scholarly journals Use of a partial humeral head resurfacing system for management of an osseous mechanical block to glenohumeral joint range of movement secondary to proximal humeral fracture malunion

2011 ◽  
Vol 5 (1) ◽  
pp. 17 ◽  
Author(s):  
Nawfal Al-Hadithy ◽  
Vinay Joshi ◽  
Daniel Rossouw ◽  
Kyriacos Eleftheriou
Keyword(s):  
Humeral Head ◽  
Proximal Humeral Fracture ◽  
Glenohumeral Joint ◽  
Humeral Fracture ◽  
Range Of Movement ◽  
Joint Range

scholarly journals Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture

2021 ◽  
Author(s):  
Xinghuo Zhang ◽  
Yakui Zhang ◽  
Tao Guo ◽  
Liang Liu ◽  
Wenhao Cheng
Keyword(s):  
Humeral Head ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Humeral Head Replacement

scholarly journals Modified percutaneous Kirschner wire with mutual linking technique in proximal humeral fracture: a technique note and preliminary results

2019 ◽  
Author(s):  
Hao-Ming Chang ◽  
Pei-Yuan Lee ◽  
Wei-Ren Su ◽  
Cheng-Li Lin
Keyword(s):  
Proximal Humeral Fracture ◽  
Glenohumeral Joint ◽  
Kirschner Wire ◽  
Humeral Fracture ◽  
Deep Infection ◽  
Bony Union ◽  
Invasive Approach ◽  
Kirschner Wire Fixation ◽  
Minimal Invasive Approach

Abstract Background: The percutaneous pinning technique (PPT) with multiple Kirschner wires (K-wires) is one of common surgical options in proximal humeral fractures. However, complications including pin migration and loss of reduction have been re-ported. We aimed to describe a novel technique employing modified percutaneous pin-ning with mutual linking for the treatment of proximal humerus fractures, which may decrease such complications. Methods: 6 patients (5 female, 1male ; mean age 60.1 years) received close reduction and the modified percutaneous Kirschner wire fixation with mutual linking technique. All wires were removed about 6 weeks postoperatively followed by progressive reha-bilitation. We used following radiograph to evaluate bony union, wires migration, and fragment displacement. Clinical outcomes were evaluated using range of motion of af-fected glenohumeral joint, a 1-10 visual analog score (VAS), UCLA shoulder rating score (UCLA), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES). Outcomes were evaluated during the 2-month follow up and at the final follow up. Results: All cases were followed-up after an average of 12.6 months (range, 12-13.5 months). The mean of anterior forward flexion of the injured shoulder were 152.5 degrees (range, 145-160 degrees) during the 2-month follow up and 166.7 degrees (range, 150-180 degree) at the final follow up respectively. The means of the VAS, UCLA score, and the ASES of the injured shoulders were 0.3 (range, 0-1), 31.8 (range, 27-34), and 92.4 (range, 82-100) respectively. No wire migrations or fracture displacements were noted in our cases. There were also no deep infection, nonunion, implant failure, or avascular necrosis of the humeral head observed during the follow-ups. Conclusions:With this modified percutaneous Kirschner wire mutual linking technique, minimal invasive approach could be achieved and additional stability was provided by mutually linking the wires to reduce pin migration and fracture displacement in proximal humeral fracture.

scholarly journals Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

2021 ◽  
Author(s):  
Hao Xiang ◽  
Yan Wang ◽  
Yongliang Yang ◽  
Fanxiao Liu ◽  
Qinsen Lu ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Humeral Head ◽  
Proximal Humeral Fracture ◽  
Anatomical Study ◽  
Humeral Fracture ◽  
Vascular Supply ◽  
Coracoid Process ◽  
Circumflex Artery ◽  
Medial Approach ◽  
Process Risk

Abstract Background: The treatment of complex 3- and 4- part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.Method: Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.Results: Medial plate can be easily placed in 86.84% anatomical patterns. An interval of 2 to 3cm (24.29 ± 3.42 mm) was available for internal fixation. ACHA (49.35 ± 8.13 mm, 35.14 - 68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67 - 66.76 mm) were about 5cm away from the coracoid process. Risk factors including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels; musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk factor should be taken seriously. Conclusion: The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

Intrathoracic Fracture-dislocation of the Humeral Head:A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Ruifeng Yang ◽  
chong wang
Keyword(s):  
Humeral Head ◽  
Early Stage ◽  
External Rotation ◽  
Multidisciplinary Treatment ◽  
Humeral Fracture ◽  
Fracture Dislocation ◽  
Range Of Movement ◽  
Multiple Fractures ◽  
Emergency Thoracotomy ◽  
Humeral Head Necrosis

Abstract BackgroundIntrathoracic displacement of a humeral head fracture is extremely rare.Only slightly more than 30 cases have been reported. Because few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions and treatment of the injury are diverse.Case presentationA 73-year-old woman presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus and intrathoracic displacement of the humeral head.The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis, and open reduction and internal fixation were not performed.Three weeks later, the orthopedic surgery team performed reverse shoulder arthroplasty.During follow-up, the patient’s shoulder was free from pain, and its range of movement (ROM) included 110° flexion, 70° abduction, 35° external rotation and 50° internal rotation.ConclusionsIntrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.

Rehabilitation outcomes after proximal humeral fracture: An observational study

2021 ◽  
Vol 41 (2) ◽  
pp. 121-131
Author(s):  
Nicholas F. Taylor ◽  
Elizabeth Wintle ◽  
Claire Longden ◽  
Alexander T.M. van de Water ◽  
Nora Shields
Keyword(s):  
Decision Making ◽  
Proximal Humeral Fracture ◽  
Goal Attainment ◽  
Humeral Fracture ◽  
Shoulder Function ◽  
Global Rating ◽  
Range Of Movement ◽  
Rehabilitation Outcomes ◽  
Meaningful Activity ◽  
Shoulder Flexion

BACKGROUND AND PURPOSE: Fractures of the proximal humerus are characterised by slow recovery and ongoing disability. We aimed to describe the recovery of patients referred to community physiotherapy after proximal humeral fracture and determine if activity thresholds based on the Shoulder Function Index (SFInX) could inform physiotherapist decision-making. METHODS: Using a prospective observational cohort design, patients referred to community rehabilitation for physiotherapy were assessed for activity limitation (SFInX, DASH), quality of life (EQ-5D), pain levels (VAS), global rating of change, and shoulder range of movement at weeks 0, 6, 12 and 26. A focus group explored treating physiotherapists’ perceptions of using the SFInX. Characteristics of participants meeting SFInX clinically meaningful activity thresholds (+Δ17 units, score ≥73 units) were compared to those who did not. RESULTS: Participants (n = 38, mean age 78 years, 29 women, 29 conservatively managed) commenced physiotherapy a median of 12 (min 4, max 62) weeks after proximal humeral fracture and received a median of 8 (min 3 max 17) sessions over 8 weeks. N = 18 achieved +ΔSFInX ≥17 units by week 6. N = 15 achieved SFInX ≥73 units by week 26. Shoulder flexion range of 112° predicted +ΔSFInX ≥17 units at week 6 (AUC 0.74, 95% CI 0.58 to 0.90). Physiotherapists reported not basing management decisions on the SFInX. CONCLUSIONS: Patients after proximal humeral fracture make clinically meaningful improvements in shoulder activity after referral to physiotherapy. Decision-making based on SFInX activity thresholds or achievement of shoulder flexion of at least 112° may be informative but physiotherapists preferred making decisions based on individual goal-attainment.

Arthroscopically treated proximal humeral fracture malunion

2002 ◽  
Vol 18 (9) ◽  
pp. 1020-1023 ◽  
Author(s):  
Viktor Hinov ◽  
Franklin Wilson ◽  
Gayl Adams
Keyword(s):  
Proximal Humeral Fracture ◽  
Humeral Fracture

scholarly journals Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noboru Matsumura ◽  
Kazuya Kaneda ◽  
Satoshi Oki ◽  
Hiroo Kimura ◽  
Taku Suzuki ◽  
...  
Keyword(s):  
Humeral Head ◽  
Glenohumeral Joint ◽  
Three Dimensional ◽  
Clinical Results ◽  
Bone Defects ◽  
Symptom Duration ◽  
Glenohumeral Instability ◽  
Explanatory Variables ◽  
Large Bone ◽  
Large Bone Defects

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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