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Journal of Orthopaedic Surgery (Hong... 2017Proximal humeral fractures are common in the elderly and can present with multiple fracture configurations. Our case series describes a three-part valgus-impacted...
BACKGROUND
Proximal humeral fractures are common in the elderly and can present with multiple fracture configurations. Our case series describes a three-part valgus-impacted fracture pattern of the proximal humerus that underwent spontaneous reduction by nonsurgical management with good functional outcomes.
METHODS
Seven patients who sustained low-energy three-part valgus-impacted fractures of the proximal humerus were studied. We retrospectively reviewed serial anteroposterior radiographs of each patient taken as part of routine follow-up. For clinical outcomes, patients were assessed by a physical examination of both shoulders. A Disability of Arm, Shoulder, and Hand (DASH) questionnaire assessed the functional outcomes.
RESULTS
In all seven patients, fractures reduced spontaneously without any complications. Radiologically, the neck-shaft angle decreased from an average of 169° to 141°. In the six patients examined, range of motion was decreased in all planes in the affected shoulder relative to the contralateral shoulder. Two patients exhibited no loss of power in the affected arm, while the rest exhibited Medical Research Council grade 4 of 5 power in the affected arm. The mean DASH score obtained in our patients was 18.17. None of our patients reported any significant limitations in their activities of daily living and all achieved premorbid functional levels.
CONCLUSION
Low-energy three-part valgus-impacted fracture pattern of the proximal humerus has the ability to spontaneously reduce by nonsurgical management with good functional outcomes.
Topics: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Female; Fracture Fixation; Humans; Male; Middle Aged; Radiography; Range of Motion, Articular; Recovery of Function; Remission, Spontaneous; Retrospective Studies; Shoulder Fractures
PubMed: 28659054
DOI: 10.1177/2309499017717180 -
International Orthopaedics Sep 2020For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate... (Review)
Review
PURPOSE
For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate fixation is still a preference and the proper selection of its strategy for each individual seems to be essential.
METHOD
The available classification system of the fracture, determination of surgical intervention, the common complications and related causes, and the latest critical surgical strategies with locking plate fixation were discussed in this review.
RESULTS
The frequent complications with complex proximal humeral fractures after operative treatment present a great challenge to orthopedic surgeons. In order to maintain the stability of locking plate fixation, several options including calcar screw, bone graft, bone cement augmentation, dual plate fixation, and fracture impaction were available for restoration of medial support.
CONCLUSION
Restoration of medial support seems of importance to provide solid stability and reduced complication for the complex fractures with fixation of locking plates.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Humeral Fractures; Shoulder Fractures
PubMed: 32535700
DOI: 10.1007/s00264-020-04544-7 -
European Journal of Orthopaedic Surgery... Apr 2017Proximal humerus fractures are characterized by their frequency, the difficulties and the absence of treatment of reference. New means of osteosynthesis appeared since...
Proximal humerus fractures are characterized by their frequency, the difficulties and the absence of treatment of reference. New means of osteosynthesis appeared since the years 2000, as well as the preferential recourse to the reversed prostheses of shoulder. A chapter is dedicated to classifications, as a whole not very reproducible. The new treatments are represented by the nails, such as Telegraph, and the plates with blocked screws. It appeared a real progress in the osteosyntheses and became infinitely more solid with the stability of the screws in the bone. The advantage of the reversed prostheses of shoulder where the stability of the tuberosities is not essential any more to the good performance from now on is recognized. They are allowed like treatment of reference for the complex fractures of the elderly people. Classifications remain of delicate use. They are known to be not very reproducible. Classification of AST, with quantification of displacement, is proposed. Various reflections relate to the rotators cuff and cephalic necrosis.
Topics: Fracture Fixation, Internal; Humans; Internal Fixators; Necrosis; Rotator Cuff; Shoulder Fractures
PubMed: 28260116
DOI: 10.1007/s00590-017-1928-6 -
Orthopaedics & Traumatology, Surgery &... Oct 2020Isolated greater tuberosity fractures account for up to a fifth of all proximal humeral fractures. There have been several retrospective cohort studies and case series... (Review)
Review
BACKGROUND
Isolated greater tuberosity fractures account for up to a fifth of all proximal humeral fractures. There have been several retrospective cohort studies and case series reporting outcomes after treatment of this pathology. This study aims to report on the clinical outcomes of surgically treated isolated greater tuberosity fractures, as well as diagnostic workup and complications associated with fracture fixation.
METHODS
A systematic review was performed under PRISMA guidelines to identify studies that reported the results or clinical outcomes of isolated greater tuberosity fracture. The searches were performed using MEDLINE through PubMed, the Elsevier Embase database, and the Cochrane Database of Systematic Reviews.
RESULTS
Sixteen studies met inclusion criteria comprising 345 patients and 345 shoulders. The mean age was 52.9 years and mean follow-up was 3.4 months. The mean postoperative American Shoulder and Elbow Surgeon Score, the most frequently utilized patient reported outcome measure across studies, was 90.1% of ideal maximum. All studies used standard shoulder radiographs in their initial workup and most commonly referred to a minimum of 5mm displacement as an indication for surgery. Fifty five percent of patients were treated using open fixation and 35.9 with arthroscopic fixation. Ninety three percent of patients were able to return to work. A total of fifty-two (15.1%) complications were reported in the included studies.
CONCLUSIONS
The current literature describes overall satisfactory functional outcomes and minimal occupational morbidity following either open or arthroscopic fixation of isolated greater tuberosity fractures despite a notable rate of complications.
LEVEL OF EVIDENCE
IV, systematic review.
Topics: Fracture Fixation; Humans; Middle Aged; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 32933866
DOI: 10.1016/j.otsr.2020.05.005 -
Rozhledy V Chirurgii : Mesicnik... 2016Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and...
INTRODUCTION
Fractures affecting the entire glenoid fossa are termed comminuted or total glenoid fractures. However, there are no detailed studies of total glenoid fractures, and only brief mentions can be found in the literature.
METHODS
The group comprised 12 patients (mean age, 39 years), who sustained 13 fractures of the glenoid fossa. In all the fractures, all parts of the glenoid fossa were separated from the scapular neck or body. In total 5 patients (6 fractures) were treated non-operatively and 7 patients were operated on. The method of treatment was based on displacement of the fragments, the patient´s general and local conditions. Indication for operative treatment was displacement of articular fragments of more than 3mm. This criterion was met by 10 patients (11 fractures). Owing to the general or local condition, operation was contraindicated in 2 patients with 3 fractures; one patient refused the operation. One patient with a bilateral fracture was lost to follow-up.
RESULTS
According to the site of separation of articular fragments, the fractures were divided into three groups - the separation line passed through the anatomical neck; through the coracoid process or surgical neck of the scapula; or through the scapular body. In 6 of the 7 operated patients, a good or very good result was achieved. In 2 patients with minimal fragment dislocation treated non-operatively, the fractures healed in an anatomical position and full range of motion was achieved. In 2 patients with severe fragment displacement treated non-operatively, the healing resulted in glenoid fossa incongruence and painful and limited range of motion.
CONCLUSION
Fractures of the entire glenoid fossa are the most severe injuries to scapula. Their diagnosis requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment from the Judet approach.Key words: scapular fractures glenoid fractures classification, operative treatment Judet approach.
Topics: Adolescent; Adult; Aged; Female; Fracture Fixation; Fracture Healing; Humans; Immobilization; Male; Middle Aged; Motion Therapy, Continuous Passive; Shoulder Fractures
PubMed: 28033016
DOI: No ID Found -
Musculoskeletal Surgery Dec 2022This systematic review of the literature aims to analyse current knowledge to inform choice between hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA)... (Review)
Review
This systematic review of the literature aims to analyse current knowledge to inform choice between hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA) for managing proximal humerus fractures (PHF) in elderly patients; the aim is to understand if rTSA can be considered the gold standard for treating PHF in the elderly when surgical fixation or conservative treatment is not viable options. Studies reporting outcomes and complications of PHF treated with shoulder arthroplasty in the elderly were included. Studies were in English and published after 2008. Evidence levels I, II, III and IV were included. According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed search engines, as well as the Cochrane Central Register of Controlled Trials. General data collected were study design, number of patients treated with HA and rTSA, age of patients (mean, mean and SD, mean and range), length of follow-up, type of implant, and clinical outcomes. rTSA can be regarded as the gold standard for surgical management of displaced 3 and 4-part fractures in the elderly. However, the literature offers mostly low-quality studies, thereby requiring further work to achieve a full understanding of this important topic.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Hemiarthroplasty; Shoulder Fractures; Treatment Outcome; Shoulder Joint
PubMed: 35974216
DOI: 10.1007/s12306-022-00761-y -
European Journal of Orthopaedic Surgery... May 2020The aim of this paper was to present our experience and the outcomes in 3 elderly patients who underwent combined shoulder and elbow arthroplasty after ipsilateral...
PURPOSE
The aim of this paper was to present our experience and the outcomes in 3 elderly patients who underwent combined shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus in our center. Also, we evaluate difficulties in their treatment and report their final follow-up.
MATERIAL AND METHODS
Three cases of elderly patients who underwent shoulder and elbow arthroplasty after ipsilateral fractures of the proximal and distal humerus were reviewed. Demographic, clinical, and radiological data were analyzed. Also, Constant Shoulder Score, Mayo Elbow Performance Score, Short-Form Health Survey, and four-point Likert scale were evaluated.
RESULTS
All patients were females (100%). Mean age was 75 years (range 73-78). Mean follow-up was 36.6 months (SD 11.5). Mean time between injury and surgery was 12 days (SD 7.6). The 3 patients had a displaced and comminuted fracture of the humeral head (4-part, by Neer classification) and a comminuted intraarticular fracture of the distal humerus (13-C3, by AO classification). One patient presented a wound infection that required debridement. Despite the complications, at final follow-up, all patients showed a sufficient capacity to perform comfortably in their daily activities. Radiographs showed good fixation of all components, without evidence of prosthetic loosening or migration. All evaluated scores had good or excellent results.
CONCLUSIONS
Our study provides further evidence that the shoulder and elbow arthroplasty could be a reliable management for ipsilateral fractures of the proximal and distal humerus in the elderly. In our study, this technique showed in the final follow-up patient's good outcomes.
Topics: Aged; Arthroplasty; Clinical Decision-Making; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humeral Fractures; Osteoporotic Fractures; Outcome and Process Assessment, Health Care; Radiography; Recovery of Function; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Spain; Time-to-Treatment
PubMed: 31893295
DOI: 10.1007/s00590-019-02608-y -
The Pan African Medical Journal 2020Posterior shoulder fracture-dislocation is a rare injury accounting for approximately 0.9% of shoulder fracture-dislocations and often misdiagnosed during the initial... (Review)
Review
Posterior shoulder fracture-dislocation is a rare injury accounting for approximately 0.9% of shoulder fracture-dislocations and often misdiagnosed during the initial presentation to a physician. Though the reverse Hill-Sachs lesion is a common injury associated with posterior shoulder dislocation, the associated scapula fracture represents only 6% of the lesions associated with a posterior dislocation of the shoulder. We report the case of a neglected posterior shoulder dislocation with a reverse Hill-Sachs lesion treated by filling with an autologous graft associated with an extra articular fracture of the scapula fixed by a plate and a posterior bone end-stop because of the posterior instability. After two years of follow-up, the patient has no episode of dislocation and is satisfied with the functional result with a constant score of 68/100 points.
Topics: Autografts; Female; Follow-Up Studies; Fracture Dislocation; Humans; Joint Instability; Middle Aged; Patient Satisfaction; Scapula; Shoulder Dislocation; Shoulder Fractures
PubMed: 33088404
DOI: 10.11604/pamj.2020.36.275.25046 -
The Journal of the American Academy of... Jan 2016Greater tuberosity fractures of the humerus can be successfully treated nonsurgically in most patients. However, as little as 3 to 5 mm of superior greater tuberosity... (Review)
Review
Greater tuberosity fractures of the humerus can be successfully treated nonsurgically in most patients. However, as little as 3 to 5 mm of superior greater tuberosity displacement may adversely affect rotator cuff biomechanics and lead to subacromial impingement in patients who are active. In these cases, surgical treatment is recommended. Multiple surgical techniques include open and arthroscopic options tailored to fracture morphology, and strategies for repair include the use of suture anchors, transosseous sutures, tension bands, and plates/screws. Three classification systems are commonly used to describe greater tuberosity fractures: the AO, Neer, and morphologic classifications. Several hypotheses have been discussed for the mechanism of greater tuberosity fractures and the deforming forces of the rotator cuff, and the use of advanced imaging is being explored.
Topics: Arthroscopy; Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Humans; Humerus; Rotator Cuff; Rotator Cuff Injuries; Shoulder Dislocation; Shoulder Fractures; Shoulder Impingement Syndrome; Suture Anchors; Suture Techniques; Sutures; Treatment Outcome
PubMed: 26700632
DOI: 10.5435/JAAOS-D-14-00289 -
BMC Musculoskeletal Disorders Aug 2018Fractures of the greater tuberosity may result from a variety of mechanisms. Missed injury remains a persistent problem, both from a clinical and medico-legal...
BACKGROUND
Fractures of the greater tuberosity may result from a variety of mechanisms. Missed injury remains a persistent problem, both from a clinical and medico-legal point-of-view. Few studies on this topic are available in the literature. We present the clinical and radiological findings of a consecutive series of 17 patients who were diagnosed and managed with undisplaced greater tuberosity fractures.
METHODS
A retrospective study of a consecutive series of 17 patients who sustained an occult greater tuberosity fracture were performed. Patients sustained a traumatic occult greater tuberosity fracture, underwent shoulder radiographs after trauma in 5 days and they were diagnosed as negative by a consultant radiologist. All patients received a standard assessment using MRI (Magnetic Resonance Imaging) scans Each patient was evaluated for arm dominance, trauma history, duration and type of symptoms and post-treatment Oxford Shoulder Score.
RESULTS
At the final follow up the mean OSS (Oxford Shoulder Score) was 38.3 (range 17-46; SD 9.11). Three patients required a glenohumeral joint injection for post-traumatic pain and stiffness and three patients required subacromial decompression for post-traumatic impingement.
CONCLUSIONS
Though undisplaced greater tuberosity fracture can be managed non-operatively with good results, patients with persistent post-traumatic shoulder pain, tenderness and limitation of shoulder function warrant investigation with MRI to identify occult fractures. Prompt identification of these fractures can facilitate patient treatment and counselling, avoiding a source of patient dissatisfaction and litigation.
Topics: Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Retrospective Studies; Shoulder Fractures
PubMed: 30170571
DOI: 10.1186/s12891-018-2225-1