Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography

Jia, Xiaoyang; Chen, Yanxi; Qiang, Min; Kun, Zhang; Li, Haobo; Jiang, Yuchen; Zhang, Yijie

doi:10.1111/os.12332

Cited by 17 publications

(12 citation statements)

References 31 publications

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“…However, radiographic parameters were only measured on radiographs. CT imaging would have given three-dimensional information of radiographic parameters and is more reliable to assess prognostic factors of reduction in proximal humerus fractures [ 36 ]. Interrater reliability was not measured, but the observer was blinded regarding shoulder function.…”

Section: Discussionmentioning

confidence: 99%

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures

Ahrend

Kühle

Riedmann

et al. 2021

International Orthopaedics (SICOT)

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Purpose Radiographic parameters which correlate with poor clinical outcome after proximal humeral fractures could be helpful indicators to answer the question which patients should be followed up closer. Moreover, during surgery, radiographic parameters correlating with unfavourable outcome should be avoided. The primary aim of the study was to compare radiographic measurements between the injured and the contralateral, uninjured shoulder. The secondary aim was to correlate these radiographic parameters with post-operative shoulder function. Methods Fifty-eight patients (age: 55.6 ± 14.4 years, age at surgery) following angular stable plate fixation of a proximal humeral fracture (2-part fractures according to Neer: 24, 3-part: 25, 4-part: 9) were included in this retrospective cohort study. All patients were followed up at least six years (7.9 ± 1.4 after surgical intervention). During follow-up examination, the Constant score (CS) was assessed, and radiographs of both shoulders were taken. Radiographs were analyzed regarding lateral humeral offset, distance between tuberculum and head apex, head diameter, head height, perpendicular height, perpendicular center, vertical height, and angles between head and humeral shaft (CCD and HSA). These parameters were compared between the injured and uninjured shoulder. The cohort was divided in two groups: patients with a CS category of excellent/good and satisfying/worse. Both groups were tested regarding differences of demographic and radiographic parameters. Results The distance between tuberculum and head apex (2.6 ± 3.4 mm vs. 4.3 ± 2.1 mm; p = 0.0017), the CCD (123.1 ± 12.9° vs. 130.1 ± 7.3°; p = 0.0005), and the HSA (33.1 ± 12.8° vs. 40.1 ± 7.3°; p = 0.0066) were significantly smaller on the treated shoulder compared to the uninjured side. Patients reached a Constant score of 80.2 ± 17.4 (95% CI 75.6–84.8) points. Regarding outcome categories of the Constant score, 46 patients had a good to excellent outcome, and 12 patients had a satisfying or bad outcome. The comparison of these groups revealed that patients with inferior outcome in the long-term follow-up were older, female, had a more complex fracture type (AO classification), smaller lateral humeral offset, smaller head diameter and height, lower perpendicular height, and lower CCD and HSA angles. Conclusion If the abovementioned parameters cannot be restored sufficiently during surgery, (reversed) shoulder arthroplasty might be a better solution to reach good post-operative outcome. Moreover, patients presenting these radiographic characteristics in the follow-up, older patients, and patients with a more complex fracture type should be followed up closer to possibly prevent poor shoulder function. Trial registration: 83 250/2011BO2

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Section: Discussionmentioning

confidence: 99%

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures

Ahrend

Kühle

Riedmann

et al. 2021

International Orthopaedics (SICOT)

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“…At each follow-up visit, radiographs were obtained in standard AP and Y views. Radiological evaluation was based on bone union, implant placement and the humeral neck–shaft angle (NSA) [ 23 ] ( Figure 1 ). Limb function was assessed and assigned to an appropriate group according to the QuickDash (QuickDASH uses 11 items to measure physical function and symptoms in people with any or multiple musculoskeletal disorders of the upper limb) and Constant–Murley scores (a summative scale that provides a global score based on weighted measures of physical impairments in range-of-motion (ROM) and strength along with patient-reported pain and activity limitation (Constant and Murley, 1987)) [ 24 , 25 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

Stabilization of Comminuted Fractures of the Proximal Humerus with Intramedullary Nails and Angularly Stable Locking Plates—Functional Results before and during the SARS-COVID-19 Pandemics

Ratajczak

Szczęsny

Tomaszewski³

2023

Medicina

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Background and Objectives: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life—being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. Materials and Methods: Investigations were performed on 112 adult patients with Neer’s three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evidence of bone union, humeral neck–shaft angle (NSA) and implant placement. Limb function was assessed with the QuickDash and Constant–Murley scores. Data obtained from patients treated in the COVID-19 pandemic were compared with those obtained before the pandemic. Results: The healing of all fractures was satisfactory, but complications developed in six cases. Three patients required secondary interventions due to inadequate repositioning: one after IMN and two after ASP. Additionally, one ASP was complicated by the secondary destabilization of a primarily properly stabilized major tubercle, and in two cases by conflict of the protruding implant with the acromion. ASP was noted to provide better functional results during the COVID-19 pandemic according to the Constant–Murley score (p = 0.0048; Student’s t-test). No significant differences were observed in the pre-COVID-19 pandemic. Conclusions: Our results suggest that ASP is more beneficial for the stabilization of comminuted fractures of the proximal humerus during the COVID-19 pandemic.

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“…In the virtual planning group, computed tomographic scans, which were obtained using a 16-detector spiral scanner (GE LightSpeed 16; GE Medical Systems), were entered into a computer-assisted orthopedic clinical research platform (SuperImage system, orthopedic edition 1.1; Cybermed). 11 , 15 A 3-D image of the fracture in the proximal femur was reconstructed using a surface-shaded display algorithm, and fracture fragments were marked with distinct colors ( Figure 1 ). The reduction of fracture procedure was simulated ( Figure 1 ), and the suitable size of intramedullary devices in the PFNA-II system (including the length and diameter of the main nail, spiral blade, and distal locking screw) was chosen ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…In the conventional planning group, preoperative planning was based on plain radiographic images and computed tomographic scans, including 2-dimensional and/or 3-dimensional (3-D) volume-rendering imaging, of the injured limb along with the surgeon’s experience, which is the standard method used by most orthopedic surgeons. In the virtual planning group, computed tomographic scans, which were obtained using a 16-detector spiral scanner (GE LightSpeed 16; GE Medical Systems), were entered into a computer-assisted orthopedic clinical research platform (SuperImage system, orthopedic edition 1.1; Cybermed) . A 3-D image of the fracture in the proximal femur was reconstructed using a surface-shaded display algorithm, and fracture fragments were marked with distinct colors (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Association of Computer-Assisted Virtual Preoperative Planning With Postoperative Mortality and Complications in Older Patients With Intertrochanteric Hip Fracture

et al. 2020

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Key Points Question Is preoperative planning using computer-assisted virtual surgical technology associated with decreases in the risks of all-cause 90-day mortality and postoperative complications among older patients with intertrochanteric hip fractures? Findings In this cohort study of 1221 older patients with intertrochanteric hip fractures, the use of computer-assisted virtual preoperative planning among a propensity score–matched cohort was associated with a lower incidence of 90-day mortality and postoperative complications compared with the use of conventional preoperative planning. Meaning This study’s findings suggest that preoperative planning using computer-assisted virtual surgical technology for older patients with intertrochanteric hip fractures is associated with decreases in the risks of all-cause 90-day mortality and postoperative complications.

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Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography

Cited by 17 publications

References 31 publications

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures

Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures

Stabilization of Comminuted Fractures of the Proximal Humerus with Intramedullary Nails and Angularly Stable Locking Plates—Functional Results before and during the SARS-COVID-19 Pandemics

Association of Computer-Assisted Virtual Preoperative Planning With Postoperative Mortality and Complications in Older Patients With Intertrochanteric Hip Fracture

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