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European Journal of Orthopaedic Surgery... Jul 2023Following proximal humeral fractures hemiarthroplasty (HA) or reversed total shoulder arthroplasty (rTSA) are performed if osteosynthesis or conservative treatment is...
PURPOSE
Following proximal humeral fractures hemiarthroplasty (HA) or reversed total shoulder arthroplasty (rTSA) are performed if osteosynthesis or conservative treatment is not possible. HA has been reported to result in decreased functional outcomes compared with rTSA. Secondary shoulder arthroplasty, performed after a different initial treatment, has also been associated with inferior outcomes.
METHODS
Patients recieving a shoulder arthroplasty related to a proximal humeral fracture from 2010 to 2019 were included. A retrospective analysis of functional outcomes was performed using QuickDASH and subjective shoulder value (SSV).
RESULTS
The mean [standard deviation (SD)] follow-up time among the 82 included patients was 48 (28) months. The mean age was 70 (10) years. The mean age for HA was significantly different from rTSA [57 (9) and 72 (21) years; p < .001]. The mean QuickDASH score for primary arthroplasty was 11 (2) versus 12 (16) for secondary arthroplasty (p = .313). The mean SSV for primary arthroplasty was 84 (22) versus 82 (17) for secondary arthroplasty (p = .578). The mean QuickDASH score for HA was 24 (36) versus 9 (15) for rTSA (p = .346). The mean SSV for HA was 70 (34) versus 86 (17) for rTSA (p = .578).
CONCLUSION
Functional outcomes after fracture-related shoulder arthroplasty were excellent in an older population, even when performed secondarily after failed primary osteosynthesis or conservative treatment. No significant differences in shoulder function were identified between rTSA and HA, likely due to restrictive indications for HA.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Retrospective Studies; Hemiarthroplasty; Fracture Fixation, Internal; Shoulder Fractures
PubMed: 35759106
DOI: 10.1007/s00590-022-03313-z -
Journal of Shoulder and Elbow Surgery Apr 2022Shoulder fracture-dislocations can represent a challenging management scenario in the emergency department (ED) because of concern for the presence of occult fractures...
BACKGROUND
Shoulder fracture-dislocations can represent a challenging management scenario in the emergency department (ED) because of concern for the presence of occult fractures that may displace during a reduction attempt. The alternative, a closed reduction attempt in the operating room, has the benefit of full paralysis but requires additional resource utilization. There is limited guidance in the literature about the risks of an initial reduction attempt in the ED as a function of fracture pattern to help guide physicians with this decision.
METHODS
This was a retrospective case review of adult patients with shoulder dislocations and fracture-dislocations seen in the ED at a level 1 trauma center over a 10-year period. Imaging and medical records were reviewed to evaluate whether the reduction attempt was successful, unsuccessful without worsening, or unsuccessful with worsening alignment of any fractures, as well as the ultimate clinical outcome.
RESULTS
We identified 165 patients with fracture-dislocations and 484 patients with simple dislocations during the same period. Of the patients with fracture-dislocations, 103 had greater tuberosity fractures, 12 had nondisplaced surgical neck fractures, and 50 had displaced surgical neck fractures. None of the patients with simple dislocations had displacement during an ED reduction attempt, including 100 patients aged >65 years. Of the 103 patients with greater tuberosity fracture-dislocations, only 1 had displacement of a humeral shaft fracture during ED reduction. Displacement occurred in 6 of 8 patients with nondisplaced neck fractures who underwent an initial ED reduction attempt vs. 1 of 4 patients who underwent the initial reduction attempt in the operating room. ED reduction was attempted in 25 of the 50 displaced humeral neck fracture-dislocations and was successful in 10 of these (40%).
CONCLUSIONS
For patients with greater tuberosity fracture-dislocations, there is a low rate of displacement with a reduction attempt in the ED, but an ED reduction attempt in nondisplaced neck fractures is not recommended because of the high rate of displacement. For displaced neck fractures, closed reduction can be successful in select patients. Finally, these data confirm prior reports that closed reduction of simple shoulder dislocations in patients aged >65 years is safe in the ED.
Topics: Adult; Aged; Emergency Service, Hospital; Humans; Humeral Fractures; Retrospective Studies; Shoulder Dislocation; Shoulder Fractures; Treatment Outcome
PubMed: 34648967
DOI: 10.1016/j.jse.2021.09.003 -
Acta Bio-medica : Atenei Parmensis May 2020The long head of biceps (LHB) is one of the tendons of the rotator cuff that runs strictly close to the humeral head. In case of pathology, it can be responsible for... (Review)
Review
BACKGROUND AND AIM OF THE WORK
The long head of biceps (LHB) is one of the tendons of the rotator cuff that runs strictly close to the humeral head. In case of pathology, it can be responsible for pain and shoulder impairment: in such cases, surgical options include tenotomy or tenodesis. The management of LHB along with surgery of the rotator cuff or during shoulder prosthetic replacement has been widely discussed in the literature. Conversely, the possibility of acute impingement and incarceration of LHB in proximal humerus fractures, as well as its role in shoulder pain in outcomes of these fractures, has been poorly considered.
METHODS
The following aspects in the literature on LHB and proximal humerus fractures have been analysed: its management during fixation of fractures, the possibility of interference of the tendon with reduction of fractures or dislocations of the shoulder and its possible role in chronic pain after fixation of proximal humerus fractures.
RESULTS
LHB can be an obstacle in the reduction of fractures, dislocations and fracture-dislocations. Only a few papers take into account acute surgery to LHB (tenotomy or tenodesis); most of the studies on fixation of proximal humerus fractures simply ignore the problem of LHB. The tendon can be a source of pain and a cause of disability in sequelae of these fractures.
CONCLUSIONS
LHB should be taken into consideration both in the acute phase of fractures of the proximal humerus and in the outcomes. Other studies are needed to better understand its optimal management during fracture surgery.
Topics: Fracture Fixation; Humans; Postoperative Complications; Shoulder Fractures; Shoulder Joint; Tendinopathy; Tendon Injuries; Tendons
PubMed: 32555078
DOI: 10.23750/abm.v91i4-S.9634 -
Der Orthopade Feb 2018In recent years, the understanding of shoulder fractures has changed due to the progress of arthroscopy. In addition to the cosmetic result, the access morbidity,... (Review)
Review
In recent years, the understanding of shoulder fractures has changed due to the progress of arthroscopy. In addition to the cosmetic result, the access morbidity, particularly the integrity of the subscapularis muscle in glenoid and scapular fractures, must be mentioned as an advantage of a minimally invasive approach. Furthermore, necessary secondary interventions, e. g. hook plate removal, can be prevented or minimized by modern implants and arthroscopic techniques.However, the available data and publications are almost exclusively limited to technical notes or small case series, so statements about faster recreation or potential reduction of infection risk cannot be made. Whether addressing concomitant injuries has an effect on the clinical and functional outcome is also unclear at the present time.
Topics: Arthroscopy; Bone Plates; Clavicle; Fracture Fixation, Internal; Glenoid Cavity; Humans; Ligaments, Articular; Postoperative Care; Rotator Cuff; Shoulder Dislocation; Shoulder Fractures
PubMed: 29318329
DOI: 10.1007/s00132-017-3512-5 -
Journal of Pediatric Orthopedics. Part B May 2022This study was undertaken to determine the incidence, need for intervention, and time to resolution of pseudosubluxation of the shoulder in pediatric proximal humerus...
This study was undertaken to determine the incidence, need for intervention, and time to resolution of pseudosubluxation of the shoulder in pediatric proximal humerus fractures. One hundred and ninety-nine radiographs (199 x-rays) were analyzed for pseudosubluxation of the shoulder following pediatric proximal humeral fractures. Pseudosubluxation occurs when the center of the humeral head aligns with the inferior one-fourth of the glenoid. Fourteen patients met the inclusion criteria for pseudosubluxation. The nonoperative cohort consisted of 100 females and 93 males and the operative cohort consisted of 3 males and 3 females. Total 14 children out of 199 had pseudosubluxation. Ten pseudosubluxations were seen 7 days postinjury and four were noted immediately after injury. Pseudosubluxation was seen in nine boys (64%) and five girls (36%) in the nonoperative group. Increased relative risk (RR) was associated with: fall >3 m (RR = 25.7; 95% CI, 2.7-244.0), motorized transport (RR = 11.7; 95% CI, 1.41-96.03) and sports injuries (RR = 11.0, 95% CI, 1.2-100). No statistical analysis was conducted on the operative group given the small sample. This study establishes incidence, risk factors and expected clinical course for pseudosubluxation following proximal humerus fractures. The overall incidence in the nonoperative cohort was 7.3%, radiographic evidence of pseudosubluxation resolution was available for (n = 10) patients with 100% resolution by 6 weeks. There were no readmissions or complications in the 14 patients. Pseudosubluxation occurrence was significantly increased in four mechanisms: falls >3 m, sports trauma and motor transportation. This study provides the natural history and risk factors for pseudosubluxation following proximal humerus fractures. Pseudosubluxation is more likely to occur in higher energy fracture mechanisms and will resolve without treatment. Level of Evidence: Level III, retrospective cohort.
Topics: Child; Female; Humans; Humeral Fractures; Male; Radiography; Retrospective Studies; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 34380986
DOI: 10.1097/BPB.0000000000000902 -
Journal of Pediatric Orthopedics Jun 2016Most proximal humerus fractures in skeletally immature individuals are treated nonoperatively with excellent functional results. Extensive remodeling of the proximal... (Review)
Review
Most proximal humerus fractures in skeletally immature individuals are treated nonoperatively with excellent functional results. Extensive remodeling of the proximal humerus and the wide arc of motion of the glenohumeral joint accommodate a large degree of fracture displacement and angulation. The treatment of severely displaced fractures and/or severely angulated fractures continues to be debated. Older patients and those with significantly displaced fractures may benefit from surgery because of their inability to remodel displacement and angulation during their limited remaining growth. The decision to treat a proximal humerus fracture in a skeletally immature patient operatively versus nonoperatively is dependent on the following 3 factors: displacement, bone age, and capacity to remodel. There is an increasing trend toward treating severely displaced and severely angulated fractures surgically, especially in older patients and adolescents. Smooth wires, percutaneous threaded wires, cannulated screws, and retrograde elastic stable intramedullary nailing are acceptable options for fixation.
Topics: Adolescent; Bone Nails; Bone Remodeling; Bone Wires; Child; Fracture Fixation, Intramedullary; Fractures, Malunited; Humans; Humerus; Joint Instability; Range of Motion, Articular; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 27100038
DOI: 10.1097/BPO.0000000000000768 -
International Orthopaedics Dec 2020Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and... (Review)
Review
PURPOSE
Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature.
METHODS
We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group.
RESULTS
Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor.
CONCLUSIONS
Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
Topics: Acromion; Aged; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Humans; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Spinal Fractures
PubMed: 32995915
DOI: 10.1007/s00264-020-04813-5 -
Der Unfallchirurg Jul 2015
Topics: Fracture Fixation, Internal; Fracture Healing; Humans; Joint Prosthesis; Plastic Surgery Procedures; Shoulder Fractures
PubMed: 26141619
DOI: 10.1007/s00113-015-0028-5 -
Rozhledy V Chirurgii : Mesicnik... 2022No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe...
INTRODUCTION
No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe pathoanatomy of these injuries.
METHODS
In a series of 519 scapular fractures in adult patients from the period of 20022020 we identified a total of 20 (3.9%) cases associated with AC dislocation. The group comprised 17 men and 3 women with the mean age of 49 years (range, 2178). Radiographs of the shoulder joint followed by CT examination, including 3D reconstructions, were performed in all patients. This documentation allowed assessment of the scapular fracture pattern and type of injury to the AC joint.
RESULTS
AC dislocation was associated with a simple scapular fracture in 15 cases (7 fractures of the coracoid base, 4 fractures of the acromion or the lateral spine, 2 fractures of the scapular body, 1 fracture of the superior and 1 fracture of the inferior glenoid). In 5 cases AC dislocation accompanied multiple or complex scapular fractures (once a combination of a coracoid fracture and a fracture of the lateral scapular spine, once a combination of a fracture of the superior glenoid and of the acromion, 2 cases of a complex intraarticular fracture and 1 case of scapulothoracic dissociation).
CONCLUSION
AC dislocation is relatively infrequent injury accompanying scapular fractures. It is most commonly associated with fractures of coracoid, acromion/lateral spine or superior glenoid. No case of AC dislocation was recorded in a fracture of the scapular neck.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Radiography; Scapula; Shoulder Dislocation; Shoulder Fractures; Young Adult
PubMed: 35973822
DOI: 10.33699/PIS.2022.101.6.272-276 -
BMC Musculoskeletal Disorders Jan 2021The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical...
BACKGROUND
The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).
METHODS
This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals).
RESULTS
Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.
CONCLUSIONS
RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.
LEVEL OF EVIDENCE
Level III.
Topics: Aged; Arthroplasty, Replacement, Shoulder; Humans; Middle Aged; Range of Motion, Articular; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 33419418
DOI: 10.1186/s12891-020-03903-0