Intramedullary nailing as a safe and efficient treatment option for all types of displaced proximal humeral fractures in geriatric patients: A retrospective evaluation of 49 patients treated with the new Targon PH+ nail

2021 ◽  
pp. 1-10
Author(s):  
Adela Maria Paniagua-Collado ◽  
Maximilian Willauschus ◽  
Johannes Rüther ◽  
Matthias Lahner ◽  
Hermann Josef Bail ◽  
...  
Keyword(s):  
Adverse Events ◽  
Geriatric Patients ◽  
Constant Score ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Consecutive Series ◽  
Dash Score ◽  
Disability Score ◽  
Efficient Treatment

BACKGROUND: Implant specific complications and outcome for the use of proximal humeral nails in different fracture types are not well described. OBJECTIVE: Evaluation of adverse effects and outcome of patients treated with the new Targon PH+ implant for proximal humeral fractures in a geriatric population. METHODS: A consecutive series of patients from a single institution was retrospectively evaluated. Adverse events (AE) were assessed from patients’ files and during follow-up examination. Current pain level was evaluated using the Visual Analogue Scale (VAS). The disability score of arm, shoulder and hand (DASH) as well as the Constant-Murley score were assessed. Patient satisfaction was evaluated by questionnaire. RESULTS: Forty-nine patients with a mean age of 72.0 ± 10.0 years were included with a follow-up of 2.2 years. Five patients showed twopart fractures (10%), 24 threepart fractures (50%) and 20 fourpart fractures (40%). Additional shaft fracture occurred in twelve cases (24%). Implant-related AE were recorded in six cases (12%). Pain under strain was moderate with a mean of 27.6 ± 27.1 mm. DASH score showed a mean of 25.9 ± 24.9. Constant score of the affected shoulder was 57 ± 23.8 with a mean difference of 16 points compared to reference shoulder. No significant differences in AE, VAS, DASH or Constant score could be found according to fracture groups. Most patients were satisfied with the surgical outcome (84%). CONCLUSIONS: The Targon PH+ nail demonstrated good functional results and low adverse events in geriatric patients. Additional studies including less experienced centres are required to further evaluate the possible benefits of this implant.

scholarly journals Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiantao Li ◽  
Yuan Gao ◽  
Caixia Yin ◽  
Hao Zhang ◽  
Shaobo Nie ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Humeral Fracture ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Dash Score ◽  
Peek Cage ◽  
Polyether Ether Ketone ◽  
Stable Osteosynthesis ◽  
Long Term Follow Up

Abstract Background The treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP). Methods A total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up. Results The average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients. Conclusion The use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

Follow-up our patients with proximal humeral fractures between 2000 and 2005

2009 ◽  
Vol 150 (49) ◽  
pp. 2237-2240 ◽  
Author(s):  
Ottó Bauer ◽  
István Horváth ◽  
Péter Kelemen ◽  
Balázs Hepp
Keyword(s):  
Constant Score ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures

A szerzők 2000-ben új módszert vezettek be osztályukon a felkar proximalis végének műtéti ellátására. A vállízület anatómiai adottságai olyanok, hogy különös hangsúlyt kap az ízületet burkoló lágy részek védelme, a minimálisan invazív műtéti technika. Ugyanakkor az időskorban jelentkező osteoporosis megnehezíti a csontegyesítő műtétet, a szövődmények aránya a leggondosabb ellátás mellett is magas. Hat év anyagát összegyűjtve a szerzők visszarendelték operált betegeiket, fizikális és röntgenvizsgálat végzése után eredményeiket Constant-score alapján értékelték. Külön értékelték szövődményeiket a tekintetben, hogy azok milyen mértékben befolyásolhatók a műtéti módszerrel, vagy függetlenek attól. Az egyik leggyakoribb szövődmény a rögzítő fémanyagok elvándorlása, a törés ismételt elmozdulása. Ennek megakadályozására – a külföldön kifejlesztett módszereket a szerzők a hazai gyakorlat számára túlságosan költségesnek találva – a hazai gyártású Kurucz-féle menetes tűződrótot alkalmazták. Következtetéseikben megállapítják, hogy az alkalmazott implantátum a célnak megfelel, a szövetkímélő műtéti eljárástól elvárt eredményeket hozza. Mindemellett nem tekinthetjük a súlyosan poroticus vállízületi töréseket megoldottnak. A felkarfejnekrózisok magas aránya a módszertől független szövődmény. Azok kezelésére a vállízületi endoprotetika szélesebb körű alkalmazása szükséges.

scholarly journals RISK FACTORS FOR HUMERAL HEAD OSTEONECROSIS IN PATIENTS WITH PROXIMAL HUMERAL FRACTURES TREATED OPERATIVELY

2021 ◽  
Vol 27 (4) ◽  
pp. 4072-4076
Author(s):  
Konstantin Totev ◽  
◽  
Georgi Dimitrov ◽  
Lyubomira Toteva ◽  
Svilen Todorov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Humeral Head ◽  
Constant Score ◽  
Functional Results ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Frequent Site ◽  
The Mean ◽  
And Gender

Proximal humerus presents the second most frequent site of posttraumatic osteonecrosis. This complication is usually related to poor functional outcomes. The aim of this study is to identify and analyze the risk factors for posttraumatic humeral head osteonecrosis in surgically treated patients. Ninety-one patients with 92 acute proximal humeral fractures were operated on for a period of 39 months. Operative methods include open reduction and internal fixation and closed reduction and percutaneous fixation. Fractures were classified according to Neer, AO and LEGO classifications. The mean age of patients was 60.9 years. From 91 operated patients for follow-up were available 82. The mean follow-up period was 15 months. Patient data was collected prospectively. Functional results are present using age and gender adjusted Constant score. In 41 patients, the result is excellent, in 28-good, in 11-fair and in 3 poor. Bone union was evident in all cases. No deep wound infections, nerve injuries, vascular injuries and implant failure were observed. Osteonecrosis was seen in 5 (6.1%) patients. Patients with posttraumatic osteonecrosis had significant lower Constant results. Analyzing the pre- and intraoperative factors in patients with osteonecrosis, we find that the most significant factors for this complication are increasing fracture severity and а combination of short medial metaphyseal extension and disrupted medial hinge.

scholarly journals Mid-term results after proximal humeral fractures following angular stable plate fixation in elderly patients—which scores can be evaluated by a telephone-based assessment?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Patrick Ziegler ◽  
Kim Stierand ◽  
Christian Bahrs ◽  
Marc-Daniel Ahrend
Keyword(s):  
Elderly Patients ◽  
Constant Score ◽  
Plate Fixation ◽  
Humeral Fracture ◽  
Weighted Kappa ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Cross Tabulation ◽  
Mid Term Results

Abstract Background The aim was to evaluate postsurgical outcome in elderly patients (> 70 years) after open reduction and internal fixation (ORIF) of proximal humeral fractures and compare the test-retest agreement of scores which are frequently used to assess the outcome of upper extremity disorders. Methods Ninety patients (78.1 ± 5.2 years) with a minimum follow-up of 2 years (3.7 ± 0.9 years) following angular stable plate fixation of a proximal humeral fracture (2-part: 34, 3-part: 41, 4-part: 12) were enrolled. Two telephone-based interviews assessed Disabilities of the Arm, Shoulder and Hand Score (DASH), Oxford Shoulder Score (OSS), and Constant Score adjusted for interview assessment (CS) by two independent interviewers. Correlations, Bland-Altman analyses, Cross tabulation, and weighted Kappa measure of agreement (k) were calculated to assess differences and the test-retest agreement between the categories of each score. Results In the first and second interview, we could state fair outcomes: CS 91 (range 40–100) and 65.5 (23–86), DASH 12.5 (0–64.2) and 18.3 (0–66.7), and OSS 58 (33–60) and 55 (25–60) points. The test-retest correlations were r = 0.67, r = 0.77, and r = 0.71 for CS, DASH, and OSS. Bland-Altman analyses showed absolute mean individual score differences of − 22.3, 4.9, and − 3.0 for CS, DASH, and OSS. Limits of agreement represented possible differences of 21.6%, 15.5%, and 9.0% of CS, DASH, and OSS. The category agreements were medium to high: CS 55.9% (k = 0.08), DASH 87.2% (k = 0.62), and OSS 99.3% (k = 0.74). Conclusion Patients showed good subjective outcomes. The test-retest agreement of the interview-adjusted CS was low, but telephone-based assessment of OSS and DASH present as an alternative to collect outcomes in elderly patients. Trial registration (250/2011BO2).

scholarly journals Review of Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals.

2021 ◽  
Author(s):  
R M Chandak ◽  
Mohit Sharma ◽  
Amrit Jha
Keyword(s):  
Constant Score ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Radiological Outcome ◽  
Neck Shaft Angle ◽  
Clinical And Radiological Outcome ◽  
Shaft Angle ◽  
Pin Site ◽  
The Mean

Abstract Introduction: Proximal humeral fracture is 3rd most common fracture in elderly population.Selection of appropriate implant is always challenging to get optimum results in theseosteoporotic bones. Though locking plates are gold standard, major complications range from9% to 36%. Many percutaneous fixation techniques described in the literature are associated with pin site infections, pin backout and loss of reduction.Objective: To study clinical and radiological outcome of J nail technique for Neer’s three orfour part proximal humeral fractures in patients more than 60 years age.Materials and Method: We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, >60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip L (Lambrinudi) wires. At final follow-up, clinical outcome was assessed using Constant Score and radiological evaluation was done according to the Bahr criteria. Statistical analysis was performed.Results: The mean Constant Score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up upto 2 yrs.Conclusions: Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections. This surgical technique can be considered as one of the effective technique for fixation of proximal humeral fractures in elderly osteoporotics.

scholarly journals More Adverse Events after Osteosyntheses Compared to Arthroplasty in Geriatric Proximal Humeral Fractures Involving Anatomical Neck

2021 ◽  
Vol 10 (5) ◽  
pp. 979
Author(s):  
Felix Porschke ◽  
Julia Bockmeyer ◽  
Philip-Christian Nolte ◽  
Stefan Studier-Fischer ◽  
Thorsten Guehring ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Geriatric Patients ◽  
Proximal Humerus ◽  
Dash Score ◽  
Ao Classification ◽  
Intraarticular Fractures ◽  
Type C ◽  
Humerus Fractures

The purpose of this study was to compare adverse events and clinical outcomes of geriatric proximal humerus fractures (PHF) involving the anatomical neck (type C according to AO classification) treated with open reduction and internal fixation (ORIF) using locking plate vs. arthroplasty. In this retrospective cohort study, geriatric patients (>64 years) who underwent operative treatment using ORIF or arthroplasty for type C PHFs were included. Complications, revisions and clinical outcomes using Constant Murley Score (CMS) and Disabilities of the Arm, Shoulder and Hand (DASH) Score were assessed and compared between groups. At a mean follow up of 2.7 ± 1.7 years, 59 patients (mean age 75.3 ± 5.5 years) were included. In 31 patients ORIF was performed and 29 patients underwent arthroplasty. Complications and revision surgeries were significantly more frequent after ORIF (32.6% vs. 7.1%, p = 0.023 and 29.0% vs. 7.1%, p = 0.045). In contrast, clinical outcomes showed no significant differences (DASH 39.9 ± 25.7 vs. 39.25 ± 24.5, p = 0.922; CMS 49.7 ± 29.2 vs. 49.4 ± 25.2, p = 0.731). ORIF of type C PHFs in geriatric patients results in significantly more complications and revision surgery when compared to arthroplasty. Therefore, osteosynthesis of geriatric intraarticular fractures of the proximal humerus must be critically evaluated.

scholarly journals Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

2017 ◽  
Vol 2 (1) ◽  
pp. 21
Author(s):  
Ali Sadighi ◽  
Bahamin Attar ◽  
Alireza Sadeghpour ◽  
HojjatHossein Pourfeiz ◽  
Hossein Aslani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Internal Fixation ◽  
Open Reduction ◽  
Locking Plate ◽  
Constant Score ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Complication Rates

Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate.Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant.Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01). Open fractures were only observed in patients with a four-part fracture (P=0.018). No significant differences were noticed regarding gender, cause, and side of the fracture.The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN) of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures.The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006).Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.

scholarly journals Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals

2021 ◽  
Vol 7 (6) ◽  
pp. 1122
Author(s):  
R. M. Chandak ◽  
Mohit Sharma ◽  
Amrit Jha
Keyword(s):  
Constant Score ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plates ◽  
Radiological Outcome ◽  
Neck Shaft Angle ◽  
Clinical And Radiological Outcome ◽  
Shaft Angle ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Proximal humeral fracture is 3rd most common fracture in elderly population. Selection of appropriate implant is always challenging to get optimum results in these osteoporotic bones. Though locking plates are gold standard, major complications range from 9% to 36%. To study clinical and radiological outcome of J nail technique for Neer’s three or four part proximal humeral fractures in patients more than 60 years age.</p><p class="abstract"><strong>Methods:</strong> We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, &gt;60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip Lambrinudi wires. At final follow-up, clinical outcome was assessed using constant score and radiological evaluation was done according to the Bahr criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean constant score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up to 2 years.</p><p class="abstract"><strong>Conclusions:</strong> Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections.</p>

scholarly journals How to treat proximal and middle one-third humeral shaft fractures: The role of helical plates

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Giulia Nicolaci ◽  
Nicola Lollino
Keyword(s):  
Range Of Motion ◽  
Radial Nerve ◽  
External Rotation ◽  
Constant Score ◽  
Distal Tibia ◽  
High Energy ◽  
Humeral Fractures ◽  
Radial Nerve Palsy ◽  
Dash Score

Complex proximal third diaphyseal humeral fractures are uncommon patterns of injury mainly caused by high energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the close proximity of the radial nerve into the radial groove represent challenge elements to deal with. Historically, straight plates were manually twisted; subsequently, helical plates created for other anatomical sites (as distal tibia) were used in humeral fractures. In both these experiences surgeons observed several disadvantages. More recently, dedicated helical plates have been created. In this study, we expose our surgical technique for using helical humeral plates (A.L.P.S.® Proximal Humeral Plating System, Zimmer Biomet), with its advantages and operative recommendation. From 2019 to 2021, nine patients who were admitted to our institution for humeral fractures involving the proximal third diaphysis have been treated with humeral helical plates. At one and six months after surgery, standard antero-posterior and lateral radiographs were obtained, and at last follow-up (fourteen months on average) clinical evaluation was performed through range of motion assessment, Constant score and DASH score questionnaires. At six months, all fractures have healed. At last follow-up (fourteen months on average, 6-22) the average range of motion were flexion 135° (90°-180°); abduction 124° (85°-180°); external rotation 52° (20°-80°), internal rotation at L3 (between scapulae-trochanter). Average Constant Shoulder Score was 70 (33-96), average Dash score was 21 (range 1,7-63). Three patients experienced temporary radial nerve palsy from injury, with subsequently improvement at EMG analysis within eight months from surgery. In our opinion this strategy avoids the deltoid tuberosity and reduces the risk of radial nerve injury, increasing the possibility of a rapid functional recovery after surgery.

scholarly journals Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 635
Author(s):  
Florian Freislederer ◽  
Susanne Bensler ◽  
Thomas Specht ◽  
Olaf Magerkurth ◽  
Karim Eid
Keyword(s):  
Closed Reduction ◽  
Biceps Tendon ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Constant Murley Score ◽  
Fractures In Children ◽  
Initial Surgery ◽  
Conjoint Tendon

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.

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