scholarly journals Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

2020 ◽  
Vol 11 (2) ◽  
pp. 29 ◽  
Author(s):  
Giuseppe Marongiu ◽  
Marco Verona ◽  
Gaia Cardoni ◽  
Antonio Capone
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Calcium Sulfate ◽  
Bone Substitutes ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Cochrane Library ◽  
Synthetic Bone ◽  
Mechanical Devices ◽  
Pmma Cement

Background: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures. Methods: A systematic review was conducted by using PubMed/MEDLINE, ISI Web of Knowledge, Cochrane Library, Scopus/EMBASE, and Google Scholar databases according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines over the years 1966 to 2019. The search term “humeral fracture proximal” was combined with “augmentation”; “polymethylmethacrylate, PMMA”; “cement”; “bone substitutes”; “hydroxyapatite”; “calcium phosphates”; “calcium sulfate”; “cell therapies”, and “tissue engineering” to find the literature relevant to the topic under review. Results: A total of 10 clinical studies considered eligible for the review, with a total of 308 patients, were included. Mean age at the time of injury was 68.8 years (range of 58–92). The most commonly described techniques were reinforcing the screw–bone interface with bone PMMA cement (three studies), filling the metaphyseal void with synthetic bone substitutes (five studies), and enhancing structural support with metallic devices (two studies). Conclusion: PMMA cementation could improve screw-tip fixation. Calcium phosphate and calcium sulfate injectable composites provided good biocompatibility, osteoconductivity, and lower mechanical failure rate when compared to non-augmented fractures. Mechanical devices currently have a limited role. However, the available evidence is provided mainly by level III to IV studies, and none of the proposed techniques have been sufficiently studied.

Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies

2019 ◽  
Vol 139 (8) ◽  
pp. 1075-1099 ◽  
Author(s):  
Niklas Biermann ◽  
Wolf Christian Prall ◽  
Wolfgang Böcker ◽  
Hermann Otto Mayr ◽  
Florian Haasters
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Plate Osteosynthesis ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures

scholarly journals Fosfato β-Tricálcico Monobloco no Tratamento de Fraturas Proximais do Úmero Cirúrgicas

2016 ◽  
Vol 29 (1) ◽  
pp. 41
Author(s):  
Marco Sarmento ◽  
Samuel Martins ◽  
Jacinto Monteiro
Keyword(s):  
Bone Graft ◽  
Range Of Motion ◽  
Tricalcium Phosphate ◽  
Functional Results ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Synthetic Bone ◽  
Synthetic Bone Graft ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

<p><strong>Introduction:</strong> The proximal humeral fractures are becoming more frequent, with a greater tendency for its surgical treatment by osteosynthesis with plate and locked screws. The mechanical and biological failure in these fractures and devices, despite the evolution of this type of implants, highlighted the synthetic bone grafts became an option.<br /><strong>Material and Methods:</strong> Over a period of 96 months, patients considered were those with proximal humeral fractures treated surgically with a plate and locked screws, and in which β-tricalcium phosphate bone graft had been used. Functional results were evaluated by the shoulder range of motion as the radiological results.<br /><strong>Results:</strong> In 19 patients, with a medial follow up of 53 months, we obtained an average shoulder range of motion of 140º in abduction, 142º in forward flexion, 37º in external rotation and L3 hand position in internal rotation for a cefalo-diaphyseal angle of 136º.<br /><strong>Discussion:</strong> The β-tricalcium phosphate synthetic bone graft allows the maintenance of reduction after fixation of proximal humeral fractures stabilized with plate and locked screws. This reduction which means the maintenance of cefalo-diaphyseal angle is in close relationship with functional results as shown by shoulder range of motion in all planes.<br /><strong>Conclusion:</strong> The β-tricalcium phosphate synthetic bone graft should be seen as an adjuvant therapy in extramedullary fixation of proximal humeral fractures, especially those with greater comminution of the medial calcar.</p>

scholarly journals Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

2017 ◽  
Vol 11 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Ioannis Gigis ◽  
Alexandros Nenopoulos ◽  
Dimitrios Giannekas ◽  
Roderich Heikenfeld ◽  
Theodoros Beslikas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Humeral Fracture ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Long Term Results ◽  
Cochrane Library ◽  
Osteoporotic Bone ◽  
Reverse Prosthesis

Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

scholarly journals Evidence-based uncertainty: do implant-related properties of titanium reduce the susceptibility to perioperative infections in clinical fracture management? A systematic review

Infection ◽  
2021 ◽  
Author(s):  
Michael C. Tanner ◽  
Christian Fischer ◽  
Gerhard Schmidmaier ◽  
Patrick Haubruck
Keyword(s):  
Systematic Review ◽  
Stainless Steel ◽  
Clinical Studies ◽  
Contemporary Literature ◽  
Titanium Implants ◽  
Cochrane Library ◽  
Randomized Controlled Studies ◽  
Fracture Management ◽  
The Cochrane Library ◽  
Tissue Trauma

Abstract Background Implant-associated infections (IAI) remain a challenging complication in osteosynthesis. There is no consensus or clear evidence whether titanium offers a relevant clinical benefit over stainless steel. Purpose In this systematic review, we sought to determine whether the implant properties of titanium reduce the susceptibility to IAI compared to stainless steel in fracture management. Methods A systematic literature search in German and English was performed using specific search terms and limits. Studies published between 1995 and 1st June 2020 in the Cochrane library, MEDLINE and Web of Science databases were included. Only clinical studies comparing titanium and stainless steel implants regarding the susceptibility to infections were selected for detailed review. Results Five studies out of 384 papers were identified and reviewed. From the studies meeting inclusion criteria one study was a systematic review, two studies were randomized controlled studies (RCT) and two studies were of retrospective comparative nature of level IV evidence. Conclusion Our results show that currently, no proven advantage for titanium implants in respect to IAI can be seen in contemporary literature. Implants preserving periosteal blood-flow and minimising soft-tissue trauma show statistically significant benefits in reducing the incidence of IAI. Clinical studies providing reliable evidence regarding the influence of titanium implants on IAI and investigating the susceptibility of titanium to infection are necessary

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