Humerus Fractures
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Author(s):  
Simranpreet Singh ◽  
Mudasser Arif ◽  
Sanjeev Gupta

Background: Distal humerus fractures are commonly encountered in the orthopedic emergency. The goals in the treatment of these fractures are aimed at perfect anatomical reduction which could be obtained by open reduction and internal fixation.Methods: A prospective cohort study was conducted from July 2019 to December 2020 in Government Medical College, Jammu on 35 patients with AO type C distal humerus fractures. Functional outcomes were recorded and evaluated at end of 6 months using mayo elbow performance score (MEPS) score. 3 patients were lost in the follow up and were not included in the study.Results: 32 patients in the age group 20-65 years were included in the study with a mean age of 42.5 years. Males outnumbered females in ratio of 3:1. Patients undergoing olecranon osteotomy for fixation of distal humerus fractures had mean elbow flexion (121±8.3), loss of elbow extension (10.3±4.2). The functional outcome was made using MEPS score with a mean of 84±8.4 at final follow up.Conclusions: In this study we concluded that olecranon osteotomy approach provided better outcome. Intraarticular distal humerus fractures was better visualized with olecranon osteotomy approach and allowed early mobilization.


Author(s):  
Petro Bilinskyi

Treatment of distal humerus fractures is a complex problem in traumatology. The result of treatment depends on the choice of fixator according to the fracture area. Objective. To improve the techno­logy of treatment in patients with complicated distal humerus fractures with fixators of small contact and multiplanar osteosynthesis and to evaluate its efficacy. Methods. 39 patients were treated for the period 2000–2020 with distal humerus nonunion (types 12-B1, 12-C1, 12-C2) and 23 patients with complicated above- and transcondylar humerus fractures (types 13-A2, 13-C1, 13-C2). Fixation of bone fragments of the distal humerus was made with device for fixation (Patent 17502 UA). It is a shaped plate with a groove on which half rings with threaded holes are stabilized. For the osteosynthesis of above- and transcondylar humerus fractures we used V-shaped plate with the possibility to regulate branch spreading width as for the condylar size (Patent 33358 UA). Autografting was performed as for necessity. Results. Plate osteosynthesis was performed mainly through anterior approach with minimal tissues traumatization. Release of radial nerve we made as for necessity. This device provides the stable fixation even in a case of short distal fragment. Device for bone fragments fixation was placed on the posterior condylar surface and lower part of the humerus through olecranon osteotomy. Osteosynthesis with suggested device is one of the options with bone autografting and can be method of choice at repeated surgery. Follow-up period was 1–2 years and later. In 60 patients we obtained good results with completed bone union. Conclusions. Suggested device can be used in cases of distal humerus nonunion. It allows to decrease the damage of surgery, to avoid many complications. Key words. Complicated fractures of the distal humerus, devices for limited-contact multiplanar osteosynthesis.


Author(s):  
John M. Brooks ◽  
Cole G. Chapman ◽  
Sarah Floyd ◽  
Brian K. Chen ◽  
Charles A. Thigpen ◽  
...  

Objective: To assess the ability of an extended Instrumental Variable Causal Forest Algorithm (IV-CFA) to provide personalized evidence of early surgery effects on benefits and detriments for elderly shoulder fracture patients. Data Sources/Study Setting: Population of 72,751 fee-for-service Medicare beneficiaries with proximal humerus fractures (PHFs) in 2011 who survived a 60-day treatment window after an index PHF and were continuously Medicare fee-for-service eligible over the period 12 months prior to index to the minimum of 12 months after index or death. Study Design: IV-CFA estimated early surgery effects on both beneficial and detrimental outcomes for each patient in the study population. Classification and regression trees (CART) were applied to these estimates to create patient reference classes. Two-stage least squares (2SLS) estimators were applied to patients in each reference class to scrutinize the estimates relative to the known 2SLS properties. Principal Findings: This approach uncovered distinct reference classes of elderly PHF patients with respect to early surgery effects on benefit and detriment. Older, frailer patients with more comorbidities, and lower utilizers of healthcare were less likely to gain benefit and more likely to have detriment from early surgery. Reference classes were characterized by the appropriateness of early surgery rates with respect to benefit and detriment. Conclusions: Extended IV-CFA provides an illuminating method to uncover reference classes of patients based on treatment effects using observational data with a strong instrumental variable. This study isolated reference classes of new PHF patients in which changes in early surgery rates would improve patient outcomes. The inability to measure fracture complexity in Medicare claims means providers will need to discuss the appropriateness of these estimates to patients within a reference class in context of this missing information.


Injury ◽  
2021 ◽  
Author(s):  
Cole M. Patrick ◽  
Joshua C. Tadlock ◽  
Leon J. Nesti ◽  
John C. Dunn ◽  
Nata Parnes

Author(s):  
John M. Brooks ◽  
Cole G. Chapman ◽  
Sarah Floyd ◽  
Brian K. Chen ◽  
Charles A. Thigpen ◽  
...  

Objective: To assess the ability of an extended Instrumental Variable Causal Forest Algorithm (IV-CFA) to provide personalized evidence of early surgery effects on benefits and detriments for elderly shoulder fracture patients. Data Sources/Study Setting: Population of 72,751 fee-for-service Medicare beneficiaries with proximal humerus fractures (PHFs) in 2011 who survived a 60-day treatment window after an index PHF and were continuously Medicare fee-for-service eligible over the period 12 months prior to index to the minimum of 12 months after index or death. Study Design: IV-CFA estimated early surgery effects on both beneficial and detrimental outcomes for each patient in the study population. Classification and regression trees (CART) were applied to these estimates to create patient reference classes. Two-stage least squares (2SLS) estimators were applied to patients in each reference class to scrutinize the estimates relative to the known 2SLS properties. Principal Findings: This approach uncovered distinct reference classes of elderly PHF patients with respect to early surgery effects on benefit and detriment. Older, frailer patients with more comorbidities, and lower utilizers of healthcare were less likely to gain benefit and more likely to have detriment from early surgery. Reference classes were characterized by the appropriateness of early surgery rates with respect to benefit and detriment. Conclusions: Extended IV-CFA provides an illuminating method to uncover reference classes of patients based on treatment effects using observational data with a strong instrumental variable. This study isolated reference classes of new PHF patients in which changes in early surgery rates would improve patient outcomes. The inability to measure fracture complexity in Medicare claims means providers will need to discuss the appropriateness of these estimates to patients within a reference class in context of this missing information.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alberto Izquierdo-Fernández ◽  
Marta Gómez-Rodríguez ◽  
Maite Urbano-Luque ◽  
Manuel García-Carmona ◽  
Rafael Quevedo-Reinoso ◽  
...  

Abstract Background There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. Material and methods A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. Results After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. Conclusions At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. Level of evidence III Controlled cohort study.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mikaela H. Sullivan ◽  
Matthew R. Stillwagon ◽  
Alysa B. Nash ◽  
Huijun Jiang ◽  
Feng-Chang Lin ◽  
...  

2021 ◽  
Vol 71 (4) ◽  
pp. 187-193
Author(s):  
Putu Astawa ◽  
Made Agus Maharjana ◽  
Surya Adisthanaya ◽  
Made Winatra Satya Putra ◽  
Agus Suarjaya Putra ◽  
...  

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.


2021 ◽  
Vol 8 ◽  
Author(s):  
Jiali Deng ◽  
Shuai Zhang ◽  
Yuanyuan Yu ◽  
Li Zhang ◽  
Li Zhang ◽  
...  

Background: Proximal humerus fractures are common in a clinic and account for ~6% of all adult fractures. Hemiarthroplasty (HA) or locking plate (LP) fixation is currently recommended for the treatment of complex proximal humerus fractures (PHFs); however, there is no uniform standard for optimal surgical treatment or functional recovery. We conducted a meta-analysis to compare the efficacy of LP and HA in the treatment of PHFs.Methods: Relative studies associated with HA and LP were searched in December 2020 in the PubMed, Embase, Cochrane Library, and OVID databases. The quality of the studies, functional outcomes (including the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Short Form Health Survey (SF-12v2), complications, and reoperation rate were extracted and analyzed with the Stata 14.0 software.Results: A total of 958 patients from 12 studies were included in the meta-analysis, which showed that patients treated with LP had a significantly lower reoperation rate, a higher complication rate, and a higher CMS score than those treated with HA. There were no significant differences in ASES, SST, or SF-12v2 scores between treatment groups.Conclusions: Compared with HA, LP exhibited better clinical efficacy in some aspects. However, large sample and randomized, controlled studies are needed for further validation.


2021 ◽  
Vol 35 (5) ◽  
pp. S11-S15
Author(s):  
Ryan Mayer ◽  
Andrew Choo ◽  
David Zuelzer

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