Dataset Information

A torque induced iatrogenic fracture of the humeral shaft in proximal humeral fracture plating - A case report and biomechanical perspectives.

ABSTRACT:

Introduction

Proximal humerus fractures are common amongst the elderly and osteoporotic cohorts. Common treatment methods include proximal locking plates. In this case, we describe an iatrogenic fracture of the proximal humeral shaft during screw insertion under power. Similar cases have not been described previously in open reduction and internal fixation of a proximal humerus fracture. Further, we focus particularly on precautionary measures that aim to avoid such complications that may lead to considerable morbidity.

Case presentation

We describe a case of a 65 year old osteoporotic female who underwent open reduction internal fixation of a proximal humerus fracture complicated by an unusual iatrogenic humeral fracture at the level of insertion of the distal screw, likely secondary to inserting the proximal locking screws under power.

Conclusion

In this case, we explore the possible factors leading to the fracture and precautionary measures to avoid them. The rate of iatrogenic intraoperative fractures are likely underreported and have not been described in open reduction and internal fixation of an existing fracture. The underlying factors that may predispose to such complications have not been previously described in similar cases. This case serves as a warning of an unanticipated complication and describes the potential biomechanical factors involved.

SUBMITTER: Lari A

PROVIDER: S-EPMC8339138 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and objectivesFractures of the proximal humerus are common, particularly in elderly populations. Anatomical locking plates target stabilization with a multitude of screws spanning into the humeral head. Sound implant placement and screw length determination are key for a successful clinical outcome but are difficult to obtain from planar X-rays. A novel implant positioning technology for proximal humerus plating (Xin1) outputs screw lengths suggestions and plate position based on hole projections in conventional X-ray images. This study investigated the performance of a prototype Xin1 system in a postmortem (in vitro) experiment as well as in a clinical handling test.Materials and methodsFor in vitro testing, twelve shoulders from six anatomical specimens were randomized into two groups to compare the Xin1 technique to the conventional operation in terms of surgical precision, procedure time and X-ray exposure. For the clinical trial, 11 patients undergoing plating of the proximal humerus were included. The aim was to investigate clinical handling of the Xin1 marker clip and to retrospectively evaluate the system performance in a real-life fracture situation. Image pairs before and after insertion of the proximal screws were retrospectively processed to investigate the influence of potential bone fragment shifts on the system output.ResultsIn the postmortem experiment, the use of the system significantly improved the surgical precision (52% error reduction), procedure time (38% shorter) and radiation exposure (64% less X-rays). Clinical handling demonstrated seamless embedding of the marker clip into existing clinical workflows without adverse events reported. Retrospective X-ray analysis on six eligible patients revealed differences in the calculated screw lengths of ≤2 mm before and after screw insertion for five patients. In one patient, the screw lengths differed up to 8 mm, which might indicate displacement of the head fragment.ConclusionsResults suggest a strong potential of the Xin1 assistance technology to enhance the surgical procedure and patient outcomes in the rising incidence of osteoporotic humeral fractures. Robust performance in a real-life fracture situation was observed. In-depth validation of the system is, however, needed before placing it into clinical practice.