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1.
Orthop Clin North Am ; 52(4): 369-379, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34538349

RESUMO

Proximal humerus fracture nonunions are heterogenous group of posttraumatic sequelae in both the operatively and nonoperatively treated proximal humerus fracture. The management of these fractures is largely based on the residual morphology. Understanding the relationship of the nonunited and malunited fragments, anatomic location of the fracture, and viability of the residual bone stock will allow for better surgical planning. Patient optimization with nonoperative care, open reduction internal fixation, intramedullary nailing, and shoulder arthroplasty, all have a role in the treatment of proximal humerus fracture nonunions.


Assuntos
Fraturas não Consolidadas/cirurgia , Úmero/cirurgia , Fraturas do Ombro/cirurgia , Artroplastia do Ombro/métodos , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Tomada de Decisão Clínica , Fixação Interna de Fraturas , Fixação Intramedular de Fraturas , Humanos , Úmero/lesões , Redução Aberta
2.
Acta Biomed ; 92(4): e2021198, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487079

RESUMO

BACKGROUND AND AIM: Proximal humeral fracture is one of the most common osteoporotic fractures in elderly people. The proper treatment choice is controversial. Open reduction and internal fixation (ORIF) with plate and screws is currently the most common treatment for the majority of displaced proximal humeral fractures. The aim of this systematic review is to investigate the surgical treatment outcomes of PHFs, focusing on main used devices and surgical approaches. METHODS: From the earliest record up to 21 July 2020, two independent authors conducted a systematic review of two medical electronic database (PubMed and Science Direct). To achieve the maximum sensitivity of the search strategy, the following terms were combined: "(proximal NOT shaft NOT distal) AND humeral AND fracture AND (plate OR locking plate OR osteosynthesis NOT nail NOT arthroplasty)" as either key words or MeSH terms. The risk of bias of the included studies was assessed, agreeing to the Cochrane Handbook guidelines. RESULTS: Thirty-four articles were initially noticed after the term string research in the two electronic databases. Finally, after full-text reading and analyzing the reference list, 8 studies were selected. The mean age recorded was 69.5 years (Range 67-72). All the studies included two-, three-, four-fragments fracture. Seven studies investigated PHILOS (Synthes, Bettlach, Switzerland) implants results, while one investigated CFR-PEEK plate (PEEK Power Humeral Fracture Plate; Arthrex, Naples, Florida, USA) outcomes or other plates. Deltopectoral and Transdeltoid approaches were the more common used. CONCLUSIONS: Both deltopectoral and transdeltoid approaches are valid approach in plating after proximal humerus fractures, for these reasons, the surgeon experience is crucial in the choice. The more valid implant is still unclear. The develop of prospective randomized comparative studies is strongly encourages.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Adulto , Idoso , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/cirurgia , Úmero , Estudos Prospectivos , Fraturas do Ombro/cirurgia , Resultado do Tratamento
3.
Acta Biomed ; 92(4): e2021251, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487103

RESUMO

Background and aim of the work Proximal humeral fractures incidence in the elderly population is increasing. Treatment management is complicated by fracture complexity and patients' comorbidities. The aim of our prospective study is the outcome evaluation of the role of minimally invasive plate osteosynthesis (MIPO) for elderly patients with a 3- or 4-parts proximal humeral fractures having an intact medial wall.   Methods We included n=42 unilateral 3- and 4-parts proximal humeral fractures treated with MIPO: 20 4-part fractures and 22 were 3-parts fractures were included. 17 patients identified as male and 25 as female (mean age 84yo).  A trans-deltoid approach has been used with minimal surgical exposure and tissue damage to preserve the local tissue for early shoulder mobilization.   Results At follow-up, the DASH recorded mean value was 72, while the Constant mean score was 68. Complications have been recorded in 23,8% of patients with 4-parts fractures having the highest complication frequency. Mean shoulder joint ROM was recorded: anterior elevation 75°, lateral elevation 80°, abduction 90°, intra-rotation 50°, extra-rotation 25°. The following factors were identified influencing the outcome: >8mm calcar fragment, head valgus impaction and periosteal medial hinge preservation.   Conclusions The increase in population longevity matches the increase in complex humeral fracture frequency. We strongly for management consensus for proximal humerus fracture, in a similar way as for neck femoral fractures. MIPO is excellent in reducing soft tissue damage and complications for elderly patients with limited functional demand.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Úmero , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Ombro , Fraturas do Ombro/cirurgia , Resultado do Tratamento
4.
Chirurg ; 92(10): 907-915, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34533598

RESUMO

After a proximal humeral fracture in older patients, locked plate fixation and reverse total shoulder arthroplasty are two competing surgical procedures. Even if recent clinical studies indicate a functional superiority of reverse shoulder arthroplasty over locked plate fixation, health-economic comparative data are lacking in the literature. Health claims data of 55,070 patients aged 65 years or older who were treated with reverse total shoulder arthroplasty or locked plate fixation after proximal humeral fractures, were analyzed regarding length of hospital stay and costs. Multivariable linear regression models were used to analyze the influence of comorbidities and complications on the length of hospital stay and costs. The length of hospital stay after reverse total shoulder arthroplasty with 20.0 days (±13.5 days) was statistically noticeable longer compared to locked plate fixation with 14.6 days (±11.4 days, p < 0.001). The costs per case showed a clear difference with 11,165.70€ (±5884.36€) for reverse total shoulder arthroplasty and 7030.11€ (±5532.02€) for locked plate fixation (p < 0.001). Statistically noticeable cost increases due to comorbidities and complications underline the urgent need for specialized geriatric trauma centers.


Assuntos
Fixação Interna de Fraturas , Fraturas do Ombro , Idoso , Placas Ósseas , Humanos , Tempo de Internação , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Resultado do Tratamento
5.
J Orthop Traumatol ; 22(1): 38, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559320

RESUMO

BACKGROUND: There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS: A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS: After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS: At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE: III Controlled cohort study.


Assuntos
Artroplastia do Ombro , Fraturas do Ombro , Articulação do Ombro , Idoso , Estudos de Coortes , Estudos Transversais , Seguimentos , Humanos , Úmero , Estudos Prospectivos , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
6.
J Pak Med Assoc ; 71(7): 1870-1874, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34410263

RESUMO

The present study evaluated and compared functional outcomes of proximal humerus fractures of different categories and their management with different procedures. Data of this prospective cohort was obtained from the orthopaedic trauma registry at a tertiary care hospital for the period from June 2015 to October 2019. Sixty-eight adult patients with proximal humerus fracture were identified out of which 57 (84%) had been operated. Functional outcomes were assessed up to 12-month follow-ups and were compared with different treatment groups, fracture category, and between isolated versus proximal humerus with additional upper limb fractures. At 3-month follow-up, there was significantly better outcomes in Proximal Humeral Internal Locking System (PHILOS) treatment group as compared to PHILOS with bone graft/BMP (p=0.041). PHILOS combined with bone graft/BMP was associated with delayed recovery compared to other management methods. There was non-significant difference in functional outcomes between isolated versus proximal humerus fractures associated with other upper limb fractures, among different fracture categories and between genders.


Assuntos
Placas Ósseas , Fraturas do Ombro , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Úmero , Masculino , Sistema de Registros , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/cirurgia , Resultado do Tratamento
7.
Ulus Travma Acil Cerrahi Derg ; 27(4): 457-464, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212996

RESUMO

BACKGROUND: Proximal humerus fractures are quite common, constituting 5% of all fractures. Plate osteosynthesis of comminuted fractures in the elderly with osteoporotic bones is prone to complications, including loss of reduction, intraarticular protrusion of screws, avascular necrosis and non-union. Hemiarthroplasty may be preferred to achieve a stable fixation, which permits early shoulder motion. Prerequisites for the successful functional outcome of this surgical technique are to have an intact rotator cuff, which is often torn, and achieve proper soft tissue balance, which is technically demanding. In RSA design, deltoid muscle replaces the function of the supraspinatus, compensating for a dysfunctional rotator cuff or a displaced tuberculum. We designed a retrospective study to evaluate the results of proximal humerus fractures treated with reverse shoulder arthroplasty using Humelock II reversible prosthesis in elderly patients. METHODS: Thirty-one patients (25 females, six males) above 65 years old who underwent reverse shoulder arthroplasty between 2014 and 2019 for Neer 3-4 part fractures or head split injuries were included in this study. Patients with a previous internal fixation attempt, cases with neurological deficit or previous upper extremity fractures, patients who presented later than three weeks after the trauma, cases with less than six months follow-up and patients with additional fractures were excluded. Twenty-eight patients were available for final analysis. Fracture mechanism, time from trauma till surgery, hospital stay and preoperative ASA scores were noted. Humelock II Reversible (FX Solutions) implants were used in all cases. Patients' shoulder range of motion and functional outcome using UCLA, DASH and Constant scores at minimum six months follow-up were evaluated. RESULTS: The mean age was 72.2 (65-95) years, and mean follow-up time was 15.5 (6-48) months. The mean UCLA, Constant and Dash scores at the last follow-up were 27.6 (14-35), 67.9 (38-80) and 30.8 (9.9-79.2), respectively. Mean shoulder flexion, abduction, internal and external rotation were 130 (110-160), 100 (70-140), 40 (15-60) and 39 (15-75) degrees, respectively. CONCLUSION: RSA is a very reliable treatment for proximal humerus fractures in patients over 65 years old. Early active and passive shoulder exercises can be started postoperatively, and good functional outcome and wide ROM can be achieved with this age group. Although stable fixation of the tuberculum is not required for shoulder abduction, it facilitates external rotation and should be attempted in all cases. Clinical outcomes of patients who underwent RSA due to proximal humerus fracture are as good as the outcomes of patients with different etiologies.


Assuntos
Artroplastia do Ombro , Fraturas do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Prótese de Ombro
8.
J Orthop Traumatol ; 22(1): 27, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34236540

RESUMO

BACKGROUND: Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. METHODS: This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (01.01.2000-14.04.2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar employing several combinations of keywords: "reverse shoulder arthroplasty," "reverse shoulder prosthesis," "inverse shoulder arthroplasty," "inverse shoulder prosthesis," "problems," "complications," "results," "outcomes," "reoperation," "revision." RESULTS: Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with an overall reoperation rate of 1.7% and overall revision rate of 2.6%. CONCLUSIONS: Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem in RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas short stems reported no humeral fractures or stem loosening. Infections (1.3%) proved to be the most common reason for component revision, and instability had a complication rate of 0.8%. LEVEL OF EVIDENCE: Systematic review IV.


Assuntos
Artroplastia do Ombro/métodos , Úmero/cirurgia , Complicações Pós-Operatórias , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Prótese de Ombro , Humanos , Reoperação , Estudos Retrospectivos , Escápula/cirurgia
9.
J Orthop Trauma ; 35(Suppl 2): S1-S2, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227586

RESUMO

SUMMARY: For the treatment of proximal humerus fractures, the intramedullary nitinol scaffold is a novel implant that has gained popularity and demonstrated promising 1-year outcomes as an alternative to bone grafting for providing intramedullary structural support to the humeral head. The aim of this video is to demonstrate the insertion of this device safely, while highlighting potential pitfalls, in a 67-year-old patient with a displaced, varus angulated 2-part proximal humerus fracture.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Fraturas do Ombro , Idoso , Ligas , Placas Ósseas , Epífises , Fixação Interna de Fraturas , Humanos , Cabeça do Úmero , Úmero , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
10.
J Orthop Trauma ; 35(Suppl 2): S3-S4, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227587

RESUMO

SUMMARY: There are a variety of treatment options available for proximal humerus fractures, including nonoperative management, open reduction internal fixation with screws, locking plates, intramedullary nailing, or suture fixation, and arthroplasty, including hemiarthroplasty and total shoulder replacements. Fracture characteristics, including the number of fracture parts and involvement of the humeral head and glenoid and the patient's functional status and postoperative goals help dictate the optimal choice. Although the indications for hemiarthroplasty as treatment for severe proximal humerus fractures have narrowed, the authors believe that there is a still a place for this technique in practice.


Assuntos
Artroplastia do Ombro , Hemiartroplastia , Fraturas do Ombro , Fixação Interna de Fraturas , Humanos , Cabeça do Úmero , Úmero/cirurgia , Ombro , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
11.
Acta Biomed ; 92(S3): e2021024, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34313659

RESUMO

BACKGROUND AND AIM OF THE WORK: Osteogenesis Imperfecta is a rare genetic condition. The use of total shoulder arthroplasty in these patients is very uncommon, with only two cases reported in the literature. This study describes a cementless reverse total shoulder arthroplasty (rTSA) for a multi-fragmented fracture in a patient affected by Osteogenesis Imperfecta (OI) type 1 and aims to review literature results of shoulder replacement in patients affected by this uncommon condition. METHODS: the case of a woman affected by OI type 1 treated with a cementless rTSA for a multi-fragmented proximal humerus facture is reported. Focusing on the fixation technique, a research of all articles regarding the orthopaedic treatments in patients affected by Osteogenesis Imperfecta was performed and compared to the techniques used in the unaffected population. RESULT: Our patient shows good results in terms of clinical and radiological outcomes at the short term follow up. Few studies treat the orthopaedic manifestation of this rare genetic condition and only two are focused on shoulder arthroplasty. Cement is the preferred method for fixation in both papers. CONCLUSION: Cementless reverse shoulder arthroplasty may be an option in patients affected by OI type 1, although literature seems to support cement as the fixation method of choice.


Assuntos
Artroplastia do Ombro , Artroplastia de Substituição , Osteogênese Imperfeita , Fraturas do Ombro , Articulação do Ombro , Feminino , Humanos , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/cirurgia , Estudos Retrospectivos , Fraturas do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 818-822, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308587

RESUMO

Objective: To investigate the effectiveness of limited open reduction via "door-shaft method" and internal fixation with locking plate for two- and three-part fractures of the proximal humerus. Methods: The clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via "door-shaft method" and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard. Results: The operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36). Conclusion: The "door-shaft method" not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness.


Assuntos
Fraturas do Ombro , Ombro , Idoso , Placas Ósseas , Feminino , Fixação Interna de Fraturas , Humanos , Úmero , Masculino , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
13.
Injury ; 52(8): 2272-2278, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34140139

RESUMO

OBJECTIVES: Proximal humerus fractures (PHF) are common, yet their optimal management remains debated. Reverse total shoulder arthroplasty (rTSA) is an increasingly popular option, particularly for non-reconstructible or osteoporotic fractures. Despite this trend, current literature provides limited guidance with regards to surgical timing and patient selection for rTSA. A trial of non-operative management might be beneficial for many patients who are not clearly indicated for surgery, provided this does not have a major negative impact on results for those who ultimately require rTSA. The purpose of this study was to investigate whether delayed reverse shoulder arthroplasty for fracture (>28 days from injury) is associated with any difference in complication rates or functional outcomes relative to acute surgery. DESIGN: Retrospective cohort study PATIENTS/PARTICIPANTS: 114 consecutive patients who underwent rTSA as the primary management of a PHF at two Level 1 trauma centers and one academic community hospital between 2004 and 2016. INTERVENTION: rTSA as primary management of proximal humerus fracture MAIN OUTCOME MEASUREMENTS: Complications, range of motion, and patient-reported functional outcomes scores (DASH, PROMIS physical function, and EQ-5D) RESULTS: Eighty-two of 114 patients (72%) underwent early surgery. Complex (4-part, head-split, dislocated) fractures were significantly more common in the acutely treated group. There was no significant difference in complications. Overall complication rate was 11.4%. There was a significant difference in DASH score favoring early surgery, with an average score of 22.4 in acutely treated patients versus 35.1 in delayed patients (p = 0.034). There was a non-statistically significant trend towards better PROMIS physical function scores and ROM in the acutely treated group. CONCLUSION: Delay in performing primary rTSA for management of PHF does not lead to an increase in complication rates but it may come at the cost of worse functional outcomes in patients who ultimately require rTSA.


Assuntos
Artroplastia do Ombro , Fraturas do Ombro , Articulação do Ombro , Humanos , Úmero , Amplitude de Movimento Articular , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
14.
Injury ; 52(8): 2285-2291, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34148652

RESUMO

INTRODUCTION: A stable fixation of highly unstable proximal humerus fractures remains challenging and complication rates, especially secondary varus dislocation, remains high. Different techniques of double plate osteosynthesis have been suggested for the treatment of complex proximal humeral fractures as they are well established for other fractures. The aim of this study was to evaluate an operative technique using an angular stable lateral plate supported by a one-third tubular plate positioned anteriorly at the lesser tuberosity for unstable proximal humeral fractures. PATIENTS AND METHODS: Retrospectively, patients treated with a double plate osteosynthesis were included between January 2014 and December 2017. Out of 31, 25 patients (80.6%) with an average age of 53.1 years ± 12.5 were available for follow-up. 60% of the patients were male. The clinical evaluation consisted of a physical examination and standardised questionnaire including subjective and objective shoulder scores like the Constant-Murley Shoulder Score, Simple Shoulder Score, and Subjective Shoulder Value. RESULTS: After a mean follow-up of 30.9 months (range, 12-76 months) eighteen patients (72%) had either excellent or good results regarding the Constant-Murley Shoulder Score with a mean value of 77 points ± 17. Average Simple Shoulder Score was 76% ± 0.2 and Subjective Shoulder Value 72% ± 0.2%. Mean NSA at time of follow-up 135° ± 13°. Nine patients had an implant-removal, five in combination with arthrolysis after a mean of 7.2 months. Three patients underwent surgery for secondary arthroplasty. The study shows a complication rate of 16%. No revision-surgery because of secondary varus dislocation was reported. DISCUSSION: Arthroplasty is the less favourable treatment for a younger, active cohort of patients with highly unstable proximal humeral fractures as results are not as good and options for revision are limited. Double plate osteosynthesis can be used in addition to calcar screws, bone graft augmentation, cement augmentation and additional free screws for more multidirectional stability and shows good clinical results despite a higher rate of avascular necrosis and high primary stability with comparable complication-rates to single plate osteosynthesis. It seems to be a valid alternative to primary fracture arthroplasty and can prevent secondary varus displacement.


Assuntos
Fraturas do Ombro , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
15.
Injury ; 52 Suppl 3: S29-S32, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088462

RESUMO

INTRODUCTION: Fractures of the proximal humerus are frequent and are widely studied with regards to their treatment indications. The aim of this article is to establish a correlation between the size of the epiphyseal fragment in fractures of the proximal humerus and the probability of loss of reduction after a surgical procedure. METHODS: A total of 47 surgically treated proximal humeral fractures were reviewed. Preoperative CT scans were used to evaluate the size of the epiphyseal fragment of the fracture. Postoperative X-rays were analyzed to assess complications, especially loss of reductions. Mean age was 61 years old (29-91 years). RESULTS: In total, 42 shoulders were evaluated. The average size of the epiphyseal fragment was 38.3 mm (32-50 mm) the largest longitudinal length; and 19.9 mm (12-30 mm) the largest cross-sectional length. The most frequent complication observed was loss of reduction. The statistical analysis showed significance that patients with smaller cross-sectional size of the epiphyseal fragment presented more complications (p = 0.034), and based on the graph and ROC curve, a value of 15.5 mm was considered as the cutoff value for failure. CONCLUSION: A cross-sectional length of the epiphyseal fragment of less than 15.5 mm indicates a higher probability of loss of reduction in fractures of the proximal end of the humerus after extra-medullary osteosynthesis.


Assuntos
Fraturas do Ombro , Estudos Transversais , Fixação Interna de Fraturas , Humanos , Úmero , Pessoa de Meia-Idade , Radiografia , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
16.
J Pediatr Orthop ; 41(Suppl 1): S20-S23, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096533

RESUMO

BACKGROUND: Fractures of the proximal humerus in skeletally immature patients are rare, and even rarer still in individuals approaching skeletal maturity. Concepts regarding remodeling potential, amount of deformity and functional demands can guide our treatment decision making, but criteria are poorly defined. The purpose of this manuscript is to discuss the issues and the best available evidence. METHODS: A search of the English literature was carried out using PubMed to identify papers on the topic of proximal humerus fractures in skeletally immature individuals. RESULTS: The literature available on the topic of pediatric proximal humerus fractures is limited, especially regarding fractures in patients approaching skeletal maturity. Certainly, as the remodeling potential decreases and the amount of deformity and functional demand increase, the need for operative treatment increases. The exact tolerances and criteria have not been established. A variety of surgical techniques exist, and have been shown to be helpful. CONCLUSIONS: Operative treatment may be necessary in individuals approaching skeletal maturity. Concepts discussed in this paper regarding remodeling, amount of deformity and functional demand may help the surgeon to make appropriate treatment decisions. Future prospective comparative studies which are pending will hopefully shed further light on this matter.


Assuntos
Fixação de Fratura , Úmero , Fraturas do Ombro/cirurgia , Adolescente , Remodelação Óssea , Criança , Desenvolvimento Infantil , Fixação de Fratura/efeitos adversos , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/prevenção & controle , Humanos , Úmero/crescimento & desenvolvimento , Úmero/cirurgia , Seleção de Pacientes , Fraturas Salter-Harris/cirurgia
17.
Medicine (Baltimore) ; 100(22): e26073, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087852

RESUMO

ABSTRACT: Treatments for proximal humerus fractures (PHFs) often fail to achieve anatomical reduction. The purpose of this study was to evaluate the role of positive medial cortical support (PMCS) in the nonanatomical reduction of PHFs.A retrospective analysis was performed of 78 patients with PHFs who underwent surgery from August 2014 to September 2017 and whose treatments did not achieve anatomical reduction. Based on the results of standard AP radiographs of the shoulders 3, 6, and 12 months after surgery, the patients were divided into PMCS or negative medial cortical support (NMCS) groups. The postsurgical change in head-shaft angle (HSA) between the 2 groups was compared. Shoulder joint function and visual analog scale (VAS) scores of the 2 groups were also compared at the same time.Of the 78 patients analyzed, 37 were in the PMCS group and, 41 in the NMCS group. There was no statistically significant difference in any of the characteristics of the 2 groups (P > .05), or in postsurgical HSA. However, the HSA of the 2 groups had become significantly different (P < .05) 3, 6, and 12 months following surgery. The changes in HSA of the 2 groups were different at various time points (P < .05). One year after surgery, the shoulder function score of the PMCS group was significantly better than that of the NMCS group, as was the VAS score (both P < .05).Patients whose surgery for PHF does not achieve anatomical reduction during surgery can undergo PMCS to achieve improved results, postoperatively. NMCS should be avoided as far as possible.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Ombro/cirurgia , Adulto , Placas Ósseas , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Bone Joint J ; 103-B(6): 1063-1069, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058878

RESUMO

AIMS: There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome. METHODS: We obtained data on 1,371 hemiarthroplasties for acute proximal humeral fractures from the Danish Shoulder Arthroplasty Registry between 2006 and 2010. Of these, 549 patients (40%) were alive and available for follow-up. The Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire was sent to all patients at nine to 14 years after primary surgery. Revision rates were calculated using the Kaplan-Meier method. Risk factors for an inferior WOOS score were analyzed using the linear regression model. RESULTS: Mean age at surgery was 67 years (24 to 90) and 445 (81%) patients were female. A complete questionnaire was returned by 364 (66%) patients at a mean follow-up of 10.6 years (8.8 to 13.8). Mean WOOS score was 64 (4.3 to 100.0). There was no correlation between WOOS scores and age, sex, arthroplasty brand, or year of surgery. The 14-year cumulative revision rate was 5.7% (confidence interval 4.1 to 7.2). Patients aged younger than 55 years and patients aged between 55 to 74 years had 5.6-times (2.0 to 9.3) and 4.3-times (1.9 to 16.7) higher risk of revision than patients aged older than 75 years, respectively. CONCLUSION: This is the largest long-term follow-up study of acute proximal humeral fractures treated with hemiarthroplasty. We found a low revision rate and an acceptable ten-year patient-reported outcome. The patient-reported outcome should be interpreted with caution as we have no information about the patients who died or did not return a complete WOOS score. The long-term outcome and revision rate suggest that hemiarthroplasty offers a valid alternative when non-surgical treatment is not possible. Cite this article: Bone Joint J 2021;103-B(6):1063-1069.


Assuntos
Artroplastia do Ombro/métodos , Hemiartroplastia/métodos , Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Reoperação/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários
19.
Injury ; 52(8): 2292-2299, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34053774

RESUMO

BACKGROUND: Several surgical techniques of osteosynthesis have been described for treatment of proximal humeral fractures. There is evidence that the quality of reduction improves the clinical outcome and decreases the number of complications. Reduction of the medial calcar is tricky when standard manoeuvres are performed. We have therefore augmented our standard surgical technique with a low-profile medial hinge plate which aims at better reconstructing the medial metaphysis without extensile soft tissue dissection in combination with proximal humerus locked plating. OBJECTIVE: Evaluate the radiological and clinical outcome after application of an augmented fixation with a low-profile medial hinge plate. We questioned: (i) The quality of reduction, (ii) The rate of complications, (iii) The clinical function in terms of the Oxford Shoulder Score (OSS). METHODS: A retrospective single-centre case series. Between 2016 and 2019, patients who had undergone open reduction and osteosynthesis by an anatomical locking plate associated with a 2.0 mm locking compression plate used as a hinge to support the medial metaphysis. Thirty-four patients, with an average age of 64 years had a clinical and/or radiological average follow-up of 36 months. RESULTS: The preoperative imaging identified three fractures in two parts, 19 fractures in three parts and 12 fractures in four parts. Seven cases with fracture-dislocation were identified, one head-split fracture, and 14 cases with a metaphyseal head extension of less than 8 mm. After comparing head-shaft displacement, cranialisation of the greater tuberosity as well as head-shaft alignment in the preoperative and postoperative radiographs, overall anatomical or near-anatomical fracture reduction was achieved in 27 of the patients. Only two cases presented postoperative complications. The two cases were complicated with nonunion without screw perforation requiring surgical intervention by re-osteosynthesis. The clinical outcome assessed by the OSS showed an average of 45/48. The age of the group with anatomical or near anatomical reduction and the group with at least one parameter of malreduction was significantly different, 65 and 74 years respectively (p<0.05). No significant differences were found when comparing the sex, surgical time, time to operation or the number of fracture parts. CONCLUSION: The technique described provides a surgical treatment option with lower complication rates and a quality of reduction consistent with the current literature as well as a satisfactory clinical outcome.


Assuntos
Fraturas Cominutivas , Fraturas do Úmero , Fraturas do Ombro , Idoso , Placas Ósseas , Fixação Interna de Fraturas , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Resultado do Tratamento
20.
J Orthop Surg (Hong Kong) ; 29(2): 23094990211010548, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34008454

RESUMO

BACKGROUND: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. MATERIALS AND METHODS: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. RESULTS: The percutaneous technique produced greater latitudinal tearing (p = 0.002) and less longitudinal tearing (p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area (p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. CONCLUSIONS: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.


Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Cabeça do Úmero/cirurgia , Lesões do Manguito Rotador/etiologia , Fraturas do Ombro/cirurgia , Lesões dos Tecidos Moles/etiologia , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador/cirurgia
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