The impacted varus (A2.2) proximal humeral fracture in elderly patients: Is minimal fixation justified? A case control study

Blonna, Davide; Rossi, Roberto; Fantino, G.; Maiello, A.; Assom, Marco; Castoldi, Filippo

doi:10.1016/j.jse.2009.02.004

Cited by 36 publications

(27 citation statements)

References 18 publications

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“…proposed that varus angulation more 25° results with poor functional outcomes; therefore they suggested surgical intervention for these fractures. [11] Furthermore, Südkamp et al . claimed that varus angulation more 30° decreases CS significantly.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is not clear that poor functional outcomes are related to the final geometry of the humeral head after fracture union. [9101112] We hypothesized that final geometry of the humeral head after the union is related with the functional outcome rather than the initial fracture comminution. This study aimed to investigate the relationship between the severity of the humeral head fragmentation and the final geometry of the humeral head after union from the functional and clinical results of elderly patients treated conservatively for displaced PHFs.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study

Canbora

Köse

Polat

et al. 2013

Int J Shoulder Surg

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Purpose:The purpose of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of conservatively treated two-, three- and four-part proximal humeral fractures in patients aged over 65 years.Materials and Methods:The study comprised 29 prospectively followed cases aged over 65 years who presented with displaced proximal humerus fracture between 2009 and 2011. The fractures were classified according to the Neer classification and all met the displacement criteria described by Neer. Standard physical therapy program was applied. Patients were evaluated clinically using Constant shoulder score, quick form of disabilities of arm, shoulder and hand score and visual analog scale. At the final follow-up, humeral head position in the coronal plane was assessed with neck-shaft angle. Any complication was recorded during the treatment period. Correlation between the functional outcomes and final radiologic results were statistically analyzed.Results:Data were analyzed from 29 cases (21 female, 8 male) with a mean age was 78 ± 8.6 years (range 65-93 years). The mean follow-up period was 18.2 ± 4.07 months (range 12-26 months). Functional results were significantly related with initial fragmentation. However, there was no correlation between the functional outcomes and the final geometry of the humeral head. Despite the union occurred with deformity, the functional outcome were satisfactory.Conclusion:The results of this study show that initial fragmentation has a negative effect on the functional results. However, the changed position of the humeral head on coronal plane does not affect the final functional results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study

Canbora

Köse

Polat

et al. 2013

Int J Shoulder Surg

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“…Conservative management has been shown to be safe and provide reasonable functional outcomes in most cases (Court-Brown et al, 2001b. Varus angulation of >45° and translation of 66% are current accepted indications for operative management (Nho et al, 2007), although only modest evidence supports these guidelines (Blonna et al, 2009;Sudkamp et al, 2011). Others argue that the amount of translation and varus angulation should dictate when surgical management is needed (Sudkamp et al, 2011;Canbora et al, 2013).…”

Section: Surgical Neck Fracturesmentioning

confidence: 99%

Proximal humerus fractures

Greiwe

2015

Shoulder and Elbow Trauma and Its Complications

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“…[1][2][3][4][5] Non-operative treatment results in poor functional outcome. 6,7 The options for operative treatment include open reduction and internal fixation, intramedullary fixation, hemiarthroplasty and closed or minimal open reduction with percutaneous fixation.…”

mentioning

confidence: 99%

Modification of the Resch procedure

Roberts

Komarasamy

Pandey

2012

The Journal of Bone and Joint Surgery. British volume

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Controversy surrounds the management of displaced three- and four-part fractures of the proximal humerus. The percutaneous Resch technique of stabilisation involves minimal soft-tissue dissection and a reduced risk of stiffness and avascular necrosis. However, it requires a second operation to remove Kirschner wires and the humeral block. We describe a modification of this technique that dispenses with the need for this second operation and relies on a sequential pattern of screw placement. We report the outcome of 32 three- or four-part fractures of the proximal humerus treated in this way at a mean follow-up of 3.8 years (2 to 8)). There were 14 men and 18 women with a mean age of 56 years (28 to 83). At final follow-up the mean Oxford shoulder scores were 38 (31 to 44) and 39 (31 to 42), and the mean Constant scores were 79 (65 to 92) and 72 (70 to 80) for three- and four-part fractures, respectively. We further analysed the results in patients aged < 60 years with high-energy fractures and those aged ≥ 60 years with osteoporotic fractures. There were no cases of nonunion or avascular necrosis. The results were good and comparable to those previously reported for the Resch technique and other means of fixation for proximal humeral fractures. We would recommend this modification of the technique for the treatment of displaced three-part and four-part fractures in patients both younger and older than 60 years of age.

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The impacted varus (A2.2) proximal humeral fracture in elderly patients: Is minimal fixation justified? A case control study

Cited by 36 publications

References 18 publications

Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study

Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study

Proximal humerus fractures

Modification of the Resch procedure

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