Classification of proximal humeral fractures based on a pathomorphologic analysis.

BACKGROUND: The purpose of this study was to analyze the pathomorphology of proximal humeral fractures to determine relevant and reliable parameters for fracture classification. METHODS: A total of 100 consecutive acute proximal humeral fractures in adult patients were analyzed by 2 non-independent observers from a single shoulder department using a standardized protocol based on biplane radiographs and 3-dimensional computed tomography scans. A fracture classification system based on the most reliable key features of the pathomorphologic analysis was created, and its reliability was tested by 6 independent shoulder experts analyzing another 100 consecutive proximal humeral fractures. RESULTS: The head position in relation to the shaft (varus, valgus, sagittal deformity) and the presence of tuberosity fractures showed a higher interobserver reliability (κ > 0.8) than measurements for medial hinge, shaft, and tuberosity displacement, metaphyseal extension, fracture impaction, as well as head-split component identification (κ < 0.7). These findings were used to classify nondisplaced proximal humeral fractures as type 1, fractures with normal coronal head position but sagittal deformity as type 2, valgus fractures as type 3, varus fractures as type 4, and fracture dislocations as type 5. The fracture type was further combined with the fractured main fragments (G for greater tuberosity, L for lesser). Interobserver and intraobserver reliability analysis for the fracture classification revealed a κ value (95% confidence interval) of 0.700 (0.631-0.767) and 0.917 (0.879-0.943), respectively. CONCLUSION: The new classification system with emphasis on the qualitative aspects of proximal humeral fractures showed high reliability when based on a standardized imaging protocol including computed tomography scans.

Release of Extensive Post Traumatic Radio-Ulnar Synostosis with Vascularized Free Flap Interposition.

Radioulnar synostosis is a rare complication after a forearm or elbow injury. The severity of initial trauma, associated head injury along with timing and the type of surgical treatment have been implicated in the formation of extra bone leading to synostosis. Surgical intervention is the standard treatment and is recommended after the maturation of synostotic bone. Surgery involves resection of the extra bone with or without tissue interposition. Materials used for interposition may include synthetic materials, allografts, and vascularized and non-vascularized autologous tissue superiority of one material over the other has not been demonstrated. Reported is a case of extensive soft-tissue defect and severe type II synostosis, with a relevant review of the literature. Level of Evidence Level IV. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00395-5.

Novel method to treat sterno-clavicular joint instability and medial clavicle fracture symptomatic nonunion.

BACKGROUND: Stabilization of the medial clavicle is traditionally associated with relatively high complication and failure rate. This is a retrospective, case series study to assess outcome of a novel two-stage surgical treatment of sterno-clavicular joint instability or symptomatic medial clavicle fracture non-union. METHODS: Between 1997 and 2007, 9 consecutive patients with an average age of 35 years were treated by a staged surgical treatment, six with sterno-clavicular joint instability, and three with symptomatic medial clavicle nonunion. The first stage involved fixation of the medial clavicle and mid-clavicle osteotomy to offload the fixation and a second stage, at an average of four months, to remove the medial clavicle fixation and fix the mid-clavicle osteotomy with a plate. Average follow-up was 41 months (range, 7-127). RESULTS: All sterno-clavicular joints were satisfactorily stabilized and all fracture non-unions united. There was no complication from the medial clavicular hardware. The average Constant score was 75 (average Constant score for the unaffected shoulder was 86) and the average quick DASH score was 14.96. All patients were very satisfied with the treatment and outcome. CONCLUSION: We cautiously recommend this method to experienced surgeons. A larger number of patients is required to endorse wider generalization of the results.