Management of proximal humeral fractures by the Ilizarov external fixator

Meselhy, Mohammed Anter; Singer, Mohamed Salah

doi:10.1007/s00402-017-2749-0

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…The current study showed the efficacy of the Ilizarov external fixator in restoring huge bone defects with a mean bone loss of 10.67 cm. Further, the frame provided adequate mechanical stability, reduced complications associated with free vascular fibular graft transfer, and overcame persistent infection 18,19. However, there were a few limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Further, the frame provided adequate mechanical stability, reduced complications associated with free vascular fibular graft transfer, and overcame persistent infection. 18,19 However, there were a few limitations. First, the number of cases was small because of the nature and the specific character of the causative trauma.…”

Section: Case Presentation: Patient Numbermentioning

confidence: 99%

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The decision in severe upper-limb injuries: amputation or reconstruction? A retrospective case series

Meselhy

Halawa

2022

Current Orthopaedic Practice

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Background:Large bone defects in the humerus that are associated with severe soft-tissue loss are a challenge. The aim of this study was to share the authors' experience with the use of an Ilizarov apparatus in treating patients with severe open humeral fractures with large bone defects and soft-tissue compromise. The authors propose important prognostic factors for surgeons to consider when deciding on treating such cases. Methods:Sixteen patients with severely injured upper extremities with open humeral fractures associated with bone loss were treated with Ilizarov distraction osteogenesis in an attempt to salvage the limb. Trauma etiology were motor vehicle accidents in 12 patients and machine crushing injuries in four. All patients had open fracture Gustilo-Anderson grade IIIB. The mean bone loss was 10.67 cm (average, 5 cm to 19.5 cm). The radial nerve was completely lost at the site of injury or cut in all patients, the ulnar nerve was found in six patients, and the median nerves and brachial arteries were intact in all patients. Results:The mean age of patients was 31.1 yr (range, 21 to 42 yr). Twelve patients were men (75%). The left limb was injured in seven patients (43.75%), and all patients were right-hand dominant Average time of fixator use was 256.87 days, (range, 220 to 355). The mean follow-up period was 4.02 yr (range, 3 to 5 yr). At the end of the follow-up period, all sixteen limbs were salvaged, and bony union was achieved in all patients. Conclusions:In severely injured upper limbs, regardless of severity scores, the authors believe that reconstructive vascular impairment is the only reasons to carry out an amputation.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentation: Patient Numbermentioning

confidence: 99%

The decision in severe upper-limb injuries: amputation or reconstruction? A retrospective case series

Meselhy

Halawa

2022

Current Orthopaedic Practice

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“…These patients were evaluated monthly after the operation, every 2 to 3 months after fracture union, and every 6 months 1 year later. At the final follow-up, the functional recovery was assessed using Neer’s criteria and the visual analog score (VAS) (0 = very satisfied, 10 = no satisfaction) [ 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes

XiaoHui¹,

Yao

Yan³

et al. 2021

Eur J Med Res

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Background Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. Methods A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. Results A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29–86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48–86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12–36 months). The mean Neer scores were 80.5 ± 7.6 (range 62–93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1–6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). Conclusion A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.

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“…Functional outcomes were assessed at the final follow up in accordance with Neer's criteria, which included pain (none to totally disabled), function (strength, reach, and stability), ROM (flexion, abduction, extension, external rotation, and internal rotation), and anatomy (rotation, angulation, joint congruity, retracted tuberosities, metal failure, myositis, nonunion, and avascular necrosis) [10]. The degree of patient satisfaction was evaluated using the visual analog score (VAS) (0 = very satisfied, 10 = no satisfaction) at the final follow up [11]. Postoperative axillary nerve function was noted while examining the sensory territories of the axillary nerve and testing the weakness or 6 atrophy of the anterior deltoid muscle.…”

Section: Postoperative Evaluation and Managementmentioning

confidence: 99%

Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

Zhou

Jiang

Liu

2019

Preprint

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Purpose This study aimed to investigate the characteristics, management and patient outcomes of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation. Methods A retrospective chart review from January 2014 to June 2017 identified 10 patients of iatrogenic proximal humeral fracture during shoulder dislocation reduction. The sex and age of patients, associated injuries and location, first-time or habitual shoulder dislocation, the type of anesthesia, the time from injury to revision surgery as well as functional outcomes were analyzed. Results There were 1 male and 9 females (female/male ratio 9:1) with an average age of 66.9 years (range, 50-77 years). All patients presented with first-time anterior shoulder dislocation, and 7 patients (70%) associated with greater tuberosity fractures (GTF). Four patients (40%) underwent reduction under general anesthesia and 6 reduction (60%) under propofol sedation. The revision surgery was performed by open reduction and internal fixation. The mean follow-up period was 18.2 months (range, 12–36 months). The mean visual analog score (VAS) was 3.0 ± 1.6 (range, 1-6), and the mean Neer scores were 82.1 ± 6.5 (range, 71-93). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). Conclusion A high risk of iatrogenic proximal humeral fracture is present in first-time anterior shoulder dislocation with GTF in senile female. Effective reduction and internal fixation performed timely may help to improve functional outcomes in case of iatrogenic injury.

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Management of proximal humeral fractures by the Ilizarov external fixator

Abstract: Level IV, case series.

Cited by 5 publications

References 13 publications

The decision in severe upper-limb injuries: amputation or reconstruction? A retrospective case series

The decision in severe upper-limb injuries: amputation or reconstruction? A retrospective case series

Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes

Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

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