Rate of avascular necrosis after fracture dislocations of the proximal humerus

Schnetzke, Marc; Bockmeyer, Julia; Loew, Markus; Studier-Fischer, Stefan; Grützner, Paul-Alfred; Guehring, Thorsten

doi:10.1007/s11678-018-0452-6

Cited by 44 publications

(25 citation statements)

References 21 publications

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“…Longer term functional outcomes of the patients are needed to better evaluate the treatment concept. [37].…”

Section: Resultsmentioning

confidence: 99%

“…plate or screw fixation, allograft, autograft) and those that were treated with arthroplasty. To define the extent of the impression type fractures (RHSL), the gamma angle was measured on axial computed tomography (CT) scans as described by Moroder et al [36] The fractures with a subcapital component were classified according to Resch [37]. Head-split fractures, as well as those with an RHSL, were identified.…”

Section: Methodsmentioning

confidence: 99%

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Posterior fracture dislocation of the proximal humerus

et al. 2019

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Background. Posterior dislocation fractures of the humerus occur as impression fractures of the humeral head (reverse Hill-Sachs fracture) and posteriorly dislocated proximal humeral (PH) fractures with a subcapital component. This study evaluated fracture patterns, current treatment, and revision rates. Methods. Data of patients who underwent surgical treatment for PH dislocation fractures in two level-I trauma centers between 2010 and 2018 were retrospectively reviewed. Results. We identified 41 shoulders in 37 patients (n = 12 female, n = 25 male; average age 52 [25-91] years) with open surgical treatment of PH posterior dislocation fractures. In 14 patients, the cause was convulsive seizure or electrical accident, in 23 patients, a fall or high-energy trauma.

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“…Longer term functional outcomes of the patients are needed to better evaluate the treatment concept. [37].…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Posterior fracture dislocation of the proximal humerus

et al. 2019

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“…Schnetzke et al. 28 observed a positive correlation between AVN and subsequent revision surgery after ORIF, noting a strong association between the degree of AVN progression and the amount of time elapsed from the initial injury to ORIF. Katthagen et al.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic-Assisted Removal of Proximal Humerus Locking Plates With Capsular Release Significantly Improves Range of Motion and Function

Chan

Kahlenberg

Gadinsky

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To investigate the clinical outcomes following the arthroscopic removal of proximal humerus locking plates for symptomatic hardware after open reduction and internal fixation (ORIF) of proximal humerus fractures. Methods Patients who underwent arthroscopic removal of hardware (ROH) with capsular release due to pain and/or immobility after receiving locking plates to treat proximal humerus fractures from 2009 to 2016 were identified. Operative and clinic records were reviewed to obtain demographic information, concomitant procedures during ROH, and pre- and postoperative active shoulder range of motion. Postoperative patient-reported outcomes included the QuickDASH, PROMIS Pain Intensity, Constant, and University of California, Los Angeles shoulder rating scale. Results In total, 88 patients were included. Patients were evaluated at a minimum of 6 weeks postoperatively after ROH. Patients with pre- and postoperative active range of motion values demonstrated significant improvements in mean forward elevation (n = 69; 78.4%; 115.1° to 152.1°, P < .001), abduction (n = 29; 33.0%; 70.9° to 138.7°, P < .001), external rotation (n = 49; 55.7%; 43.7° to 58.6°, P = .012), and internal rotation (n = 45; 51.1%; 25.7° to 61.9°, P < .001). Patients also reported positive patient-reported scores, including the QuickDASH (4.1 ± 7.8), PROMIS Pain Intensity (3.5 ± 0.9), Constant (84.6 ± 10.7), and University of California, Los Angeles shoulder rating scale (33 ± 2.9), which were measured 70.6 ± 26.6 months postoperatively. There were no surgical complications, no arthroscopic cases were converted to open, but 2 reported refractures (2.3%). Conclusions Arthroscopic-assisted removal of proximal humerus locking plates significantly improves motion and function while allowing for management of concomitant shoulder pathology and potentially avoiding open surgery complications. Given that patients undergoing this procedure frequently have multiple comorbidities, arthroscopic-assisted removal with smaller incisions may minimize risks while restoring shoulder mobility. Therefore, arthroscopic ROH for patients experiencing symptomatic hardware after ORIF is recommended. Level of Evidence Level IV, therapeutic case series.

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“…The incidence rate of osteonecrosis after surgical treatment of proximal humeral fractures is reported to be 3-35% [26]. Especially in the proximal humeral head, after 48 hours, the frequency of this is high.…”

Section: Discussionmentioning

confidence: 99%

Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

Shin

Kang

Son

et al. 2019

Preprint

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Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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Rate of avascular necrosis after fracture dislocations of the proximal humerus

Cited by 44 publications

References 21 publications

Posterior fracture dislocation of the proximal humerus

Posterior fracture dislocation of the proximal humerus

Arthroscopic-Assisted Removal of Proximal Humerus Locking Plates With Capsular Release Significantly Improves Range of Motion and Function

Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

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