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Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae).

BACKGROUND: Fracture sequelae of the proximal part of the humerus are challenging conditions, and various treatment options have been described. The purpose of this multicenter study was to analyze the clinical and radiographic outcomes as well as the complications following semiconstrained reverse total shoulder arthroplasty for the treatment of nonunion of a surgical neck fracture of the proximal part of the humerus. METHODS: Thirty-two patients with a mean age of sixty-eight years (range, forty-eight to eighty-three years) managed with a reverse shoulder arthroplasty for the treatment of n

Comparison of reverse shoulder arthroplasty and total shoulder arthroplasty for patients with inflammatory arthritis.

BACKGROUND: End-stage glenohumeral joint arthritis is common in patients with inflammatory arthritis. Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are both indicated in this setting. RSA is often considered based on the impacts of long-standing inflammatory arthritis including glenoid and humeral bone erosion and rotator cuff insufficiency. However, acromial and scapular spine fractures following RSA have been reported more commonly in these patients, which can have a significant impact on outcomes. Currently, no study has directly compared the efficacy an

Official Positions for FRAX® clinical regarding prior fractures from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as ca … prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental histor …

Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures.

Introduction: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. Materials and Methods: A retrospective analysis of 25 patients treated with ante

Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members.

INTRODUCTION: Coronal shear fractures of the distal humerus are uncommon injuries representing 6% of distal humeral fractures. There is no univocal consensus about the correct management of this type of fracture. A national survey was conducted to gain more insight into the current classification, diagnosis and treatment of coronal shear fractures in Italy. MATERIALS AND METHODS: A postal survey was sent to all AO Italian members including residency orthopaedic surgeons. The survey consisted of general questions about personal experience in the management of these fractures: types of classifi…

[Operative strategies in the treatment of upper limb fractures in polytraumatized patients].

BACKGROUND: Optimal timing of operative treatment of upper extremity long bone fractures in polytraumatized patients depends on the type and location of the fractures, as well as on the cardiorespiratory stability of the patient, and should be early in diaphyseal fractures in order to optimize intensive care treatment. The timing of surgery in cases of upper limb fractures is secondary to life-saving therapies. The same applies to stabilization of fractures of the lower limbs, including fractures of the femur and tibial shaft. METHODS: The recommended operative procedure for adult polytraumat

Quantifying Distal Deltoid Disruption With Linear versus Curvilinear Plating of Proximal Humerus Fractures: A Cadaveric Study.

BACKGROUND: Plate fixation of proximal humeral fractures is usually associated with some degree of distal deltoid dissection. The purpose of this study was to quantify deltoid release with standard linear versus curvilinear plates used in the repair of proximal humeral fractures. METHODS: Seven nonpaired, fresh-frozen, clavicle-to-fingertip cadaveric shoulders met the inclusion criteria for this study. Four different proximal humerus implants were tested. One of these plates was curvilinear (89 mm), and the other 3 plates were linear (85, 98, 109 mm in length). Plates were compared based on t…

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

BACKGROUND: The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP). METHODS: Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to th

Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries.

BACKGROUND: Comminuted intra-articular distal humeral fractures represent a challenging upper extremity injury. This study reviews clinical and radiographic results in patients with distal humeral hemiarthroplasty (DHH). METHODS: DHH with the Latitude prosthesis (Tornier, Saint-Ismier, France) was performed in 8 patients (mean age, 64 years; age range, 33-75 years) for unreconstructible fractures of the distal humerus or salvage of failed internal fixation. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons elbow instrument; Mayo Elbow Performance Index; and Disabil…

Management of Long Bone Fractures in Two Dogs Using 4.5mm Dynamic Compression Plates.

The objective of this study was to describe clinical outcomes associated with the use of the 4.5mm dynamic compression plate (DCP) for repair of long bone fractures in two giant breed dogs. Case 1, a 6-year-old male Great Dane, underwent surgical stabilization of a comminuted antebrachial fracture with a 4.5mm broad DCP fixation of the radius in addition to a 3.5mm seven-hole locking compression plate (LCP) that was placed on the ulna. The patient developed a recurrent surgical site infection that was considered a major complication. Follow-up 2 years later demonstrated clinical union of the f

Intramedullary Nailing for Pathological Fractures of the Proximal Humerus.

BACKGROUND: Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. METHODS: We reviewed 32 patients with pathological fractures of the proximal humerus who underwent interlocking IM nailing and cement augmentation. Functional scores and pain relief were assessed as outcomes. RESU

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… fractures. 13 , 15) However, the use of IM nails for pathological proximal humeral fractures has not been reported. … In a study by Blum et al., 16) pain associated with rotator cuff injury was observed in less than 10% of patients after IM nailing for proximal humeral fractures (n = 151). …

Osteochondral flap avulsion fracture in a child with forearm compartment syndrome.

Traumatic elbow dislocations account for approximately 3% to 6% of childhood upper extremity injuries, and 41% of these dislocations are concomitant injuries around the elbow. Most of these injuries are associated with a fall on an outstretched hand. Compartment syndrome is one recognized complication after elbow dislocation and distal humeral and radial neck fracture. Compartment syndrome in the forearm is a devastating complication in children with forearm, elbow, and supracondylar fractures. Compartment syndrome occurs as the result of hypoxic damage caused by interruption of the circulatio

Comparative efficacy and safety of different posterior surgical approaches for Intra-articular distal humerus fractures.

OBJECTIVE: To systematically compare the clinical efficacy and safety of four posterior surgical approaches-olecranon osteotomy (OO), triceps-reflecting approach (TRA), triceps-splitting approach (TS), and triceps tongue approach (TT)-for the treatment of AO/OTA type C complete intra-articular distal humerus fractures, and to provide evidence-based guidance for surgical approach selection. METHODS: This study was conducted in accordance with the PRISMA 2020 guidelines. PubMed, EMBASE, Web of Science, the Cochrane Library, and major Chinese databases were systematically searched for randomized

Outcome determinants for coronal shear fractures of the distal humerus.

PURPOSE: Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal shear fractures treated with internal fixation. METHODS: A retrospective analysis of 61 patients with distal humerus coronal shear fractures who were treated surgically was done. Demographics, fracture morphology, time to surgery, operative

Standardized fracture creation in the distal humerus and the olecranon for surgical training and biomechanical testing.

INTRODUCTION: Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope. METHODS: Twenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and frac

Capitellum Fracture Open Reduction and Internal Fixation With Headless Screws.

Partial articular fractures involving the capitellum represent an injury to the lateral column of the distal humerus. Capitellum open reduction and internal fixation restores this portion of the distal humerus articular surface and biomechanical integrity to the lateral column. This video demonstrates open reduction and internal fixation of a type I capitellar fracture with headless compression screws through an extensile lateral approach.

ORIF versus arthroplasty for open proximal humerus fractures: Nationwide Inpatient Sample data between 1998 and 2013.

BACKGROUND: Limited data exists in analyzing open reduction and internal fixation (ORIF) and arthroplasty in the management of open proximal humerus fractures. We analyzed differences in hospital course between these procedures, patient demographics, complication rate, length of stay, hospital charges, and mortality rate. MATERIALS AND METHODS: This is a retrospective review of the Nationwide Inpatient Sample database. ICD-9 codes identified patients hospitalized for open proximal humerus fractures from 1998 to 2013 who underwent ORIF or shoulder arthroplasty (hemi-, total, or reverse). Demog

Displaced Fracture Dislocation of the Proximal Humerus.

The patient was a 41-year-old man who injured his right shoulder falling onto his outstretched hand while skiing. Radiographs taken in the emergency department demonstrated a 3-part fracture dislocation of the proximal humerus for which he underwent same-day surgery. Physical therapy was initiated on postoperative day 27, and postoperative radiographs and physical examination results assisted in devising an appropriate plan of care and treatment. J Orthop Sports Phys Ther 2018;48(9):728. doi:10.2519/jospt.2018.6208.

Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures.

OBJECTIVES: In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. METHODS: Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plat

Plastic deformation of the forearm in adults: an analysis of 30 cases.

BACKGROUND: Plastic deformation of the forearm is a rare and frequently missed injury in adults that can result in a significant loss of forearm rotation. The condition is reported mainly in Western countries; however, it is not uncommon in Eastern developing countries. We conducted a retrospective study of 30 cases of forearm deformation to find common factors to increase awareness of the condition in trauma doctors. METHODS: We analyzed 30 cases of forearm plastic deformation in adult patients first diagnosed and treated at the Orthopedic Department of our hospital between January 2000 and