Lateral minimally invasive plate osteosynthesis (MIPO) with long PHILOS for proximal metaphyseal-diaphyseal humeral fracture: surgical techniques and a clinical series.

The minimally invasive plate osteosynthesis (MIPO) for proximal metaphyseal-diaphyseal humeral fracture is an effective alternative treatment with satisfactory outcomes. In this study, we described the surgical techniques and clinical results using MIPO via a lateral approach and long PHILOS plate fixation in 23 patients. All fractures were successfully united within a mean union time of 13.5 weeks (range 9-18). There was no iatrogenic radial nerve palsy. The deltoid power was grade 5 in all patients, except for 2 patients who had associated brachial plexus injury and gunshot injury at the deltoid muscle. The mean Constant-Murley score was 85.6 (range 16-98) and DASH score was 12.1 (range 1.7-85). Based on these findings, the lateral MIPO with long PHILOS plate fixation could be an alternative for the proximal metaphyseal-diaphyseal fractures of the humeral shaft.

THE OUTCOME OF PULSELESS PINK HAND FOLLOWING CLOSED SUPRACONDYLAR FRACTURE HUMERUS IN PEDIATRICS.

Management of children with supracondylar humeral fractures with pulseless pink hands is still controversial, whether to choose operative or conservative treatment. Proponents of conventional treatment mentioned that most patients can restore the motor and sensory function of the hand shortly after the injury without the need to restore distal pulse by surgery. Opponents of this treatment strategy claim that many patients will develop limb shortening a few years after the injury leading to functional and psychological problems. In this study, we made a comparison of the outcomes of each treatment to help in making policy for the treatment of such types of injuries in our center. This study answers the question "Which method is preferred for treating supracondylar humeral fracture with suspected vascular injury represented by pulseless pink hand, and what are the short and long-term outcomes of each treatment method. The main objective of the study is to settle a policy for the treatment of such types of injuries in our center. This study is a retrospective for the 10-year period from 2010 to 2020, it included 74 patients with blunt trauma to one upper extremity. All patients were children aged one year to fourteen years. Patients with penetrating trauma, combined penetrating and blunt trauma, victims of burns and explosions, and patients with other co-morbidities were excluded. We have two treatment strategies: Conservative (watchful waiting) and Operative exploration. We compared the outcomes of these two strategies regarding the short-term outcome (6 months follow-up) and the long-term outcome (5 years follow-up). We looked for acute and chronic limb ischemia and chronic pain syndrome as the short-term follow-up, while we took limb shortening and chronic limb ischemia and limb function as variables of the long-term follow-up. We don't have the ability to control patients for the psychological examination by a psychiatrist, therefore; we excluded this variable from our study.

La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero / The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO

Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyeron retrospectivamente en 2 instituciones pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC 95%: 0-9%) (p 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)

Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero

Purpose: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. Methods: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. Results: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6–38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0–9%) (P 0.009). Conclusion: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.(AU)

Antecedentes y objetivo: El abordaje posterior percutáneo del húmero se ha descrito utilizando una placa LCP de 4,5mm. A pesar de que las placas rectas han demostrado buenos resultados, estas no han sido diseñadas para adaptarse a la metáfisis del húmero distal. El objetivo de este estudio es probar la hipótesis nula de que no existen diferencias en la extracción de la osteosíntesis después de una MIPO posterior utilizando una placa recta comparado a una placa anatómica. Materiales y métodos: Se incluyó retrospectivamente en 2 instituciones a pacientes mayores de 18 años que habían sufrido una fractura diafisaria de húmero distal tratados mediante técnica percutánea posterior con una placa bloqueada y con un seguimiento mínimo de 12 meses. Los pacientes se dividieron en: grupo 1 (placa recta LCP de 4,5mm) y grupo 2 (placa de forma anatómica de 3,5mm). Durante el postoperatorio se reportó la evaluación clínica y radiológica, así como la necesidad de retirar el implante debido al dolor. Resultados: Sesenta y siete pacientes cumplieron los criterios de inclusión. Veintisiete pacientes en el grupo 1 y 40 en el grupo 2. No se perdió ningún paciente durante el seguimiento. Dentro del grupo 1, el 18% (IC del 95%: 6-38%) de los pacientes requirieron extracción del implante, mientras que en el grupo 2 esta incidencia fue del 0% (IC del 95%: 0-9%) (p = 0,009). No hubo diferencias estadísticas entre las medidas de resultado informadas por los pacientes; todas las fracturas consolidaron. Conclusión: Los resultados de nuestro estudio demostrarían que el uso de placas LCP rectas de 4,5mm comparado a las placas anatómicas LCP de 3,5mm en MIPO posterior de húmero genera mayores molestias y, por lo tanto, conllevan un incremento en el riesgo de extracción del implante de un 18%.(AU)

Predicting the deltoid tuberosity index in proximal humerus fractures using fracture characteristics and patient age: development of the LBQ-PHF score.

BACKGROUND: The aim of this study was to investigate (1) whether fracture pattern and age are associated with local bone quality (LBQ), and (2) whether a scoring system based on these variables is able to predict LBQ in proximal humerus fractures (PHF). MATERIALS AND METHODS: A retrospective study was performed of all acute PHF at a Level 2 trauma center with plain radiographs and CT between June 2009 and March 2022. Local bone quality was measured by using the deltoid tuberosity index (DTI). In addition to age and gender, fracture morphology was categorized using the following classification systems: Neer, Resch, AO Foundation/Orthopaedic Trauma Association (AO/OTA), and Hertel/LEGO. Additionally, coronal head alignment was calculated by measuring the head-shaft angle. RESULTS: Only the Resch classification system revealed a significant relationship between fracture type and bone quality, as there was a significant association between coronal head alignment and DTI (p = 0.001). Valgus head alignment was observed significantly more frequent in patients with low bone quality (p = 0.002). Multinomial logistic regression analysis revealed a significant relative risk ratio for age (RRR = 0.97, [95% CI, 0.94-1], p = 0.039) and a non-significant trend for DTI (RRR = 1.26, [95% CI, 0.96-1.64], p = 0.092) for occurrence of anatomic relative to valgus head alignment. Using a DTI cut-off value of 1.3 instead of 1.4, age and also varus head alignment were identified as significant predictors of LBQ (OR = 1.12, [95% CI, 1.1-1.15], p < 0.001; OR = 0.54, [95% CI, 0.3-0.96], p = 0.037). A scoring system called the LBQ-PHF score (local bone quality in proximal humerus fractures), developed based on these two variables was able to predict LBQ with a sensitivity of 79.2% and a specificity of 86.7%. CONCLUSION: Age and coronal humeral head alignment are independent predictors of LBQ in PHF. A simple scoring system developed based on these variables is able to assess BQ with solid predictive characteristics.

A case report of membrane induction combined with RIA technique for the repair of distal humerus segmentary bone defect.

Bone nonunion and bone defect are common postoperative complications in clinic. Membrane induction or Ilizarov technique is often used to repair bone defect. Autologous bone is often used for bone defect repair and reconstruction, and the anterior superior iliac spine, posterior superior iliac spine or fibula bone is used as the donor area for bone extraction, but there are problems of donor area complications. In recent years, the development of bone marrow aspiration (RIA) has provided a new alternative way for the source of autogenous bone. We report a 48-year-old female patient with a comminuted supracondylar intercondylar fracture of the left humerus due to a car accident. After 8 months of emergency debridement and suture with Kirschner wire internal fixation, the fracture was found to be unhealed with extensive bone defects. We used membrane induction combined with RIA technology to repair and reconstruct the patients, and found good osteogenesis through late follow-up. In theory, membrane induction technique can realize the reconstruction of large segmental bone defects, but the scope of repair is often limited by the lack of autologous bone source. The emergence and development of RIA technology provides us with a new autologous bone donor area for bone repair and reconstruction surgery. It can provide a large amount of high-quality cancellar bone mud through minimally invasive means. Meanwhile, it can reduce patients' pain, infection, fracture, aesthetics and other problems caused by iliac bone extraction, and shorten patients' bed time. Maximize the preservation of the patient's autologous bone source. For the first time in the world, we reported the combination of membrane induction technology and RIA technology in the treatment of segmental bone defects, providing a new idea for the treatment of bone defects.

Surgical repair of Salter-Harris type II fracture of the distal humerus: short and long-term outcomes in a case series of three dogs and one cat.

CASE HISTORIES: Three dogs and one cat sustained forelimb trauma and were presented to a university veterinary clinic (Liège, Belgium) and a private veterinary hospital (Beacouzé, France). All four animals were referred for surgery. CLINICAL FINDINGS: Two dogs and the cat were ambulatory on admission but unable to bear weight on the affected limb. One dog was non-ambulatory and lacked voluntary movement and sensation in one forelimb. Salter-Harris type II fractures of the distal humerus were diagnosed by radiography in all cases; avulsion of the brachial plexus and pelvic fractures were also present in the non-ambulatory dog. TREATMENT AND OUTCOME: All Salter-Harris type II fractures were stabilised by open reduction and internal fixation with cross pins. One minor complication (seroma) and three major complications (implant migration) developed after surgery. The pins were completely removed in one case and partially removed in two cases to resolve these complications. At the final follow-up examination (12-31 months after surgery), owners reported no lameness in three of the four cases and grade 2/5 left forelimb lameness in one case. CLINICAL RELEVANCE: This type of fracture is rarely described in the literature; however, it should be included in the differential diagnoses of traumatic humeral fractures in growing dogs and cats. In this case series, we achieved fair-to-excellent short-term and long-term outcomes after osteosynthesis of Salter-Harris type II fractures by cross pinning.

Little League Shoulder and Subsequent Proximal Humeral Fracture in the Setting of Human Growth Hormone Use: A Case Report.

CASE: A 16-year-old right-hand dominant male baseball player presented with little league shoulder in the setting of recombinant growth hormone utilization for growth hormone deficiency. After a prolonged treatment course, including physical therapy and throwing programs, the patient returned to baseball but suffered an ipsilateral proximal humerus fracture around the growth plate. CONCLUSION: The occurrence of such an injury in the context of human growth hormone treatment merits consideration in youth athletes undergoing similar treatment regimens. Clinically, we recommend screening pediatric patients with sports-related epiphysiolysis for current or previous growth hormone use because of the possible prognostic implications of such treatment.

Humeral shaft fractures: a practical guide to assessment and management.

Fractures of the humeral shaft represent roughly 5% of all fractures. They occur in an approximate bimodal distribution, typically affecting young adults following trauma and older females after low energy falls in the presence of osteoporosis. Humeral shaft fractures are associated with pain, temporary disability and a reduced quality of life for the duration of treatment. Treatment goals are directed towards achieving and maintaining a fracture environment conducive to healing, pain relief and early restoration of function. While most humeral shaft fractures are conservatively managed, operative management is indicated in certain circumstances. This article provides an overview of these fractures, including their initial management approach and definitive treatment.

Does a hip fracture mean we should we operate on a concomitant proximal humerus fracture?

BACKGROUND: Concomitant upper extremity and hip fractures present a challenge in postoperative mobilization in the geriatric population. Operative fixation of proximal humerus fractures allows for upper extremity weight bearing. This retrospective study compared outcomes between operative and non-operative proximal humerus fracture patients with concomitant hip fractures. METHODS: A trauma database of 13,396 patients age > 55 years old was queried for concomitant hip and proximal humerus fracture patients between 2014-2021. Medical records were reviewed for demographics, hospital quality measures, Neer classification, morphine milligram equivalents (MME), and outcomes. All hip fractures were treated operatively. Patients were grouped based on operative vs. non-operative treatment of their proximal humerus fracture. Primary outcomes included comparing postoperative ambulatory status, pain, length of stay (LOS), intensive care unit (ICU) need, discharge disposition, and readmission rates. RESULTS: Forty-eight patients (0.4%) met inclusion criteria. Twelve patients (25%) underwent operative treatment for their proximal humerus fracture and 36 (75%) received non-operative treatment. Patients with operative fixations were younger (p < 0.01), had more complex Neer classifications (p = 0.031), more likely to be community ambulators (p < 0.01), and required more inpatient MMEs (p < 0.01). There were no differences in LOS (p = 0.415), need for ICU (p = 0.718), discharge location (p = 0.497), 30-day readmission (p = 0.228), or 90-day readmission (p = 0.135) between cohorts. At 6 months postoperatively, among community or household ambulators, a higher percentage of operative patients returned to their baseline ambulatory functional status, however, this was not significant (70% vs. 52%, p = 0.342). There were three deaths in the non-operative cohort and no deaths in the operative cohort. CONCLUSION: Patients with hip fractures and concomitant proximal humerus fractures treated operatively required more inpatient MMEs and trended toward maintaining baseline ambulatory function. There were no differences in inpatient LOS, ICU need, discharge location, or readmissions. Future larger, multicenter studies are needed to further delineate if operative repair of concomitant proximal humerus fractures provides a benefit in the geriatric population.

Epidemiology of proximal humerus fractures in Qatar.

OBJECTIVE: This study aimed to investigate the epidemiological characteristics and treatment options of proximal humerus fractures at a level one trauma center and to compare our data with the current literature. METHODS: A retrospective review was conducted on all patients diagnosed and treated for proximal humerus fractures at Hamad General Hospital, a level one trauma center, between January 2018 and December 2019. Age, gender, mechanism of injury, fracture classification, mode of treatment, implant type, length of hospital stay, associated injuries and complications were analyzed. RESULTS: A total of 190 patients with a mean age of 52.4 years were included; 56.8% were males. The incidence of proximal humerus fracture was 4.1/100,000 per year. Falling from a standing height was the most common cause of injury (50.5%). Additionally, Neer's two-part fracture was found to be the most common type (n = 132, 69%). Forty-one patients (21.3%) had other associated injuries. Most fractures were treated nonoperatively with an arm sling (n = 138, 72.6%). CONCLUSION: In summary, the incidence of proximal humerus fractures during the two-year study period was found to be 4.1 per 100,000 persons per year. Our results showed a lower incidence of proximal humerus fractures with a predominance of males and younger patients in Qatar's population compared to females and older patients in the developed countries. Our results may contribute to the development of effective strategies for preventing and treating proximal humerus fractures, and can provide important data for further high-level clinical research. LEVEL OF EVIDENCE: IV.

Proximal Humerus Fractures: Leave It Alone, Fix It, Replace It?

Proximal humerus fractures are common injuries that account for 10% of all fractures in the elderly. Several options are available for the management of proximal humerus fractures. Optimal treatment is based on the fracture pattern and the patient characteristics. Most of these fractures are minimally displaced and managed nonsurgically. Approximately 15% of proximal humerus fractures are comminuted, head-split, fracture-dislocation, or severely displaced, which make the best treatment option more challenging. Hemiarthroplasty is still a viable option in selected patients of these groups; however, advancements in locking plate designs and introduction of reverse total shoulder arthroplasty have led to better clinical outcome in meticulously selected patients. Nonetheless, the debate continues regarding the best management. It is important to discuss the best treatment options based on current literature.

Epidemiology of 936 humeral shaft fractures in a large Finnish trauma center.

BACKGROUND: Humeral shaft fractures are relatively common injuries and are classified according to location and fracture morphology. Epidemiological studies improve understanding of injury patterns and lay foundations for future research. There are only a few published larger epidemiological studies on humeral shaft fractures. METHODS: We retrospectively analyzed the medical records of adult patients having sustained a humeral shaft fracture treated in the Helsinki University Hospital between 2006 and 2016. We recorded patient and fracture characteristics, timing and mechanism of injury, associated injuries, and 1-year mortality. RESULTS: We identified 914 patients (489 females, median age = 61.4 years; 425 males, median age = 50.4 years) with 936 fractures. Over 60% of these fractures were sustained from simple falls. The patient age distribution was bimodal, with highest fracture rates in elderly females and young males. We divided the fractures into typical traumatic, periprosthetic, and pathological fractures. Of the 872 typical traumatic fractures, 3.0% were open. In addition, there were 24 (2.6%) periprosthetic and 40 (4.3%) pathological fractures. An associated injury was found in 24% of patients, with primary radial nerve palsy (PRNP) being the most common (10%). PRNPs were more common in distal shaft fractures and high energy injuries. The 1-year mortality was 9.2%. CONCLUSIONS: In this study, the most common injury mechanism was a simple fall. The most common associated injury was PRNP. The observed bimodal fracture distribution is consistent with previous literature.

Does mechanism of injury impact the outcome of operative fixation of geriatric proximal humerus fractures.

BACKGROUND: The purpose of this study is to determine the effects of energy mechanism on outcomes following repair of proximal humerus fractures (PHF) in the middle aged and geriatric population. METHODS: Two hundred sixty-nine patients who presented to our academic medical center between 2006 and 2020, and underwent operative treatment of a proximal humerus fracture were prospectively enrolled in an IRB-approved database. Patients above 55 were divided into high energy (motor vehicle accident, pedestrian struck, or fall > 2 stairs) or low energy mechanisms (fall from standing or < 2 stairs). Of 97 patients with complete documentation and follow-up, 72 were included in the low velocity (LV) group and 25 were included in the high velocity (HV) group. Demographic information, primary injury details, healing and time to union, range of motion (ROM), complications, and need for reoperation were assessed at initial presentation and subsequent follow-up appointments. RESULTS: Mean age, BMI, and gender were significantly different between the LV and HV cohorts (p = 0.01, 0.04, 0.01). OTA/AO fracture patterns were similar between the groups. (p = 0.14). Bony healing and complications occurred with similar frequency between groups (p = 1.00, 0.062). The most common complications in the LV and HV groups included avascular necrosis (9.7%, 16.0%), and screw penetration (4.2%, 12.0%), while the HV group also had rotator cuff issues including weakness and tendonitis (12.0%). There was no significant difference in need for reoperation between cohorts (p = 0.45). Time to healing, shoulder ROM, and DASH scores did not differ between each group. CONCLUSIONS: Energy and mechanism demonstrates similar outcomes in operatively treated proximal humerus fractures. These factors should not play a role in decisions for surgery in these patients and can help guide patient expectations.

Refractory humeral non-union: treatment with photodynamic intramedullary implant IlluminOss® and internal fixation.

Surgically treated humeral shaft fractures can develop into pseudoarthrosis (PSA). Even if PSA is treated according to the proposed literature, refractory non-union of the humerus can be determined. Due to the rarity of this condition, we report our experience in the management of refractory pseudarthrosis of the humerus at the IRCCS Galeazzi Orthopedic Institute (Milan, Italy). We used internal fixation with plate and screws associated with the implant of the IlluminOss® Photodynamic Bone Stabilization System to increase bone stability and improve anchoring of the implant medium. This combined treatment allowed the consolidation of the complex fracture despite the bone loss, ensuring excellent stability of the fracture stumps and constituting a flexible and stable system with the most favourable biomechanical conditions. An increase in refractory PSA cases is likely in the future, due to a higher incidence of surgically treated humeral shaft fractures than in the past. Further studies on the effectiveness of the combined use of plate and screw and the IlluminOss® system will be indispensable.

Treatment patterns of ABOS part II candidates: A decline of operative management among geriatric proximal humerus fractures over the decade (2010-2020).

BACKGROUND: The purpose of this study was to assess trends in ABOS part II candidate's operative management of geriatric (≥65 years) proximal humerus fractures over the 2010-2020 decade. METHODS: This retrospective database cohort study utilized the American Board of Orthopaedic Surgery (ABOS) database for candidates taking Part II of their boards. Surgical coding was reviewed and the ICD10 data was correlated to the CPT code for shoulder arthroplasty or open reduction internal fixation. We investigated the number of proximal humerus fracture operative cases per year, the percent arthroplasty used per year, the stratification of percent arthroplasty per orthopaedic fellowship subspecialty and geographic region. RESULTS: A total of 2,409 operative cases for proximal humerus fractures in patients 65 years of age and older were submitted by 1,420 ABOS candidates. There was a 37% reduction in operatively managed proximal humerus fractures among ABOS part II candidates between the first half of the decade (2010-2015, 263.2 +/- 13.4) and the second half of the decade (2016-2020, 166 +/- 31.2; p<.05). There also was a downward trend with a 53% reduction in percent treated with arthroplasty as compared to ORIF during those same windows (2010-2015, 34.4 +/-11.7) and (2016-2020, 16.2 +/- 6.4; p<.5). Partitioned by single fellowship training, Shoulder and Elbow (S&E) surgeons performed the highest percent arthroplasty at 25.2%, followed by Sports at 23.1% and the lowest percent arthroplasty was Trauma at 11.7%. The Southeast United States had the lowest percentage arthroplasty at 15.8% as compared to the Midwest (23.8%) and Northeast (25.8%). CONCLUSION: Despite the rapid growth of both the elderly population and related geriatric proximal humerus fractures, ABOS candidates are treating less with surgery. There has been approximately a 37% decrease in the total number of operatively treated proximal humerus fractures between the first and second half 2010-2020 decade. When operative treatment is performed, there is a trend towards ORIF over an arthroplasty. Trauma fellowship trained surgeons are less likely to perform an arthroplasty as compared to other subspecialties. The Southeast region is least likely to perform an arthroplasty as compared to the Midwest or Northeast.

Posterior Humeral Avulsion of the Glenohumeral Ligament: A Critical Analysis Review.

➢: Posterior humeral avulsions of the inferior glenohumeral ligament represent an increasingly recognized but likely underdiagnosed source of posterior shoulder instability and pain. ➢: Injuries are commonly reported in athletic individuals who have sustained injury by either traumatic or atraumatic mechanisms; the ligament is most susceptible to injury with the shoulder in flexion, adduction, and internal rotation. ➢: Posterior humeral avulsions of the glenohumeral ligament often occur in the setting of concurrent injuries to the posterior or inferior labrum. ➢: Diagnosis is often challenging due to nonspecific symptoms and physical examination findings; a magnetic resonance arthrogram generally is utilized to identify avulsion from the humeral attachment; however, a definitive diagnosis is often made at the time of arthroscopic evaluation. ➢: In patients with persistent discomfort and limitations following nonoperative management, operative fixation, primarily utilizing arthroscopic techniques, can be performed to restore motion and glenohumeral stability.

[An integrated approach for early recovery of function in patients after fractures of the humerus in its proximal section]. / Kompleksnyi podkhod dlya rannego vosstanovleniya funktsii konechnosti u patsientov posle perelomov plechevoi kosti v ee proksimal'nom otdele.

The frequency of fractures of the proximal humerus (PH) is 4-5% of fractures of all human bones and can reach 80% of all bone injuries of the humerus. An analysis of the long-term results of the methods used to treat fractures of the proximal humerus showed the absence of a generally accepted universal method that provides consistently good results for all variants of fractures of the PH. PURPOSE OF THE STUDY: Creation of a complex highly effective system for the treatment of PH fractures, which includes a minimally invasive method of surgical treatment using the method of cephalomedullary osteosynthesis with direct locking pins and a highly specialized program of rehabilitation measures using a biofeedback (BFB) device, which will reduce the duration of treatment and improve the results of functional recovery injured limb. MATERIAL AND METHODS: The results of treatment of 214 patients with fractures of the proximal humerus were analyzed. Of these, in 122 (57%) patients (the main group) osteosynthesis was used with a direct cephalomedullary fixator with the possibility of blocking the screws in the nail in different planes. The comparison group included 92 (43.0%) patients treated using other surgical techniques. Rehabilitation measures were started in the early postoperative period (from the 2nd day) in both groups and included a complex of physiotherapeutic treatment, physical exercises in different modes, in addition in the main group of the study, training was performed using a device with biofeedback. RESULTS: It is shown that the used treatment approach allows to increase the frequency of achieving good and excellent (52.4% in the main group and 27.2% in the comparison group) results and reduce the frequency of unsatisfactory results of treatment (9.8% in the main group and 21.7% in the comparison group) on the Constant score. CONCLUSION: The data obtained prove the high efficiency of the developed complex method for the treatment of proximal humerus fractures and restoration of the function of the upper limb.

Overuse Injury to Proximal Phalanx in Throwing Athlete (Little Leaguer's Finger): A Case Report.

ABSTRACT: The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.

Diagnosis and management of medial epicondyle avulsion fracture in a 27-year-old female: A case report.

OBJECTIVE: The purpose of this case report is to describe the diagnosis and management of an adult patient presenting with a rarely reported avulsion fracture of the medial epicondyle of the humerus. CLINICAL PRESENTATION: A 27-year-old female sought care following an injury sustained when the elbow gave out on an attempted back flip. The clinical assessment found an indication of elbow fracture with a diagnosis of medial epicondyle avulsion fracture made on radiographic examination. INTERVENTION AND OUTCOME: Following in-house imaging, the patient was referred for an orthopedic consultation. An MRI was ordered and revealed numerous internal joint derangements. The orthopedist prescribed a hinged brace and followed up in 4 weeks. Physical therapy was ordered by the surgeon with follow-up again in 4 more weeks. CONCLUSION: Medial epicondyle avulsion fractures are extremely rare in adults, and in this case, were accompanied by extensive internal joint derangements in the elbow. Chiropractors should be able to diagnose this condition from x-ray and can be of assistance with rehabilitation therapies.