Outcomes following non operative management for proximal humerus fractures

Khoriati, Al-Achraf; Antonios, Tony; Bakti, Nik; Mohanlal, P; Singh, Bijayendra

doi:10.1016/j.jcot.2019.02.017

Cited by 12 publications

(9 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Attached to the greater tuberosity are the supraspinatus, infraspinatus, and teres minor, and positioned superior, posterosuperior, and posterior, respectively. For the lesser tuberosity, only the subscapularis is attached [13,16,36,37,42]. The balance between the deltoid and rotator cuff (supraspinatus, infraspinatus, subscapularis, supraspinatus, and teres minor) provides the correct variable forces to move the arm naturally.…”

Section: Muscles Tendons and Movementsmentioning

confidence: 99%

“…The treatment for this type of fracture is still debatable, due to the fracture/patient factors involved in the treatment decision process, and the high complication rates of surgical treatments. The stability and displacement of the fracture, the bone mineral density, the fracture pattern, and the age and comorbidities of the patient are some of the factors to consider for the proper selection of treatment [3,4,[13][14][15]. The potential poor outcomes of surgical treatments include non-union, varus collapse, screw-cut, loss of reduction, avascular necrosis, and the need for reoperation [14,16,17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Castro-Franco¹,

Mendoza-Muñoz²,

González-Ángeles³

et al. 2020

Applied Sciences

View full text Add to dashboard Cite

Proximal humerus fractures are becoming more common due to the aging of the population, and more related scientific research is also emerging. Biomechanical studies attempt to optimize treatments, taking into consideration the factors involved, to obtain the best possible treatment scenario. To achieve this, the use of finite element analysis (FEA) is necessary, to experiment with situations that are difficult to replicate, and which are sometimes unethical. Furthermore, low costs and time requirements make FEA the perfect choice for biomechanical studies. Part of the complete process of an FEA involves three-dimensional (3D) bone modeling, mechanical properties assignment, and meshing the bone model to be analyzed. Due to the lack of standardization for bone modeling, properties assignment, and the meshing processes, this article aims to review the most widely used techniques to model the proximal humerus bone, according to its anatomy, for FEA. This study also seeks to understand the knowledge and bias behind mechanical properties assignment for bone, and the similarities/differences in mesh properties used in previous FEA studies of the proximal humerus. The best ways to achieve these processes, according to the evidence, will be analyzed and discussed, seeking to obtain the most accurate results for FEA simulations.

show abstract

Section: Muscles Tendons and Movementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Castro-Franco¹,

Mendoza-Muñoz²,

González-Ángeles³

et al. 2020

Applied Sciences

View full text Add to dashboard Cite

show abstract

“…In a previous randomised controlled trial (RCT), it was reported that there was no significant difference between surgical and non-surgical treatment at two-year followup in people with displaced PHFs involving the surgical neck (Rangan et al, 2015). However, given the lack of evidence to inform non-surgical management, further research is required to evaluate the most effective non-surgical approach to rehabilitation in people with PHF (Khoriati et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Recovery from PHFs can be a long and often incomplete process that can be hindered by complications (Handoll et al, 2017), including a higher risk of rehospitalisation or further fracture (Clinton et al, 2009). Rehabilitation is regarded as an important contributor to recovery but there is a lack of high‐quality evidence available to inform rehabilitation practice (Handoll & Brorson, 2015; Khoriati, Antonios, Bakti, Mohanlal, & Singh, 2019).…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information

Rohun

May

Littlewood

2020

Musculoskeletal Care

View full text Add to dashboard Cite

Introduction Proximal humeral fractures (PHF) are a common injury in the older population but there is limited research evaluating rehabilitation following PHF. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following PHF as a platform for conducting future research. Methods Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following PHF, for example, duration of immobilisation. One reviewer extracted data and a second reviewer verified this. Results Seventeen PIS from 17 different NHS trusts were identified. All provided some information on the method of immobilisation but only six provided guidance on duration of immobilisation with the median time being 2 weeks (range 0–6). The median time to commencement of passive exercise was 2 weeks (range 0–4) and 9 weeks (range 6–12) for active exercise. Only one PIS reported on the time for commencement of resisted exercises and this was reported as 6 weeks. The median time recommended return to work was 7.5 weeks (range 6–12). Conclusion This study found limited publicly available information for rehabilitation following PHF in the NHS but offers some insight into current approaches. Our results will facilitate development of relevant information for patients and evaluation of rehabilitation strategies in future research.

show abstract

“…Most simple PHFs are non-displaced or minimally displaced fractures, and can be treated conservatively with good outcomes [6] . Complex PHFs, however, are often complicated by injury to the humeral head blood supply, to the rotator cuff and to other soft tissues, and surgical treatment is necessary if the patient's condition allows it.…”

Section: Introductionmentioning

confidence: 99%

Locking Plate Fixation versus Hemiarthroplasty for Complex Proximal Humeral Fractures: an Updated Systematic Review and Meta-analysis

Qiu

2020

Preprint

View full text Add to dashboard Cite

BackgroundThis updated systematic review and meta-analysis was performed to compare clinical efficacy and safety of locking plate fixation (LPF) and hemiarthroplasty (HAP) for surgical treatment of complex proximal humeral fractures (PHFs).MethodsFive electronic databases (PubMed, EMBASE, CNKI, Wanfang database and the Cochrane Library) were searched from their start dates to July 2020 to identify all relevant studies. Our main endpoints were Constant–Murley score (efficacy), and method-related complications and revisions (safety). Cochrane Collaboration’s RevMan 5.3 was used for meta-analysis.ResultsSixteen retrospective trials and one randomized controlled trial involving a total of 936 patients (506 patients in the LPF group and 430 patients in the HAP group) were included in this analysis. The Constant–Murley score was significantly higher with LPF than with HAP [SMD=0.73, 95%CI: (0.23, 1.22)]. In subgroup analysis however, there was no significant difference in Constant-Murley score between LPF and HAP for four-part fractures [SMD=0.35, 95%CI (-0.07, 0.77)] or for subjects over 60 years of age [SMD=0.54, 95%CI: (-0.45, 1.52)]. Revision rate [OR=3.61, 95%CI (1.99, 6.56)] and postoperative complications [OR=1.80, 95%CI (1.24, 2.61)] were significantly lower with HAP than with LPF.ConclusionsIn general, for treatment of complex PHFs, LPF was superior to HAP in postoperative shoulder joint function assessed by the Constant–Murley score. However, there was no significant difference in efficacy for patients with four-part fractures or those older than 60 years of age. Since LPF was associated with significantly higher revision and postoperative complications rates, we suggest that HAP should be considered the preferred procedure for patients older than 60 years with four-part proximal humeral fractures.

show abstract

Outcomes following non operative management for proximal humerus fractures

Cited by 12 publications

References 47 publications

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Rehabilitation following proximal humeral fracture in the UK National Health Service: A survey of publicly facing information

Locking Plate Fixation versus Hemiarthroplasty for Complex Proximal Humeral Fractures: an Updated Systematic Review and Meta-analysis

Contact Info

Product

Resources

About