

Surgeon Experience ◽

Humerus Fractures

Introduction The presence of retained intramedullary fibular allograft presents many challenges during reverse shoulder arthroplasty (RSA), which have been discussed in limited fashion. This case series presents a single-surgeon experience with 6 patients treated with RSA following failed osteosynthesis of proximal humerus fractures using intramedullary allografts. Methods A retrospective review was conducted of RSA patients with a minimum of 2-year follow-up (exception of 1 deceased patient) for failed plate fixation of proximal humerus fractures. Two cohorts were created based on the presence of an intramedullary allograft during the procedure. Patient-reported outcome measures, active range of motion, time to revision, surgical time, complications, and case descriptions were obtained from chart review and radiographic analysis. Results When treating patients with a retained allograft, the surgeon used a guide pin from a cannulated screw set to advance through the graft, and a cannulated drill was used to ream and bypass the allograft, contributing to a 22% increase in surgical time (151 vs 124 min). Intraoperative complications were observed only in the allograft cohort (50%; 3 of 6), including cortical perforation with cement extrusion, humeral loosening, and proximal humerus bone loss. Patients treated with a retained allograft experienced pain relief ( P = .001) but did not gain significant functional improvements. Conclusion RSA for failed proximal humerus fixation with healed intramedullary allograft is associated with increased operative time and intraoperative complications, and patients can mostly expect pain relief. Techniques for humeral canal preparation and stem placement to bypass the allograft are helpful in managing these revisions.

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Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures: A Retrospective Study Describing Principles and Advantages of the Technique

Advances in Orthopedics ◽

10.1155/2018/5904028 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Riccardo Luigi Alberio ◽

Matteo Del Re ◽

Federico Alberto Grassi

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humeral Fractures ◽

Radiographic Evaluation ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Greater Tuberosity ◽

Humerus Fractures ◽

The Mean

Background. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Materials and Methods. From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48–80) were surgically treated with the MIPO technique for proximal humeral fractures. According to Neer classification, there were 12 two-part, 24 three-part, and 2 four-part fractures and 1 two-part fracture-dislocation; the AO/OTA system was also used to categorize the fractures. The Constant-Murley (CMS) and the Oxford Shoulder (OSS) Scores were used to evaluate shoulder function. Results. Thirty-four patients were available for clinical and radiographic evaluation at a mean follow-up of 31.8 months (range: 12–54 months). All fractures healed and no postoperative complications occurred. Full recovery of pretrauma activities was reported by 27 patients, while 7 patients presented mild functional limitations. The mean absolute CMS was 75.2 (range: 55–95), the mean normalized CMS was 90.5 (range: 69–107), and the mean OSS was 43.7 (range: 31–48). The only statistically significant correlation was found between the female gender and lower absolute CMS and OSS. Radiographic evaluation revealed varus malunion in 4 cases and valgus malunion in 1 case, while incomplete greater tuberosity reduction was detected in 4 cases. All malunions were related to inadequate reduction at time of surgery and not to secondary displacement. Conclusions. MIPO for proximal humeral fractures is an effective and safe surgical procedure. The limited tissue dissection allows minimizing the incidence of nonunion, avascular necrosis, and infection. The technique is not easy, requires experience to achieve mastery, and should be reserved for selected fracture patterns. In our experience, the main advantage of this approach consists in the direct access to the greater tuberosity, thus facilitating its anatomic reduction and fixation.

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