Outcomes following fixation for proximal humeral fractures.
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ABSTRACT:
SUBMITTER: Antonios T
PROVIDER: S-EPMC6491912 | biostudies-literature | 2019 May-Jun
REPOSITORIES: biostudies-literature
Publications
Outcomes following fixation for proximal humeral fractures.
Antonios Tony T Bakti Nik N Nzeako Obinna O Mohanlal Paras P Singh Bijayendra B
Journal of clinical orthopaedics and trauma 20190208 3
Fractures of the proximal humerus are a very common presentation in modern Trauma and Orthopaedic practice. In an ever-aging population, the incidence has dramatically increased resulting in a large socioeconomical burden. The surgical management of these injuries has evolved over the years. Patient outcomes are variable and there is no consensus on treatment approach. This review article focuses on the outcomes following fracture fixation using common surgical techniques. ...[more]
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Project description:BACKGROUND: Different operative techniques used for treating displaced proximal humeral fractures could result in malunion, non-union, osteonecrosis of humeral head, loosening of screw and loss of reduction particularly in comminuted and osteoporotic fractures. Locking compression plate (LPHP) has been proposed for open reduction and internal fixation of these fractures and is associated with less complication rate. MATERIALS AND METHODS: We prospectively assessed the functional outcome and the complications after an average follow-up of 24.9 months in 25 patients of proximal humeral fractures with osteoporosis. Mean age was 62 years. Using AO classification, 48% were type A and 52% type B. RESULTS: Mean constant score was 80 points. According to constant score, 28% had excellent outcome, 64% had good functional outcome, and 8% had moderate outcome. When the results were related to grades of osteoporosis, grade IV osteoporotic fractures had highest average Constant-Murley score (83 points, range 78-88 points), followed by grade III osteoporotic fractures (80 points, range 71-92 points), followed by grade II osteoporotic fractures (78 points, range 66-88 points). Varus malalignment and subacromial impingement were observed in 8% patients. Loosening of implant and loss of reduction were observed in 4% patients. Superficial infection was observed in 4% patients. CONCLUSIONS: Locking compression plate (LPHP) is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.
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Project description:BackgroundThe surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time.MethodsRetrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal-Wallis tests.ResultsOf the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: -35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; p < 0.001), and a 30-day mortality of 2%.ConclusionsWithin an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.
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Project description:BackgroundReverse Total Shoulder Arthroplasty is commonly performed for elective indications, such as cuff tear arthropathies, salvage arthropathies and tumours with excellent outcomes. However, its use in treating acute conditions such as 3- and 4-part proximal humeral fractures in the elderly has been more controversial. The aim of our study is to directly compare the short-term intra-operative and post-operative outcomes of RTSA for traumatic proximal humeral fractures as compared to elective shoulder arthroplasty.MethodsWe retrospectively identified 78 consecutive patients who had undergone RTSA from 2009 to 2018 at a tertiary hospital. These patients were classified by etiology as either elective or trauma cases. Comparative analysis of the baseline demographics, as well as post-operative surgical, functional and range-of-movement outcomes between the two groups was performed.Results57 Patients made up the elective cohort and 14 patients made up the trauma cohort. The elective cohort was significantly older compared to the traumatic fracture cohort (73.2 vs 78.6, p = 0.026). No significant differences were observed when comparing post-operative surgical outcomes. At 6 months, the elective cohort demonstrated greater forward flexion (105.8° vs 127.2°, p = 0.041), as well as higher SF-36 PCS (27.85 vs 43.99, p = 0.018) and ASES scores (35.5 vs 76.31, p = 0.009). However, these differences resolved by 1-year post-op and no significant differences were noted comparing functional and range-of-movement outcomes at 1-year post-op.ConclusionsOur study suggests that the application of reverse total shoulder arthroplasty in the management of traumatic humeral fractures may produce similarly favourable 1-year outcomes to that performed for elective etiologies.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-022-00625-4.
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Project description:IntroductionFor surgical treatment of proximal humeral fractures (PHF) in older patients, there is no consensus if locked plate fixation (LPF) or reverse total shoulder arthroplasty (RTSA) yields better clinical results. The purpose of this study was to systematically review the clinical and functional outcomes of LPF and RTSA. We hypothesized that RTSA would outperform LPF in patients with PHF aged 65 years or older.Materials & methodsA comprehensive literature search was performed on PubMed and Google Scholar from 1 July 2022 up to 12 January 2024 by two independent reviewers. Comparative studies reporting on the functional outcome using the Constant-Murley score (CMS) in patients aged 65 years or older, treated after 2012 for PHF with LPF or RTSA and with a mean follow-up time of at least 12 months were included. Ten studies with 244 LPF and 287 RTSA patients were included into the statistical analysis. We used a frequentist network meta-analysis to assess the comparative effectiveness of the treatments. Individual risk of bias of the studies was assessed using the ROB2 and ROBINS-I tools.ResultsOur network meta-analysis of the CMS resulted in the following order ranked from lowest to highest: LPF, LPF + screw augmentation, hemiarthroplasty (HA), RTSA + cemented stem, non-surgical treatment, LPF + fibular allograft, RTSA with an inclination angle of 135° (RTSA IA 135°), RTSA. However, none of the direct or indirect comparisons resulted in statistically noticeable differences.ConclusionIn conclusion, functional superiority of either treatment method is still unknown, with even high-powered RCT not being able to detect statistically noticeable differences in terms of function. Patient-individual factors, such as bone quality, sex and age have to be included when making treatment decisions.
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Project description:BackgroundThe unique anatomy and biomechanics of the distal humerus make distal humeral shaft fractures a significant challenge in orthopedic surgery. Conventional posterior surgical approaches are associated with risks such as iatrogenic radial nerve injury and increased soft tissue trauma.ObjectiveThis study aimed to assess the clinical efficacy of an inverted PHILOS plate using an anterior minimally invasive percutaneous approach for treating distal humeral shaft fractures.MethodsWe enrolled 32 patients with distal humeral shaft fractures. The surgical technique involved an anterior minimally invasive percutaneous application of an inverted PHILOS plate. Outcome measures included operative time, intraoperative blood loss, incision length, fracture healing time, and functional scores (Constant-Murley and Mayo Elbow Performance Scores). Postoperative complications, including nerve injury and nonunion, were documented.ResultsThe mean operative time was 1.69 ± 0.66 h, with a median blood loss of 50 ml (IQR: 50-100 ml). The mean incision length was 10.9 ± 1.78 cm, and the mean time to fracture healing was 11.2 ± 3.68 weeks. Functional outcomes were satisfactory, with a mean Constant shoulder score of 92.69 ± 6.6 and a mean Mayo Elbow Performance Score of 91.4 ± 8.04. No instances of iatrogenic nerve injury or nonunion were observed.ConclusionThe anterior minimally invasive percutaneous approach using an inverted PHILOS plate is an effective method for treating distal humeral shaft fractures. This technique minimizes soft tissue damage, reduces the risk of iatrogenic radial nerve injury, and ensures reliable fracture stabilization, thus offering a promising alternative to conventional posterior approaches.
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