Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus

Spross, Christian; Grueninger, Patrick; Gohil, Satyen; Dietrich, Michael

doi:10.2106/jbjs.st.n.00106

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…Autologous bone graft was harvested from the iliac crest in a standard manner. Fractures were fixed with a PHILOS plate (DePuy Synthes, Zuchwil, Switzerland), using at least four locking screws in the humeral head with lengths assessed per the Spross protocol [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients

et al. 2022

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Background and Objectives: The treatment of proximal humerus fractures in elderly patients is challenging, with reported high complication rates mostly related to implant failure involving screw cut-out and penetration. Metaphyseal defects are common in osteoporotic bone and weaken the osteosynthesis construct. A novel technique for augmentation with polymethylmethacrylate (PMMA) bone cement was developed for the treatment of patients in advanced age with complex proximal humerus fractures and metaphyseal voids, whereby the cement was allowed to partially cure for 5–7 min after mixing to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window with a volume of 4–6 mL per patient. The aim of this retrospective clinical study was to assess this technique versus autologous bone graft augmentation and no augmentation. Materials and Methods: The outcomes of 120 patients with plated Neer three- and four-part fractures, assigned to groups of 63 cases with no augmentation, 28 with bone graft augmentation and 29 with cement augmentation, were assessed in this study. DASH, CS, pain scores and range of motion were analyzed at 3, 6 and 12 months. Statistical analysis was performed with factors for treatment and age groups, Neer fracture types and follow-up periods, and with the consideration of age as a covariate. Results: DASH and CS improved following cement augmentation at three and six months compared to bone grafting, being significant when correcting for age as a covariate (p ≤ 0.007). While the age group had a significant effect on both these scores with worsened values at a higher age for non-augmented and grafted patients (p ≤ 0.044), this was not the case for cement augmented patients (p ≥ 0.128). Cement augmentation demonstrated good clinical results at 12 months with a mean DASH of 10.21 and mean CS percentage of 84.83% versus the contralateral side, not being significantly different among the techniques (p ≥ 0.372), despite the cement augmented group representing the older population with more four-part fractures. There were no concerning adverse events specifically related to the novel technique. Conclusions: This study has detailed a novel technique for the treatment of metaphyseal defects with PMMA cement augmentation in elderly patients with complex proximal humerus fractures and follow-up to one year, whereby the cement was allowed to partially cure to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window. The results demonstrate clinically equivalent short-term results to 6 months compared to augmentation with bone graft or no augmentation—despite the patient group being older and with a higher rate of more severe fracture patterns. The technique appears to be safe with no specifically related adverse events and can be added in the surgeon’s armamentarium for the treatment of these difficult to manage fractures.

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Section: Methodsmentioning

confidence: 99%

A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients

et al. 2022

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“…Three pairs of high-strength, non-absorbable sutures were inserted into the tendon to fix and reduce the fragments. A superior suture was used for the supraspinatus tendon, an anterior suture for the subscapularis tendon, and a posterior suture for the infraspinatus tendon as previously described [ 5 ] (Fig. 1 b).…”

Section: Methodsmentioning

confidence: 99%

“…Although various methods such as applying traction on the arm and suture, elevator, and joystick techniques [ 4 , 5 ] have been proposed, the overall anatomical or acceptable fracture reduction remains low, which results in a high complication rate. This is especially true for unstable and displaced proximal humeral fractures involving the anatomical neck or with disruption of the medial hinge [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Reduction and fixation of proximal humeral fracture with severe medial instability using a small locking plate

et al. 2021

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Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

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“…Three pairs of high-strength, non-absorbable sutures were inserted into the tendon to x and reduce the fragments. A superior suture was used for the supraspinatus tendon, an anterior suture for the subscapularis tendon, and a posterior suture for the infraspinatus tendon as previously described [5] (Figure 1b). Then, the alignment of the fractures was restored by pulling down the sutures along the diaphyseal axis, distraction of the humeral shaft, and levering the humeral head using the joystick technique, followed by temporary K-wire xation and C-arm uoroscopy.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Although various methods such as applying traction on the arm and suture, elevator, and joystick techniques [4,5] have been proposed, the overall anatomical or acceptable fracture reduction remains low, which results in a high complication rate. This is especially true for unstable and displaced proximal humeral fractures involving the anatomical neck or with disruption of the medial hinge [6,7].…”

Section: Introductionmentioning

confidence: 99%

Reduction and Fixation of Proximal Humeral Fracture With Severe Medial Instability Using a Small Locking Plate

Zhang

Wan

Zhang

et al. 2021

Preprint

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Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 minutes (range, 70–130 minutes), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

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Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus

Cited by 4 publications

References 25 publications

A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients

A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients

Reduction and fixation of proximal humeral fracture with severe medial instability using a small locking plate

Reduction and Fixation of Proximal Humeral Fracture With Severe Medial Instability Using a Small Locking Plate

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