The Humeral Head Push-Pull Plate Technique Significantly Diminishes Secondary Screw Penetration in the Treatment of Osteoporotic Varus-Displaced Proximal Humeral Fractures

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 minutes (range, 70–130 minutes), 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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Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001711010297 ◽

2017 ◽

Vol 11 (1) ◽

pp. 297-308

Author(s):

Dominik Saul ◽

Tobias Himmelmann ◽

Klaus Dresing

Keyword(s):

Predictive Factors ◽

Humeral Head ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Anatomic Reconstruction ◽

Daily Routine ◽

X Rays ◽

Tip Apex Distance ◽

Over Time

Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS®plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.

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Optimal viewing angles of intraoperative fluoroscopy for detecting screw penetration in proximal humeral fractures: a cadaveric study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-018-2247-8 ◽

2018 ◽

Vol 19 (1) ◽

Author(s):

Qiuke Wang ◽

Yifei Liu ◽

Ming Zhang ◽

Yu Zhu ◽

Lei Wang ◽

...

Keyword(s):

Cadaveric Study ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Intraoperative Fluoroscopy ◽

Screw Penetration

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

10.21203/rs.3.rs-934274/v1 ◽

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.

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