Operative Management of Proximal Humerus Nonunions in Adults: A Systematic Review

Zastrow, R; Patterson, Diana C.; Cagle, Paul J.

doi:10.1097/bot.0000000000001769

Cited by 8 publications

(8 citation statements)

References 55 publications

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“…In such patients, the decision between humeral head preservation or replacement can be far more nuanced [16]. Although ORIF with angular locking plates is one of the most common treatments for proximal humerus fracture [47], prior reports suggest failure rates as high as 37% and complication rates up to 49% [40,45]. Consequently, many of these patients will undergo additional procedures, with up to 20% undergoing revision [23,26], sometimes involving a secondary hemiarthroplasty or total shoulder arthroplasty [12,13].…”

Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years

Lanzetti

Gaj

Berlinberg

et al. 2022

Clin Orthop Relat Res

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BackgroundProximal humeral fractures are traditionally treated with open reduction and internal fixation (ORIF), but reverse total shoulder arthroplasty (RTSA) has emerged as an increasingly popular treatment option. Although ORIF with angular locking plates is a common treatment for proximal humerus fractures, prior reports suggest high failure and complication rates. Although RTSA has become an increasingly popular option for complex proximal humeral head fractures given its low complication rates, there are concerns it may lead to limited postoperative ROM. Thus, the optimal treatment for patients older than 70 years from a functional and radiographic perspective remains unclear.Questions/purposes(1) In patients older than 70 years with three-part and four-part proximal humerus fractures, does RTSA result in better functional outcome scores (Constant, American Shoulder and Elbow Surgeons [ASES], and DASH scores) than ORIF with a locking plate? (2) Does RTSA result in greater ROM than ORIF? (3) Does RTSA result in a lower risk of complications than ORIF? (4) In patients with either procedure, what are the rates of negative radiographic outcomes in those treated with ORIF (such as malunion, bone resorption, malalignment, or avascular necrosis) or those with RTSA (such as resorption, notching, and loosening)? (5) At a minimum of 2 years of follow-up, does ORIF result in a greater number of revision procedures than RTSA?MethodsBetween January 1, 2013, and June 30, 2018, we treated 235 patients for a proximal humeral fracture. We considered only patients without previous ipsilateral fracture or surgery, other fractures, or radial nerve injuries; age older than 70 years; and patients without neurologic disease or cognitive dysfunction as potentially eligible. Sixty-nine percent (162 patients) of the patients were eligible; a further 31% (73 patients) were excluded because 18% (13 of 73 patients) did not meet the inclusion criteria, 62% (45 patients) underwent nonoperative treatment, and 21% (15 patients) declined to participate. Patients were nonrandomly allocated to receive RTSA if they had supraspinatus Goutallier/Fuchs Grade 3 or 4 atrophy or ORIF if they had supraspinatus Goutallier/Fuchs Grade 1 or 2 atrophy. This left 81 patients who were treated with RTSA and another 81 patients who were treated with ORIF. Among the 81 patients treated with RTSA, 11% (nine patients) were lost to the minimum study follow-up of 2 years or had incomplete datasets, leaving 89% (72 patients) for analysis. Among the 81 patients treated with ORIF, 19% (15 patients) were lost before the minimal study follow-up of 2 years or had incomplete datasets, leaving 82% (66 patients) for analysis. The median follow-up for both groups was 53 months (range 24 to 72 months). The mean age was 76 ± 2.9 years in the RTSA group and 73 ± 2.9 years in the ORIF group. In the RTSA group, 27 patients had a three-part fracture and 45 patients had a four-part fracture. In the ORIF group, 24 patients had three-part fractures and 42 patients had four-p...

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Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years

Lanzetti

Gaj

Berlinberg

et al. 2022

Clin Orthop Relat Res

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“…On the other hand, considering proximal humerus nonunions, especially with severe bone loss, a variety of therapeutic options are available, including open reduction and internal fixation with several fixation constructions, hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty [ 6 ]. While there is a consensus on the use of megaprosthesis in oncologic shoulder surgery [ 4 ], a similar consensus does not yet exist for proximal humerus nonunions.…”

Section: Discussionmentioning

confidence: 99%

Reverse Shoulder Megaprosthesis for Massive Proximal Humeral Bone Loss in Fracture Outcome Settings: A Report of Two Cases and Literature Review

Morea,

Polizzi,

Niccoli

et al. 2024

Cureus

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In trauma settings, including the management of outcomes, there is no consensus on the most appropriate reconstructive method in the presence of severe bone loss of the proximal humerus. The objective of this report is to evaluate the short-term functional outcomes of two patients in whom reverse shoulder megaprosthesis was used to treat the failure of trauma surgery with severe bone loss. The secondary objective was to compare the results obtained with the literature regarding the use of megaprosthesis in shoulder trauma surgery. The patients showed a satisfying functional recovery and increased quality of life. At the 12-month follow-up, no complications occurred. Regarding the risk of complications, especially the risks of mobilization of the megaprosthesis, the CT-based intraoperative navigation system optimizes the configuration of the screw for the initial fixation of the glenoid component. Shoulder megaprosthesis appears to be a viable option not only in oncologic surgery but also in cases of failed trauma surgery. The functional results, considering functional score and range of motion, are encouraging and allow patients to improve their quality of life.

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“…We have used a lateral PHILOS plate, through which some screws have been applied through FSG to enhance the strength of fixation. Other than locking plates and FSG, we also used cancellous autograft, which has provided improved biomechanical stability [ 24 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Quadlbauer et al concluded that locking plate fixation without bone grafting is a reasonable and safe option for treating proximal humerus non-union. However, Zastrow et al found lesser union time when used with autograft [ 24 , 29 ]. The union time of PHN using a locked plate augmented with autograft and found shorter (3.9 months) for those managed conservatively for original fracture and more for those managed operatively (5.5 months) for original fracture [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

Mukhopadhaya,

Singh,

Gupta

et al. 2024

jocr

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Introduction: It can be challenging to treat proximal humeral non-union (PHN). The challenge gets compounded when they are presented either late or after previous surgery. The challenges are far greater due to small proximal fragments, scalloping of the head, medial bone defect, osteoporosis, soft tissue contractures, and problems related to the previous implants. Materials and Methods:In this retro-prospective study (2007–2020), we report on six cases of PHN which were presented to us more than 5 years after the original injury and managed using an intra-medullary autologous fibular strut graft (FSG) along with fixation with a proximal humeral locking plate and cancellous bone grafting. We quantified shoulder function based on constant score and disabilities of the arm, shoulder and hand (DASH) score. Results: The mean age of patients is found to be 54.3 years (range, 22–74 years) with females dominating our study. The mean pre-operative constant score is 26.33 which improved to 71.83 in the post-operative period. The mean DASH score is 77.98 preoperatively, which improved to 19.5 postoperatively. The paired sample t-test compared the difference in mean of the pre-operative and post-operative scores, which shows significant improvement in outcome. Conclusion: Even in very late PHN in poor-quality bone, the additional use of intramedullary strut grafts provides structural support to the fixation and further enhances the ability to withstand the load-start early motion and have a satisfactory functional outcome. Keywords: Non-union, proximal humerus non-union, proximal humerus fracture, proximal humerus internal locking system, locking plate, autogenous fibular strut graft.

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Operative Management of Proximal Humerus Nonunions in Adults: A Systematic Review

Cited by 8 publications

References 55 publications

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years

Reverse Total Shoulder Arthroplasty Demonstrates Better Outcomes Than Angular Stable Plate in the Treatment of Three-part and Four-part Proximal Humerus Fractures in Patients Older Than 70 Years

Reverse Shoulder Megaprosthesis for Massive Proximal Humeral Bone Loss in Fracture Outcome Settings: A Report of Two Cases and Literature Review

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series

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