How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction–internal fixation of proximal humeral fractures

Spross, Christian; Zeledon, Rebeca; Zdravkovic, Vilijam; Jost, Bernhard

doi:10.1016/j.jse.2017.02.026

Cited by 60 publications

(64 citation statements)

References 29 publications

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“…Bone density is a predictor of surgical reduction quality and screw cutout. 21 , 22 Density can be assessed with cortical bone thickness measurements on AP views of the shoulder. Two techniques are detailed in Figure 4 : the Tingart measurement 23 and the deltoid tuberosity index.…”

Section: Evaluation and General Considerationsmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

159

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Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

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Section: Evaluation and General Considerationsmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

159

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“…13 This may guide the decision to manage fractures of the proximal Humerus non-operatively as poor bone density is a predictor of surgical reduction quality and screw cutout. 14…”

Section: Assessment and Imagingmentioning

confidence: 99%

Outcomes following non operative management for proximal humerus fractures

Khoriati

Antonios

Bakti

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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“…Several studies evaluated risk-factors of complications and unsuccessful functional outcomes after locked plating of proximal humeral fractures [ 7 – 9 ]. Comorbidities and the integrity of the medial hinge have been shown to significantly influence clinical outcome and should be assessed for indication preoperatively [ 7 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Open reduction and internal fixation of displaced proximal humeral fractures. Does the surgeon‘s experience have an impact on outcomes?

et al. 2018

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IntroductionTo evaluate outcomes following open reduction and internal fixation of displaced proximal humeral fractures with regards to the surgeon’s experience.Material and methodsPatients were included undergoing ORIF by use of locking plates for displaced two-part surgical neck type proximal humeral fractures. Reduction and functional outcomes were compared between procedures that were conducted by trauma surgeons [TS], senior (>2 years after board certified) trauma surgeons [STS] and trauma surgeons performing ≥50 shoulder surgeries per year [SS]. Quality of reduction was measured on postoperative x-rays. Functional outcomes were assessed by gender- and age-related Constant Score (nCS). Secondary outcome measures were complication and revision rates.ResultsBetween 2002–2014 (12.5 years) n = 278 two-part surgical neck type humeral fractures (AO 11-A2, 11-A3) were included. Open reduction and internal fixation was performed with the following educational levels: [TS](n = 68, 25.7%), [STS](n = 110, 41.5%) and [SS](n = 77, 29.1%). Functional outcome (nCS) increased with each higher level of experience and was significantly superior in [SS] (93.3) vs. [TS] (79.6; p = 0.01) vs. [STS] (83.0; p = 0.05). [SS] (7.8%) had significantly less complications compared with [TS] (11.3%; p = 0.003) and [STS](11.7%; p = 0.01) moreover significantly less revision rates (3.9%) vs. [TS](8.2%) and [STS](7.4%) (p<0.001). Primary revision was necessary in 13 cases (4.7%) due to malreduction of the fracture.ConclusionQuality of reduction and functional outcomes following open reduction and internal fixation of displaced two-part surgical neck fractures are related to the surgeon’s experience. In addition, complications and revision rates are less frequent if surgery is conducted by a trauma surgeon performing ≥50 shoulder surgeries per year.

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How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction–internal fixation of proximal humeral fractures

Cited by 60 publications

References 29 publications

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Outcomes following non operative management for proximal humerus fractures

Open reduction and internal fixation of displaced proximal humeral fractures. Does the surgeon‘s experience have an impact on outcomes?

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