The 2-year outcome after implantation of a pyrocarbon ball in failed proximal humerus fractures with advanced collapse of the humeral head

Objective. It is common to get lost during a comminuted proximal humerus surgery, and the pectoralis major insertion is always a constant. Therefore, this study aimed to do a cadaveric study on the Filipino population to assess the distance from the pectoralis major tendon to the top of the humeral head (PMT) as a reference during proximal humerus surgery. Methods. This study dissected the shoulders of cadavers. The distance from the pectoralis major tendon insertion to the top of the humeral head (PMT) was measured using a caliper. This PMT distance was also correlated to the cadaver's height and sex. Results. This study dissected 110 shoulders (55 cadavers | 24 females, 31 males). The median PMT was 5.40 cm for males and 4.90 cm for females, with a combined value of 5.40 cm overall. There was a direct and moderate correlation between the PMT with overall height. Height and PMT of both the left and right shoulder were significantly longer among males compared to females. The study showed that for every centimeter increase in the height of males, there was a corresponding 0.02 cm increase in the PMT, adding the constant factor of 1.83. A corresponding 0.04 cm increase in the PMT for females added the constant factor of -0.81. Conclusion. The pectoralis major tendon insertion is a consistent landmark that can accurately restore humeral length when reconstructing complex proximal humerus fractures where landmarks are otherwise lost because of comminution.

Download Full-text

A new classification of impacted proximal humerus fractures based on the morpho-volumetric evaluation of humeral head bone loss with a 3D model

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.02.022 ◽

2020 ◽

Vol 29 (10) ◽

pp. e374-e385 ◽

Cited By ~ 1

Author(s):

Raffaele Russo ◽

Antonio Guastafierro ◽

Giuseppe della Rotonda ◽

Stefano Viglione ◽

Michele Ciccarelli ◽

...

Keyword(s):

Bone Loss ◽

Humeral Head ◽

3D Model ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

New Classification ◽

Humerus Fractures

Download Full-text

Humeral head replacement for acute, four-part proximal humerus fractures

Journal of Shoulder and Elbow Surgery ◽

10.1016/s1058-2746(09)80084-0 ◽

1993 ◽

Vol 2 (5) ◽

pp. 249-254 ◽

Cited By ~ 42

Author(s):

Andrew Green ◽

W. Lloyd Barnard ◽

Richard S. Limbird

Keyword(s):

Humeral Head ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

Humeral Head Replacement

Download Full-text

Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03715-w ◽

2020 ◽

Author(s):

Lukas Dankl ◽

Werner Schmoelz ◽

Romed Hoermann ◽

Simon Euler

Keyword(s):

Humeral Head ◽

Locking Plate ◽

Proximal Humerus ◽

Treatment Options ◽

Test Group ◽

The Elderly ◽

Bending Test ◽

Control Group ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Abstract Introduction Proximal humerus fractures are common injuries of the elderly. Different treatment options, depending on fracture complexity and stability, have been recommended in the literature. Particularly for varus displaced fractures with a lack of medial support, and patients suffering from osteoporosis, structural allografts can be used to enhance the stability of the construct. An individually shaped allograft has been suggested in the literature and investigated in a clinical setting. However, biomechanical properties have yet to be evaluated. Materials and methods Twenty-four fresh-frozen humeri and 12 femoral heads were obtained, and an unstable three-part fracture of the humeral head was simulated. Fracture fixation was achieved by using a locking plate in both groups. In the test group, a mushroom-shaped allograft was tailored out of a femoral head to individually fit the void inside the humeral head. Specimens were fitted with a 3D motion analysis system and cyclically loaded with a stepwise increasing load magnitude in a varus-valgus bending test until failure or up to a maximum of 10,000 load cycles. Results The mushroom group reached a significantly higher number of load cycles (8342; SD 1,902; CI 7133–9550) compared to the control group (3475; SD 1488; CI 2530–4420; p < 0.001). Additionally, the test group showed significantly higher stiffness values concerning all observational points (p < 0.001). Conclusion This mushroom-shaped allograft in combination with a locking plate significantly increased load to failure as well as stiffness of the construct when exposed to varus-valgus bending forces. Therefore, it might be a viable option for surgical treatment of unstable and varus displaced proximal humerus fractures to superiorly prevent loss of reduction and varus collapse.

Download Full-text

Primary Hemiarthroplasty Following Severe Proximal Humerus Fracture Dislocations with Irretrievable Humeral Head in Young Patients

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1171 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Lim Chia Hua ◽

Khairul Nizam Siron

Keyword(s):

Humeral Head ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Young Patients ◽

Humerus Fracture ◽

Fracture Dislocation ◽

Proximal Humerus Fractures ◽

Range Of Movement ◽

Humerus Fractures ◽

Good Range

Neer first popularised the use of primary hemiarthroplasty to treat complex proximal humerus fractures, especially when the humeral head is nonviable or not reconstructable with internal fixations, and with younger patients. A 16-year-old boy had a motor vehicle accident and sustained a closed right proximal humerus fracture dislocation without neurovascular injury. Intraoperatively, due to difficulty retrieving the humeral head which dislocated and positioned behind the clavicle, hemiarthroplasty was done to avoid injuring the brachial plexus, vessels and lung. Mr Y, a 34-year-old man similarly sustained closed left proximal humerus fracture dislocation with an irretrievable head. He too underwent hemiarthroplasty. Both patients were followed up for a year with no pain and fairly good range of movement and muscle power. In complex proximal humerus fractures, there is still debate regarding primary hemiarthroplasty. There are risks of secondary displacement of fracture fragments and head necrosis after internal fixation. Neer and Cofield reported over 90% patients had relief of pain and 66% patients had free range of movement post hemiarthroplasty. Other authors described primary malposition and subsequent migration or deficient osseous integration as a complication after prosthesis. In a thirteen-year observational cohort study of 163 patients with hemiarthroplasty, the overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. Of the factors that were assessed, the age is most important due to factors such as degenerative changes in the rotator cuff, osteoporosis, and motivation to achieve a good range of motion. Successful treatment of acute proximal humerus fractures with prosthetic replacement is challenging to orthopaedic surgeons as it requires proper patient evaluation, good surgical technique, especially in soft-tissue tensioning and stability, and meticulous rehabilitation. In young patients with good bone quality and irretrievable head, hemiarthroplasty is a choice.

Download Full-text