Practice guidelines for proximal humeral fractures

Misra, Sanjay; Vaishya, Raju; Trikha, Vivek; Maheshwari, J

doi:10.1016/j.jcot.2019.04.005

Cited by 13 publications

(11 citation statements)

References 7 publications

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“…Proximal humerus fractures are a common affliction in the elderly population and can be treated by various means. They can be treated either nonoperatively or conservatively if they fit these criteria: the fracture is a NEER two or three nondisplaced both in older and young patients; nondisplaced NEER two, three, or four in the elderly population; a slightly displaced fracture where the risks of anesthesia are too high [ 4 ]; minimal involvement of the articular surface [ 5 ]; and the patient is unfit for surgery.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation With Proximal Humerus Locking Plate, Screws, and Fibular Strut Graft: An Alternative to Shoulder Arthroplasty and Solution to Medial Instability and Varus Collapse in Comminuted Proximal Humerus Fractures

Pop,

Morcovescu,

Mihai

et al. 2024

Cureus

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Fractures of the proximal humerus are a frequent ailment in the senior population. One concern with such a case that presented in our emergency room was the risk of varus collapse following open reduction and internal fixation (ORIF) in a patient with marked calcar comminution. The surgical method used in this case of a NEER four-part fracture with medial column instability proved effective in terms of good surgery outcome, patient satisfaction, good range of motion, and low or no pain at post-surgical follow-ups. ORIF with a locking plate and fibular strut graft proved to be a viable alternative to solo plating or shoulder arthroplasty. We conducted upper extremity patient-reported functional outcome scales (ASES, CONSTANT, and Neer’s “limited goals”) with this particular patient. At the last visit, two years after the first surgical intervention, the patient had a normal range of motion, was pain-free, and was generally satisfied with the results of the surgery. We concluded that ORIF of the proximal humerus with locking plate and fibular strut graft was, in our case, a good solution for preventing varus malalignment in a patient with severe comminution of medial calcar.

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Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation With Proximal Humerus Locking Plate, Screws, and Fibular Strut Graft: An Alternative to Shoulder Arthroplasty and Solution to Medial Instability and Varus Collapse in Comminuted Proximal Humerus Fractures

Pop,

Morcovescu,

Mihai

et al. 2024

Cureus

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“…Segmental humeral fractures are rare and limited literature is available concerning their classification and treatment. The co-existence of these three different types of fractures extends surgical approaches, increases tissue damage and surgical time, thereby increasing non-union and infection rates [8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Elastic Intramedullary Nails in the Treatment of Multi-Segmental Humeral Fracture in a Polytrauma Patient

Sidiropoulos¹,

Athanaselis²,

Saridis³

et al. 2021

Cureus

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A polytrauma patient with a life-threatening condition is a quite demanding situation due to special considerations regarding the time, the way, and the sequence of the necessary procedures. Elastic intramedullary nails (EIN) could be used under these conditions for adult patients with humeral fractures requiring fixation. Here we present a case of a multi-segmental closed humerus fracture in a polytrauma patient treated by EIN. The general condition of the patient and the need for multiple surgical procedures required the selection of a minimally invasive and time-saving fixation technique. The patient's follow-up was uneventful with complete healing of the humeral fracture; the functional scores results are excellent at five years post operatively. A review of the literature revealed limited published cases of humeral fractures (128 patients) treated by EIN, despite the fact that the results are quite encouraging. Based on our results and the current literature, we believe that EIN could become an effective treatment choice for multi-level humerus fractures, especially in damage control surgery.

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“…78 It is thought that 15-30% of elderly PHF patients are good candidates for early surgery. [90][91][92][93] Traditionally, elderly patient with fractures which are not displaced are not candidates for early surgery. Among elderly PHF patients with displaced fractures, meta-analyses indicate that the benefits and detriments of early surgery relative to conservative management are likely heterogeneous 94 but a consensus has not been reached.…”

Section: Populationmentioning

confidence: 99%

Personalizing Evidence for Shoulder Fracture Patients Using an Extended Instrumental Variable Causal Forest Algorithm

Brooks

Chapman

Floyd

et al. 2021

Preprint

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Objective: To assess the ability of an extended Instrumental Variable Causal Forest Algorithm (IV-CFA) to provide personalized evidence of early surgery effects on benefits and detriments for elderly shoulder fracture patients. Data Sources/Study Setting: Population of 72,751 fee-for-service Medicare beneficiaries with proximal humerus fractures (PHFs) in 2011 who survived a 60-day treatment window after an index PHF and were continuously Medicare fee-for-service eligible over the period 12 months prior to index to the minimum of 12 months after index or death. Study Design: IV-CFA estimated early surgery effects on both beneficial and detrimental outcomes for each patient in the study population. Classification and regression trees (CART) were applied to these estimates to create patient reference classes. Two-stage least squares (2SLS) estimators were applied to patients in each reference class to scrutinize the estimates relative to the known 2SLS properties. Principal Findings: This approach uncovered distinct reference classes of elderly PHF patients with respect to early surgery effects on benefit and detriment. Older, frailer patients with more comorbidities, and lower utilizers of healthcare were less likely to gain benefit and more likely to have detriment from early surgery. Reference classes were characterized by the appropriateness of early surgery rates with respect to benefit and detriment. Conclusions: Extended IV-CFA provides an illuminating method to uncover reference classes of patients based on treatment effects using observational data with a strong instrumental variable. This study isolated reference classes of new PHF patients in which changes in early surgery rates would improve patient outcomes. The inability to measure fracture complexity in Medicare claims means providers will need to discuss the appropriateness of these estimates to patients within a reference class in context of this missing information.

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Practice guidelines for proximal humeral fractures

Cited by 13 publications

References 7 publications

Open Reduction and Internal Fixation With Proximal Humerus Locking Plate, Screws, and Fibular Strut Graft: An Alternative to Shoulder Arthroplasty and Solution to Medial Instability and Varus Collapse in Comminuted Proximal Humerus Fractures

Open Reduction and Internal Fixation With Proximal Humerus Locking Plate, Screws, and Fibular Strut Graft: An Alternative to Shoulder Arthroplasty and Solution to Medial Instability and Varus Collapse in Comminuted Proximal Humerus Fractures

Elastic Intramedullary Nails in the Treatment of Multi-Segmental Humeral Fracture in a Polytrauma Patient

Personalizing Evidence for Shoulder Fracture Patients Using an Extended Instrumental Variable Causal Forest Algorithm

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