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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 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 -
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 -
Clinical Orthopaedics and Related... Dec 2011Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.
BACKGROUND
Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.
QUESTIONS/PURPOSES
We therefore asked (1) to what degree function would be restored, (2) whether tuberosity healing would reliably occur, and (3) whether stem design would influence function in patients treated with hemiarthroplasty for proximal humerus fracture.
PATIENTS AND METHODS
We retrospectively reviewed all patients treated with a hemiarthroplasty for proximal humeral fracture between September 2001 and May 2006. The first 58 patients (September 2001 to March 2004) were treated with a conventional humeral prosthesis. The next 112 patients (April 2004 to May 2006) were treated with a fracture-specific humeral prosthesis. Clinical measures (American Shoulder and Elbow Surgeons scores, visual analog pain scores, and goniometric measurements of glenohumeral motion) and radiographic evaluation of tuberosity healing were performed at minimum 24-month followup (mean, 32 months; range, 24-96 months).
RESULTS
Mean active anterior elevation was 118°, mean active external rotation 37.6°, and mean American Shoulder and Elbow Surgeons score 66. Overall, 127 of 170 (75%) greater tuberosities healed. With respect to stem design, active anterior elevation, active external rotation, and American Shoulder and Elbow Surgeons score were better with fracture-specific stems (129.8°, 39°, and 72, respectively) than with conventional stems (95.4°, 33.0°, and 55, respectively). Fewer tuberosities healed with conventional stems (38 of 58, 66%) than with fracture-specific stems (89 of 112, 79%).
CONCLUSIONS
The use of fracture-specific stems during proximal humeral hemiarthroplasty for fracture appears to improve functional use of the injured shoulder and tuberosity healing compared to conventional stems.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Female; Humans; Joint Prosthesis; Male; Middle Aged; Prosthesis Design; Radiography; Retrospective Studies; Shoulder Fractures
PubMed: 21598120
DOI: 10.1007/s11999-011-1919-6 -
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 -
Orthopaedics & Traumatology, Surgery &... Oct 2010Proximal humerus fracture devascularizing the humeral head may require management by prosthesis. Hemiarthroplasty is a logical attitude in such cases, but analysis of... (Comparative Study)
Comparative Study Review
Proximal humerus fracture devascularizing the humeral head may require management by prosthesis. Hemiarthroplasty is a logical attitude in such cases, but analysis of functional results and complications has identified a certain number of risk factors limiting indications. Strict analysis of patient characteristics and of fracture type is an essential prerequisite to deciding against treatment by immobilization or osteosynthesis. Results in hemiarthroplasty are primarily dependent on respecting the rules of the art, which aim at stable anatomic osteosynthesis of the surrounding structures so as to restore normal shoulder function. The critical steps are the adjustment of implant height and retroversion, reduction and fixation of tuberosities and good management of the postoperative course. The recent development of fracture-dedicated shoulder implants should improve results. In elderly patients, when local conditions are unsuitable to hemiarthroplasty, a reverse prosthesis may be used, with an adapted surgical technique. Whatever the type of prosthesis, implantation for proximal humerus fracture is a demanding operation with definitive impact on the functional evolution of the shoulder.
Topics: Adult; Age Factors; Aged; Arthroplasty, Replacement; Bone Transplantation; Follow-Up Studies; Fracture Healing; Fractures, Malunited; Fractures, Ununited; Humans; Joint Prosthesis; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Sensitivity and Specificity; Shoulder Fractures; Tomography, X-Ray Computed
PubMed: 20692881
DOI: 10.1016/j.otsr.2010.07.001 -
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 -
Acta Orthopaedica Et Traumatologica... Jul 2022The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of...
OBJECTIVE
The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.
METHODS
A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.
RESULTS
There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).
CONCLUSION
This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.
LEVEL OF EVIDENCE
Level IV, Diagnostic Study.
Topics: Cross-Sectional Studies; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Retrospective Studies; Shoulder; Shoulder Dislocation; Shoulder Fractures
PubMed: 35943077
DOI: 10.5152/j.aott.2022.21316 -
Orthopaedics & Traumatology, Surgery &... Feb 2013Malunion of a proximal humerus fracture is difficult to manage once bone union has been achieved in a wrong position. Malunion may be encountered after conservative... (Review)
Review
Malunion of a proximal humerus fracture is difficult to manage once bone union has been achieved in a wrong position. Malunion may be encountered after conservative treatment or internal fixation of fractures, and also around a joint prosthesis. The malunion can involve the greater and lesser tuberosities, humeral head, bicipital groove, or the entire epiphysis. The nature of the malunion must be precisely characterized. Malunion can affect bone structures and the articular surface; any resulting displacements must be carefully measured. Clinical assessments will help to evaluate the functional repercussions and determine the need for correction. Radiographic imaging and CT scan guide the treatment plan. Arthroscopic surgery (acromioplasty or tuberoplasty) can be used to treat biceps tenosynovitis or impingement syndrome in cases where full correction of the malunion is not required. Corrective surgery of a metaphyseal malunion is used to realign the proximal humeral into the proper position. Tuberosity osteotomy is the main predictor for a poor outcome following secondary arthroplasty.
Topics: Fractures, Malunited; Humans; Shoulder Fractures
PubMed: 23333124
DOI: 10.1016/j.otsr.2012.11.006 -
Medicine Dec 2017Proximal humerus fracture occuring simultaneously with dislocation of a shoulder in children is extremely rare, with only a few recent reports of on such cases having... (Review)
Review
RATIONALE
Proximal humerus fracture occuring simultaneously with dislocation of a shoulder in children is extremely rare, with only a few recent reports of on such cases having been reported.
PATIENT CONCERNS
A 6-year-old girl fell from a ladder and landed on her dominant right arm with pain in the right shoulder and unable to perform movements; her shoulder did not allow for passive movements as well.
DIAGNOSES
Proximal humerus fracture combined with shoulder dislocation.
INTERVENTIONS
The patient was treated with open reduction, elastic stable intramedullary nail (ESIN) fixation, immobilization with U-shape cast and shoulder spica brace.
OUTCOMES
The patient was pain-free, with full range movement of the injured shoulder and no sign of avascular necrosis in a 2-year follow-up period.
LESSONS
We recommend open reduction with ESIN fixation for severely displaced proximal humeral metaphyseal fractures with shoulder dislocation in children. Preoperative bilateral anteroposterior shoulders x-ray is needed to confirm the shoulder location.
Topics: Accidental Falls; Casts, Surgical; Child; Female; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Shoulder Dislocation; Shoulder Fractures
PubMed: 29310407
DOI: 10.1097/MD.0000000000008977