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JPMA. the Journal of the Pakistan... Aug 2022Posterior shoulder dislocation is a rare condition, while bilateral posterior shoulder fracture is extremely rare. Dislocations with a fracture of the bilateral...
Posterior shoulder dislocation is a rare condition, while bilateral posterior shoulder fracture is extremely rare. Dislocations with a fracture of the bilateral posterior shoulder are observed more often after epileptic seizures. As dislocations with posterior shoulder fracture are rare, clinicians sometimes experience difficulty in diagnosing it timely. Although it can be diagnosed and treated early, based on a proper shoulder examination and accurate radiological imagery. In the treatment of posterior shoulder dislocations, closed reduction can be performed at an early stage, while methods of osteosynthesis with open reduction or arthroplasty are the most frequently used procedures at delayed stage. In this study, it was shown for the first time in literature, that a very rare case of dislocation with bilateral posterior shoulder fracture after epileptic seizure, in a 68 years old patient, had good clinical and functional results, following simultaneous hemiarthroplasty treatment.
Topics: Humans; Aged; Hemiarthroplasty; Shoulder Fractures; Shoulder Dislocation; Fracture Fixation, Internal; Seizures; Epilepsy
PubMed: 36280938
DOI: 10.47391/JPMA.3976 -
Journal of Orthopaedic Surgery and... Feb 2022Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of...
BACKGROUND
Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs.
METHODS
From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55-85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN).
RESULTS
Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups.
CONCLUSION
We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852.
Topics: Aged; Aged, 80 and over; Bone Plates; Bone Screws; Fracture Fixation, Internal; Humans; Middle Aged; Necrosis; Postoperative Complications; Retrospective Studies; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 35109905
DOI: 10.1186/s13018-022-02947-3 -
BMC Musculoskeletal Disorders May 2015Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. The outcomes of these fractures are frequently... (Review)
Review
BACKGROUND
Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. The outcomes of these fractures are frequently disappointing and previous systematic reviews are unable to guide clinical practice. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of proximal humerus fractures.
METHODS
We utilized a scoping review technique because of its novel ability to map research activity and identify knowledge gaps in fields with diverse treatments. Through multiple electronic database searches, we identified a comprehensive body of proximal humerus fracture literature that was classified into eight research themes. Meta-data from each study were abstracted and descriptive statistics were used to summarize the results.
RESULTS
1,051 studies met our inclusion criteria with the majority of research being performed in Europe (64%). The included literature consists primarily of surgical treatment studies (67%) and biomechanical fracture models (10%). Nearly half of all clinical studies are uncontrolled case series of a single treatment (48%). Non-randomized comparative studies represented 12% of the literature and only 3% of the studies were randomized controlled trials. Finally, studies with a primary outcome examining the effectiveness of non-operative treatment or using a prognostic study design were also uncommon (4% and 6%, respectively).
CONCLUSIONS
The current study provides a comprehensive summary of the existing proximal humerus fracture literature using a thematic framework developed by a multi-disciplinary collaboration. Several knowledge gaps have been identified and have generated a roadmap for future research priorities.
Topics: Age Factors; Aged; Aged, 80 and over; Bibliometrics; Biomechanical Phenomena; Biomedical Research; Fracture Healing; Frail Elderly; Humans; Humerus; Knowledge Bases; Middle Aged; Orthopedics; Risk Factors; Shoulder Fractures; Treatment Outcome
PubMed: 25958203
DOI: 10.1186/s12891-015-0564-8 -
Orthopaedics & Traumatology, Surgery &... Apr 2017Tuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and...
BACKGROUND
Tuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns. We aimed to evaluate, which forces currently used suture and cerclage materials withstand and to assess whether they are useful with regard to stability of reconstruction of tuberosities and which failure modes they display.
MATERIAL AND METHODS
Using sheep infraspinatus tendons with attached tuberosities three different suture materials (suture 1: Ethibond size 2; suture 2: Orthocord size 2; suture 3: Fiberwire size 5) and a 0.8mm titanium cerclage wire were investigated. For each suture material as well as the cerclage wire 6 tests were carried out. A material testing machine was used to perform cyclic loading tests (20mm/min, F=50N, F=100N, respectively after 50 cycles: F+50N until failure). Outcome measures and thus comparison criteria were the maximum holding force, number of cycles reached, total elongation of the system (tendon and suture) and qualitative appraisal and documentation of the mechanism of failure.
RESULTS
Overall average maximum forces between the fixation materials differed significantly (P=0.003), especially suture 3 (braided polyethylene coating, non-resorbable polyfile UHMW core) displayed superior results in comparison to the cerclage wire (P=0.016). Although, primary elongation of the cerclage technique was significantly lower compared to the suture materials (P=0.002). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and huge displacement of the tuberosities.
DISCUSSION
Currently used suture and cerclage materials have a limited usefulness for refixation of tuberosities due to an increased risk of obstruction for bony consolidation.
LEVEL OF EVIDENCE
Basic science, Biomechanics.
Topics: Animals; Arthroplasty; Biomechanical Phenomena; Bone Wires; Equipment Failure; Equipment Failure Analysis; Humans; Humerus; Materials Testing; Polyethylene; Polyethylene Terephthalates; Sheep; Shoulder Fractures; Shoulder Prosthesis; Suture Techniques; Sutures; Tendons
PubMed: 28093375
DOI: 10.1016/j.otsr.2016.12.001 -
Archives of Orthopaedic and Trauma... Dec 2023Hitherto, the decision-making process for treatment of proximal humerus fractures (PHF) remains controversial, with no established or commonly used treatment regimens....
INTRODUCTION
Hitherto, the decision-making process for treatment of proximal humerus fractures (PHF) remains controversial, with no established or commonly used treatment regimens. Identifying fracture- and patient-related factors that influence treatment decisions is crucial for the development of such treatment algorithms. The objective of this study was to define a Delphi consensus of clinically relevant fracture- and patient-related factors of PHF for clinical application and scientific research.
METHODS
An online survey was conducted among an international panel of preselected experienced shoulder surgeons. An evidence-based list of fracture-related and patient-related factors affecting treatment outcome after PHF was generated and reviewed by the members of the committee through online surveys. The proposed factors were revised for definitions, and suggestions from the first round mentioned in the free text were included as possible factors in the second round of surveys. Consensus was defined as having at least a two-thirds majority agreement.
RESULTS
The Delphi consensus panel consisted of 18 shoulder surgeons who completed 2 rounds of online surveys. There was an agreement of more than two-thirds of the panel for three fracture-related factors affecting treatment decision in the case of PHF: head-split fracture, dislocated tuberosities, and fracture dislocation. Of all patient-related factors, a two-thirds consensus was reached for two factors: age and rotator cuff tear arthropathy.
CONCLUSION
This study successfully conducted a Delphi consensus on factors influencing decision-making in the treatment of proximal humeral fractures. The documented factors will be useful for clinical evaluation and scientific validation in future studies.
Topics: Humans; Consensus; Delphi Technique; Treatment Outcome; Shoulder Fractures; Humeral Fractures
PubMed: 37658856
DOI: 10.1007/s00402-023-05028-0 -
Journal of Shoulder and Elbow Surgery May 2021The most appropriate treatment for displaced multiple-fragment proximal humeral fractures in elderly patients is currently unclear. Reverse total shoulder arthroplasty... (Randomized Controlled Trial)
Randomized Controlled Trial
Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial.
BACKGROUND
The most appropriate treatment for displaced multiple-fragment proximal humeral fractures in elderly patients is currently unclear. Reverse total shoulder arthroplasty (rTSA) is a promising treatment option that is being used increasingly. The purpose of this study was to compare the outcome of rTSA vs. hemiarthroplasty (HA) for the treatment of displaced 3- and 4-part fractures in elderly patients.
METHODS
This was a multicenter randomized controlled trial. We included patients aged ≥ 70 years with displaced 3- or 4-part proximal humeral fractures between September 2013 and May 2016. The minimum follow-up period was 2 years, with outcome measures including the Constant score (primary outcome), Western Ontario Osteoarthritis of the Shoulder index, EQ-5D (EuroQol 5 Dimensions) index, and range of motion, as well as pain and shoulder satisfaction assessed on a visual analog scale.
RESULTS
We randomized 99 patients to rTSA (48 patients) or HA (51 patients). Fifteen patients were lost to follow-up, leaving 41 rTSA and 43 HA patients for analysis. The mean age was 79.5 years, and there were 76 women (90%). The rTSA group had a mean Constant score of 58.7 points compared with 47.7 points in the HA group, with a mean difference of 11.1 points (95% CI, 3.0-18.9 points; P = .007). Compared with HA patients, rTSA patients had greater mean satisfaction with the shoulder (79 mm vs. 63 mm, P = .011), flexion (125° vs. 90°, P < .001), and abduction (112° vs. 83°, P < .001), but there was no difference in Western Ontario Osteoarthritis of the Shoulder index, pain, or EQ-5D index scores. We identified 3 and 4 adverse events in the rTSA and HA groups, respectively. Among patients aged ≥ 80 years (n = 38), there was no difference between rTSA treatment and HA treatment in pain (17 mm vs. 9 mm, P = .17) or shoulder satisfaction (77 mm vs. 74 mm, P = .73).
CONCLUSION
We found that rTSA provides better shoulder function than HA as measured with the Constant score, further emphasized by rTSA patients being more satisfied with their shoulder function. The difference appears to be mainly a result of better range of motion (abduction and flexion) in the rTSA group. The results also indicate that patients aged ≥ 80 years benefit less from rTSA than patients aged 70-79 years.
Topics: Aged; Arthroplasty, Replacement, Shoulder; Female; Hemiarthroplasty; Humans; Ontario; Range of Motion, Articular; Shoulder; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 33301926
DOI: 10.1016/j.jse.2020.10.037 -
Acta Orthopaedica Et Traumatologica... Jul 2019The aim of this study was to analyze and compare the results of reverse shoulder arthroplasty (RSA) in proximal humeral fracture sequelae (PHFS) in fractures initially...
OBJECTIVE
The aim of this study was to analyze and compare the results of reverse shoulder arthroplasty (RSA) in proximal humeral fracture sequelae (PHFS) in fractures initially treated conservatively versus those initially treated with open reduction and internal fixation (ORIF).
METHODS
It is a retrospective study that includes all PHFS treated with a RSA from September 2006 to December 2013. Twenty-seven patients met the inclusion criteria. There were 9 patients (7 females and 2 males; mean age: 79.11 years) treated with RSA due to a fracture sequelae following conservative treatment and 18 patients (15 females and 3 males; mean age: 76.83 years) treated with a RSA owing to a fracture sequelae after ORIF. The functional outcome was recorded with the aid of the pre-surgery Constant Score and at the latest follow-up (minimum of two years). All the patients included underwent an imaging study that included plain X-Rays and a CT scan prior to surgery and plain X-Rays after surgery. All complications and reoperations during follow-up were also recorded.
RESULTS
Both groups had significantly increased Constant Scores after surgery (p < 0.0001), but the patients in the conservative group had significantly better outcomes for the total Constant Score (p = 0.024), for forward elevation (p = 0.026) and for external rotation (p = 0.004). A total of 4 complications (14.8%) were present during the follow-up period. In the conservative group, 1 patient developed an infection and there were 2 dislocations and 1 infection in the ORIF group.
CONCLUSION
The use of RSA in the treatment of PHFS results in a limited outcome improvement but with an acceptable complication rate. Patients developing PHFS after conservative treatment may expect better outcomes and fewer complications than those developing PHFS after ORIF.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
Topics: Aged; Arthroplasty, Replacement, Shoulder; Conservative Treatment; Female; Fracture Fixation, Internal; Humans; Male; Postoperative Complications; Radiography; Reoperation; Retrospective Studies; Shoulder Fractures; Treatment Outcome
PubMed: 30982758
DOI: 10.1016/j.aott.2019.03.010 -
Clinical Orthopaedics and Related... Oct 2022
Letter to the Editor: What Factors Are Associated With Poor Shoulder Function and Serious Complications After Internal Fixation of Three-part and Four-part Proximal Humerus Fracture-dislocations?
Topics: Fracture Fixation, Internal; Humans; Humerus; Joint Dislocations; Shoulder; Shoulder Fractures
PubMed: 35944071
DOI: 10.1097/CORR.0000000000002334 -
Archives of Orthopaedic and Trauma... Aug 2023Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving...
INTRODUCTION
Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving surgical treatment using locking plate osteosynthesis is still high. Problems include insufficient fracture reduction and implant misplacement. Using conventional intraoperative two dimensional (2D) X-ray imaging control in only two planes, a completely error-free assessment is not possible.
MATERIALS AND METHODS
The feasibility of intraoperative three-dimensional (3D) imaging control for locking plate osteosynthesis with screw tip cement augmentation of proximal humerus fractures was retrospectively studied in 14 cases with an isocentric mobile C-arm image intensifier set up parasagittal to the patients.
RESULTS
The intraoperative digital volume tomography (DVT) scans were feasible in all cases and showed excellent image quality. One patient showed inadequate fracture reduction in the imaging control, which then could be corrected. In another patient, a protruding head screw was detected, which could be replaced before augmentation. Cement distribution in the humeral head was consistent around the screw tips with no leakage into the joint.
CONCLUSION
This study shows that insufficient fracture reduction and implant misplacement can be easily and reliably detected by intraoperative DVT scan with an isocentric mobile C-arm set up in the usual parasagittal position to the patient.
Topics: Humans; Aged; Imaging, Three-Dimensional; Cone-Beam Computed Tomography; Retrospective Studies; Fracture Fixation, Internal; Shoulder Fractures; Bone Plates; Bone Cements; Humeral Fractures; Humerus
PubMed: 36879154
DOI: 10.1007/s00402-023-04820-2 -
The Orthopedic Clinics of North America Jan 2000Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality,... (Comparative Study)
Comparative Study Review
Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.
Topics: Bone Nails; Fracture Fixation; Fracture Fixation, Internal; Humans; Humeral Fractures; Shoulder Fractures
PubMed: 10629329
DOI: 10.1016/s0030-5898(05)70124-3