Proximal humeral fracture

OBJECTIVE: Reconstruction of proximal humeral bone defects in the setting of shoulder revision arthroplasty by implantation of a modular humeral component. INDICATIONS: Severe segmental humeral bone defects in revision total shoulder arthroplasty, after tumor resection, trauma, pathological fractures, post-infectious or after failed osteosynthesis. CONTRAINDICATIONS: Acute or chronic local infections, large diaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months)...

Reverse shoulder arthroplasty (RSA) for proximal humerus fractures (PHFs) is traditionally performed with cemented humeral fixation. The purpose of this study was to compare the clinical and radiographic outcomes of cemented and cementless RSA for PHF. Between 2010 and 2014, 38 acute PHFs were treated with RSA and followed for a minimum of 2 years (mean, 37 months; range, 24-66 months). The mean time from fracture to RSA was 7 days (range, 1-30 days). Humeral stems were cemented in 19 shoulders and uncemented in 19 shoulders...

INTRODUCTION: The proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%-33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment...

Stabilisation of proximal humerus fractures remains a surgical challenge. Spatial subchondral support (S3) plate promises to overcome common complications associated with conventional proximal humerus plates. This study compared the biomechanical performance of S3 plate with a fixed-angle hybrid blade (Equinoxe Fx) plate and a conventional fixed-angle locking plate (PHILOS). The effects of removal of different S3 plate screws on the humeral stability were also investigated. A total of 20 synthetic left humeri were osteotomised transversely at the surgical neck to simulate a two-part fracture and were each treated with an S3 plate...

Multifragmented proximal humeral fractures frequently require operative fixation. The locking plates commonly used are often placed relative to the greater tuberosity, however no quantitative data exists regarding the effect of positional changes. The aim of the study was to establish the effects from variations in proximal-distal PHILOS humeral plate positioning on predicted fixation failure risk. Twenty-one left-sided low-density virtual humeri models were created with a simulation framework from CT data of elderly donors and osteotomized to mimic an unstable three-part malreduced AO/OTA 11-B3...

OBJECTIVES: To evaluate tuberosity union rate and clinical outcome after 3- and 4-part proximal humerus fractures in the elderly. DESIGN: Retrospective, multicenter database cohort study. SETTING: Level I and Level II trauma centers. PATIENTS: Fifty-five patients older than 65 years had insertion of reverse shoulder arthroplasty (RTSA) for OTA/AO 11-B and 11-C proximal humerus fractures. INTERVENTION: Treatment with RTSA using a dedicated low profile onlay fracture stem using variable tuberosity fixation...

Introduction: Bilateral posterior fracture dislocation of both shoulders is a rare condition which can easily be missed due to its imprecise presentation. In this case report, we emphasize its diagnosis and summarize the various treatment options available for bilateral posterior fracture-dislocation of shoulders and also its management in conjunction with cavernous sinus venous thrombosis (CSVT). Case Report: A 29-year-old gentleman had bilateral posterior fracture-dislocation of shoulders, with comminuted three-part fractures of both humeral heads, after two episodes of seizures, following CSVT...

BACKGROUND: Patients with pain and disability due to a prior failed shoulder arthroplasty with associated proximal humeral bone loss have limited reconstruction options. Our purpose was to report the results of a large cohort of patients treated with a reverse shoulder allograft-prosthetic composite (APC). METHODS: Between 2002 and 2012, a total of 73 patients were treated with a reverse shoulder APC and had adequate follow-up. Clinical outcome scores, range of motion, and radiographic evidence of failure were assessed...

OBJECTIVE: The aim of surgical stabilization of proximal humerus fractures is to restore the anatomical relations between the greater and lesser tubercle, to reconstruct the joint and preserve the vascular supply of the fragments. INDICATIONS: Approximately 80% of proximal humeral fractures can be treated conservatively. Surgical treatment is indicated based on the fracture pattern, patient-related factors and the risk of avascular head necrosis. Two-part fractures with a metaphyseal comminution zone and 3/4-part fractures can benefit from near to anatomic reconstruction depending on the patient's demands and bone quality...

BACKGROUND: The γ‑nailing system is a widespread intramedullary therapeutic option that has been used for intertrochanteric and subtrochanteric fractures since the late 1980s; however, some reports from the 1990s describing femoral shaft fractures questioned the indications for this system in simple fracture types. Due to increasing numbers of patients treated with this system, the complication rate is continuously falling as confirmed by many recent studies. OBJECTIVE: Between 2008 and 2013 a total of 1500 operations using the γ‑nailing system were performed at this traumatology department...

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BACKGROUND: Recent literature has shown that acute reverse total shoulder arthroplasty (RTSA) yields good outcomes in the treatment of displaced proximal humeral fractures, and there have also been recent studies showing that delayed RTSA can be successfully used for sequelae of proximal humeral fractures such as nonunion and malunion. The use of meta-analysis affords the opportunity to formally compare the outcomes of acute RTSA for fracture and delayed RTSA for fracture sequelae. METHODS: We searched the MEDLINE, Embase, and Cochrane Library databases...

The MIPO (Minimally Invasive Plate Osteosynthesis) technique for treating metadiaphyseal fractures of the proximal humerus has gained great attention during the past years. The purpose of this retrospective study was to underline all the important difficulties when the MIPO technique is applied, to propose practical solutions and to evaluate the overall clinical outcome of our patients treated with this technique. A total of 14 patients had been operated in two different surgical units, at San Carlo Borromeo Hospital (Milan, Italy - 11 patients) and in Policlinico Umberto I Hospital (Rome, Italy - 3 patients), between June 2013 and November 2016...

BACKGROUND: Fractures of the proximal humerus make up 4 to 10% of all fractures. Their incidence increaseswith age, usually affecting individuals over 40 years old, reflecting the mineral status of the bone, Material and methods. Out of a group of 131 patients operated on due to comminuted proximal humeral fractures, 25 cases presenting inappropriate postoperative results were selected for further analysis. RESULTS: Failures were found in 16 cases, but affected the final outcome in seven cases only (lack of anatomical repositioning of bone fragments, including one that was stabilized at the fifth postfracture week, in whom a severe contracture of the supraspinatus muscle dislocated the major tubercle, or conflict of the implant with the acromion), and were negligible in the other nine...

PURPOSE: Only a few reports compare the mid- and long-term outcome of the minimally invasive deltoid split (MIDS) with the classic anterior deltopectoral (DP) approach for osteosynthesis in proximal humeral fractures. This study compared the mid-term functional and the radiological results in patients with proximal humeral fractures undergoing osteosynthesis with the proximal humeral internal locking system (PHILOS™). METHODS: All patients undergoing osteosynthesis between 2008 and 2015 were clinically and radiologically examined with a minimal follow-up period of 1 year...

BACKGROUND: In the last decade, the biomechanics of reverse shoulder arthroplasty (RSA) for proximal humeral fractures in the elderly have led to more functional outcomes and greater pain relief. However, its use has also introduced a significant rate of complications. The purpose of this study is to assess the complication rate of RSA in these cases as well as the relationship to ASA score and basic disease history. METHODS: We evaluate patients who underwent RSA due to acute proximal humeral fractures at three hospitals from 2010 to 2016...

A few treatment options for radial neck non-union have been reported, including radial head excision, radial head replacement, and internal fixation with a bone graft. We describe a new treatment for radial neck non-union using a reverse vascularized bone graft of the lateral distal humerus. In the anatomical study, the posterior radial collateral artery (PRCA) was dissected in eight fresh-frozen cadaver arms. The number of branches from the PRCA to the humerus was determined, and the distances from these branches to the lateral epicondyle of the humerus were measured...

The proximal humerus is a common, yet understudied site for osteoporotic fracture. The current study explored the impact of prolonged physical activity on proximal humerus bone health by comparing bone properties between the throwing and nonthrowing arms within professional baseball players. The proximal humerus in throwing arms had 28.1% (95% CI, 17.8 to 38.3%) greater bone mass compared to nonthrowing arms, as assessed using dual-energy x-ray absorptiometry. At the level of the surgical neck, computed tomography revealed 12...

BACKGROUND: Proximal humeral fractures (PHFs) are the third most common fracture in older patients. The purpose of the study was to prospectively evaluate the outcomes of PHF fixation with a locking blade nail (LBN) or locking plate (PHILOS) osteosynthesis in a homogeneous elderly patient population. METHODS: Inclusion criteria were an age > 60 years and the capacity to give informed consent. Patients with isolated tuberosity fractures, previous trauma or surgery, advanced osteoarthritis, fracture dislocation, pathological fractures, open fractures, neurological disorders, full-thickness rotator cuff tears, fracture line at the nail entry point or severely reduced bone quality intra-operatively were excluded...

BACKGROUND: Humeral bone loss is commonly encountered during revision shoulder arthroplasty and anticipating humeral bone defects can help the revision surgeon make appropriate plans to achieve adequate fixation and stability. No validated classification system exists to characterize humeral bone loss in the setting of revision shoulder arthroplasty. QUESTIONS/PURPOSES: The purposes of this study were (1) to create a classification system for humeral bone loss in revision shoulder arthroplasty; (2) to determine the classification system's reliability; and (3) to determine whether humeral bone loss type is associated with intraoperative humeral-related reconstruction characteristics...