Custom mega-prosthetic replacement for proximal humeral tumours.
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ABSTRACT:
SUBMITTER: Mayilvahanan N
PROVIDER: S-EPMC2532098 | biostudies-other | 2006 Jun
REPOSITORIES: biostudies-other
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Project description:BackgroundAseptic loosening after total hip arthroplasty is likely related to nicotine ingestion. However, aseptic loosening as a direct consequence of smoking habits has not been described with regard to proximal mega-prosthetic femoral replacement. The aim of the present study was to evaluate the association between nicotine consumption and aseptic loosening rates after proximal mega-prosthetic femoral replacement.Materials and methodsA consecutive series of patients who received mega-prosthetic replacement of the proximal femur at our hospital between 2005 and 2015 were included. Their files were reviewed and evaluated for the influence of smoking on aseptic loosening rates. All living patients were invited to complete a functional follow-up assessment at our clinic.ResultsTwenty-six patients with 27 prostheses were included. Five patients were active smokers, and 21 patients were non-smokers. Aseptic loosening was observed in three patients in the smoking group, whereas none of the non-smokers developed aseptic loosening. Fisher's exact test showed a relationship between nicotine consumption and aseptic loosening of the prostheses (p = 0.003).ConclusionsSmoking increases the likelihood of aseptic loosening after proximal mega-prosthetic femoral replacement.Level of evidenceLevel 4 according to Oxford Centre of Evidence-Based Medicine 2011.
| S-EPMC5429249 | biostudies-literature
Project description:We analysed 17 patients with primary malignant bone tumour of the femur who underwent limb salvage surgery with the total femoral custom mega prosthesis during the period 1994-2008. The patients were in the age group of 12-73 years, with a mean age of 30.94 years. There were 14 males. The most common diagnosis was osteosarcoma. The average follow-up period was 54.05 months with the longest being 168 months. The average Musculoskeletal Tumour Society (MSTS) functional score was 66.6%. The two- to 14-year overall survival was 82.4%. Three patients died of disease and one patient required amputation. Complications encountered were deep infection and dislocation of the prosthesis.
| S-EPMC2899109 | biostudies-literature
Project description:Treatment for displaced proximal humeral fractures is still under debate. Few studies exist at the highest level of evidence. Although reversed total shoulder prosthesis has gained popularity and showed promising results in the treatment for proximal humeral fractures in the elderly patients, no randomized controlled trials exist to the authors' knowledge.This study is a randomized semi-blinded controlled multicenter trial designed according to the Consort statement and the recommendations given by the Cochrane reviewers for proximal humeral fractures. The study will investigate whether a reversed total shoulder prosthetic replacement gain better functional outcome compared to open reduction and internal fixation using an angular stable plate in displaced three- and four parts proximal humeral fractures after two and five years follow-up.Participants are aged 65-85 admitted in seven different hospitals with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2. The intervention group is surgical treatment using a reversed total shoulder prosthesis (Delta X-tend) compared to open reduction and internal fixation with an angular stable plate (Philos) and thread cerclage in the control group. 60 patients will be randomized to each group.The primary outcome is shoulder function (Constant score). Secondary outcomes will be patient self-assessment form (Oxford shoulder score), a quality of life questionnaire (15D score) and resource implications (cost-effectiveness). Follow-ups take place at 3, 6, 12 and 24 months, and five years. The trial design is semi-blinded with blinded physiotherapists performing the functional testing of patients at all follow-ups.Randomization to treatment groups is electronic online, by independent supervisor (web-CRF). The recruitment of patients started at January 1.st 2013. Inclusion of 120 patients during three years is expected.This semiblinded trial include a high number of patients compared to existing randomized trials in this field. To our knowledge and according to ClinicalTrials.gov, this is the first study that compare these two treatments for a displaced proximal humeral fracture in elderly patients. This may provide important information to help the surgeon to decide the best treatment in the future.ClinicalTrials.gov Identifier: NCT01737060.
| S-EPMC4247153 | biostudies-literature
Project description:BackgroundTreatments for metastatic fracture of the humeral shaft continue to evolve as advances are made in both oncological and operative management. The purposes of this study were to critically evaluate the effectiveness of intercalary endoprostheses in treating metastatic humeral shaft fractures and to clarify the surgical indications for this technique.MethodsSixty-three patients treated surgically for 66 metastatic fractures of the humerus shaft were retrospectively reviewed. Intramedullary nailing (IMN) was performed in 16 lesions, plate fixation (PF) in 33 lesions, and prosthetic replacement in 17 lesions. The operative time, intraoperative blood loss, and postoperative complications were noted. The function of the upper extremities was assessed by the Musculoskeletal Tumor Society (MSTS) score and American Shoulder and Elbow Surgeons (ASES) score. All included patients were followed until reconstructive failure or death.ResultsThe operative time was relatively shorter in the prosthesis group than in either the IMN group (p = 0.169) or PF group (p = 0.002). Notably, intraoperative blood loss was significantly less in the prosthesis group than in either the IMN group (p = 0.03) or PF group (p = 0.012). The average follow-up time was 20.3 (range, 3-75) months, and the overall survival rate was 59.7% at 12 months and 46.7% at 24 months. One rotator cuff injury, 3 cases of iatrogenic radial nerve palsy, 5 cases of local tumor progression, and 1 mechanical failure occurred in the osteosynthesis group, whereas one case of aseptic loosening of the distal stem and one case of local relapse were observed in the prosthesis group. There were no significant differences in functional scores among the three groups.ConclusionsIntercalary prosthetic replacement of the humeral shaft may be a reliable solution for pathologic fractures patients; it is indicated for lesions with substantial bone loss, or accompanied soft tissue mass, or for those patients with better prognosis.
| S-EPMC8101207 | biostudies-literature
Project description: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.
| S-EPMC6491912 | biostudies-literature
Project description:Background and purposeThe methods of reconstruction for proximal femur bone tumors that are used most often include modular prosthetic replacement and allograft-prosthesis composite reconstruction. In modular prostheses, the abductors are detached from the insertion and then reinserted into the implant, and the iliopsoas is detached and left free. In the allograft-prosthesis composite, the detached tendons are fixated to the graft. We assessed whether the latter procedure provides functional advantages regarding gait.Patients and methodsWe studied 2 groups of 10 patients, each with prosthetic reconstruction of the proximal femur either with modular prosthetic replacement or with allograft-prosthesis composite. Functional performance was analyzed by gait analysis 2.5-10 years after surgery. At that time, all the patients had good function according to the Musculoskeletal Society score.ResultsWalking speed was reduced in all patients, and especially in patients with modular prosthetic replacement. Different hip extension patterns during late stance were found in the 2 groups. Surface EMG showed a typical prolonged muscle co-contraction pattern during gait, which was more evident in modular prosthetic patients.InterpretationAlthough both procedures provided good functional outcome in the long-term follow-up, gait analysis revealed mechanical changes during gait that were probably related to the muscle reinsertion procedure. Direct fixation of the muscles to the bone graft appeared to result in a more efficient muscular recovery.
| S-EPMC3639346 | biostudies-literature
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.
| S-EPMC2656990 | biostudies-other
Project description:PURPOSE: The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock. METHODS: Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up. RESULTS: Forty-three fractures were available for follow-up. The amount of humeral head impaction was 3.9 mm on average and was directly correlated with patient's age, sex, Codman-Lego classification, varus inclination and mataphyseal comminution. The postoperative cervico-diaphyseal angle was restored in 35 cases, with 81 % good results. The Humerusblock was removed in 41 % of cases because of K-wire perforation of the humeral head. A negative correlation was found between impaction and Constant score. CONCLUSIONS: The amount of humeral head impaction is related to patients' age, sex, and fracture patterns, being the most prone to compaction those with metaphyseal comminution. Humeral head impaction negatively affects final Constant score.
| S-EPMC4071502 | biostudies-literature
Project description:BackgroundHumeral head inferior subluxation often occurs immediately after osteosynthesis for proximal humeral fracture; however, the underlying cause remains largely unknown. In addition, the prognosis of postoperative inferior subluxation has not been fully investigated. This study aimed to clarify the predictive factors that affected the onset of postoperative inferior subluxation using multivariate analysis and examine the postoperative course of inferior subluxation and its influence on postoperative outcomes.MethodsWe retrospectively reviewed 212 patients who underwent osteosynthesis for Neer 2- or 3-part proximal humeral fractures. In the multivariate analysis, the dependent variable was set as the inferior subluxation observed 1 week after the surgery. The explanatory variables included age, sex, affected side, body mass index, smoking, local osteoporosis, preoperative axillary nerve injury, time from injury to surgery, fracture dislocation, fracture pattern, preoperative inferior subluxation, surgical procedure, surgical approaches, blood loss, operative time, and postoperative drainage. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models. Furthermore, based on the presence of inferior subluxation at 1 week after the surgery, we divided the patients into two groups: with inferior subluxation (+IS group) and without inferior subluxation (-IS group). We compared the postoperative outcomes (incidence of postoperative complications and range of motion) between these two groups.ResultsOf 212 patients, 64 (30.7%) experienced inferior subluxation at 1 week after the surgery. On multivariate analyses, preoperative inferior subluxation (odds ratio = 4.69; 95% confidence interval = 2.45-9.76; P < .001) and longer operative time (odds ratio = 1.01; 95% confidence interval = 1.00-1.02; P = .049) were the risk factors for postoperative inferior subluxation. In the +IS group, inferior subluxation resolved at 1 year after the surgery in 89.5% of patients. There was no significant difference in the postoperative outcome between the +IS and -IS groups. However, four of six patients with persistent inferior subluxation, more than 6 months after the surgery, experienced complications, such as varus angulation of the humeral head or screw joint perforation.ConclusionsThis study provides new information on the risk factors for and prognosis of postosteosynthesis inferior subluxation in patients with proximal humeral fracture. Longer operative time and presence of preoperative inferior subluxation was associated with an increased risk of postoperative inferior subluxation, although it was temporary in most cases, and had no significant influence on the postoperative outcomes. However, in patients with persistent inferior subluxation of more than 6 months duration, inferior subluxation may be related to postoperative complications.
| S-EPMC8245978 | biostudies-literature
Project description:Proximal humeral fractures are common injuries with increasing incidence, particularly in the aging population. Nondisplaced or minimally displaced fractures can be treated conservatively whereas surgical fixation is usually indicated in the cases of displaced fractures. Various surgical options have been used for treatment of these fractures. Good outcomes have been reported with use of the Proximal Humeral Internal Locking System (PHILOS plate; Synthes, Zuchwil, Switzerland) as the implant of choice. However many complications have been reported, including varus malalignment, excessive retroversion of the articular part of the humerus, penetration of screws, and avascular necrosis of the humeral head. Therefore, we have hypothesized that an inadequate intraoperative fluoroscopic assessment may be an important factor contributing to these complications. We have described a step-by-step intraoperative fluoroscopic setup, including the proposal of a plate and screw view, focusing on the accuracy of reduction and proper placement of the PHILOS plate to prevent the complications previously described.
| S-EPMC5621472 | biostudies-literature