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PubMed2003

[Experiences with the OrTra-prosthesis in primary prosthetic replacement of fractures of the humeral head--indication, technique and results].

Displaced three - and four - part fractures of the humeral head are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy and early mobilisation is possible. Functional outcome after hemiarthroplasty of the shoulder joint after trauma however is poor, regardless the type of implant used. However, a stable, painless joint is obtained at a "one time surgery". In our institute from April 1996 until January 2001 fifty-eight primary OrTra-prostheses were implanted. In 43 patients we could perform the follow up. The patients revealed a mean range of active movement from about flex./ext. 54 degrees/0/40 with abd./add. 67 degrees/0/20 degrees. Most important for the patients was the achieved painfree shoulder in 86% (ASES index) of all cases.

Follow-Up Studies↗
PubMedDate not supplied

Fixation of proximal humeral fractures with the Polarus nail.

Thirty patients with fractures of the proximal humerus were treated by internal fixation with an intramedullary locked nail. Fourteen of these patients were more than 60 years of age; 23 patients had 2-part fractures (surgical neck fractures) and were operated on within an average of 3 days after injury. At follow-up, 20 (80%) of 25 patients showed satisfactory to excellent functional outcomes, as measured by Constant score. All but 1 fracture progressed to clinical and radiologic union. The good functional results indicate that the Polarus nail is a satisfactory mechanical device that can be used in the treatment of displaced proximal humeral fractures in both the young and the elderly with osteopenic bone.

Adolescent↗
PubMed1991

[Functional results of Neer II type hemi-arthroplasty joint replacement of multi-fragment humerus head fractures].

Among the fractures of the proximal humerus--a typical kind of injury affecting elderly people, as well as gainfully employed patients, the comminuted and dislocated humeral head fractures have a specific position because of therapeutical reasons. By means of a retrospective analysis, a review is given of the results of 26 comminuted humeral head fractures type IV-VI according to Neer, treated with a Neer prosthesis type II at the surgical clinic of the Kantonsspital Lucerne between 1983 and 1989. Our interest is mainly concentrated on the functional results and on their correlation with biomechanical and perioperative factors. We use the fracture-classification and functional evaluation as described by Neer. For the results classified as "failures" (13 cases) the functional deficits of the glenohumeral joint mobility are essential. The scores reveal no significant correlation to the age of the patients, to the time interval between trauma and operation, as well to the duration of the postoperative physiotherapy. On the other hand the scores of patients with preoperative manipulation of the fractured joint (i.e. osteosynthesis, reduction attempts, physiotherapy) were significantly worse than those with primary prosthetic replacement. Furthermore, because of the insufficient restitution of the lever arm conditions, the implantation of the small-head component (15 mm) leads to significantly less favorable functional scores, with a corresponding radiological hyperpression in the cranial articular space. Our analysis leads to the following conclusions: 1. Under the condition of a conclusive preoperative diagnosis a primary prosthetic procedure is recommended depending on the type of fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

[Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases].

PURPOSE OF THE STUDY: We present the results of an original technique for reconstruction of valgus-impacted humeral head using autologous iliac bone. MATERIAL AND METHODS: Between 1992 and 1993, 8 patients (average age 66 years, range 43 to 79 years) with four-part valgus impacted proximal humeral fractures were operated with the aim of preserving the humeral head. All fractures were treated with open reduction and were stabilized only with autologous bone. This procedure provided fixation without osteosynthesis. Using a deltopectoral approach the impacted segment of the humeral head was raised, the void was filled with autologous three-cortical iliac bone graft, and the tuberosities were relocated with the goal of anatomic reconstruction. The assessment included clinical examination including Constant's score, radiographic examination and MRI examination. Only one patient was not available for the review at follow-up evaluation (minimum 12 months, average 16 months). RESULTS: According to Constant's criteria, two results were excellent, two very good, one good, one fair and one patient were considered failure. Average Constant's score was 62; average score in comparison with the healthy side was 76 per cent. Radiographic findings showed in all cases healing and incorporation of the graft. MRI results showed only one asymptomatic partial avascular necrosis (14 per cent). DISCUSSION: This specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment without lateral displacement has a rate of avascular necrosis lower than that of other displaced four-part fractures. Blood supply of the articular segment is maintained via the periosteum extending to the medial part of the anatomic humeral neck. These data authorized the authors to propose a new conservative treatment for four-part valgus impacted proximal humeral fractures.

Adult↗
PubMed1997

[Prosthetic humeral head replacement in dislocated humerus multi-fragment fracture in the elderly--an alternative to minimal osteosynthesis?].

In a prospective randomised study, comprising 30 aged patients with fractures of the proximal humerus (4-fragment fractures according to Neer) minimal osteosynthesis was compared to primary endoprosthetic replacement. The Constant score was used for evaluation during follow-up. After one year the results were similar in both groups. There were two complications necessitating revision surgery among the patients with minimal osteosynthesis and in four cases the implants had to be removed. In the group with primary endoprosthetic repair neither complications nor revision surgery occurred. Primary endoprosthetic replacement for the treatment of proximal humeral fractures appears as a therapeutic option with a low complication rate and a satisfying functional outcome. In older patients we need a safe mode of therapy permitting early mobilization and quick discharge from the hospital back to the patient's home. Endoprosthetic replacement fulfils these demands since it resembles a "one time surgery" without the risk of revision surgery for implant loosening, pseudarthrosis or ischemic necrosis of the humeral head.

Activities of Daily Living↗
PubMed2002

Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment.

We present a retrospective study of 125 patients with an impacted valgus fracture (B1.1) of the proximal humerus. This fracture rarely occurs in young patients and is much more common in elderly fit subjects. All patients were documented prospectively and followed for one year. None was treated surgically. At one year, 80.6% of the patients had a good or excellent result, the quality of which depended on the age of the patient and the degree of displacement of the fracture. Mean outcome scores based on these two parameters are presented. A comparison with data from other studies suggests that operative fixation of these fractures is not necessary.

Adult↗
PubMed2005

[Study on the bone mineral density of elderly patients].

OBJECTIVE: To analyze bone mineral density (BMD) of elderly patients in Beijing suffering from osteoporotic fracture, and discuss Chinese population BMD threshold of osteoporosis complicated by fracture. METHODS: Randomly selected three hundred male and female patients over the age of fifty years old with hip, shoulder or wrist fracture forming a research group. And randomly selected one hundred and fifty male and female patients over fifty years old with lumbar diseases forming a comparison group. Hip and spine BMD values of both groups were measured by dual energy X-ray absorptiometry and statistically analyzed by t-test; The BMD values were analyzed using a receiver operating characteristic (ROC) curve to determine the optimal cutoff point as the fracture thresholds. RESULTS: BMD values relate negatively to age (research group, L2-L4 r value: -0.267, femur neck r value: -0.284, Ward triangle r value: -0.368, great trochanter r value: -0.314, all P < 0.01; comparison group, femur neck r value: -0.383, Ward triangle r value: -0.476, great trochanter r value: -0.305, all P < 0.01); There is evident difference between statistical comparisons of experimental and control group (P < 0.01); The cutoff point of the Ward triangle BMD at 0.732 g/cm(2) (91.0% sensitivity, 56.1% specificity, 9% missed diagnosis, 43.9% misdiagnosis) yields the likelihood of osteoporotic fracture for male; and it is at 0.577 g/cm(2) (72.6% sensitivity, 64.5% specificity, 27.4% missed diagnosis, 35.5% misdiagnosis) for female. CONCLUSION: It is reasonable to take the cutoff point values as thresholds of fracture risk of osteoporosis.

Absorptiometry, Photon↗
PubMed1980

[Traumatic lesions of the capsula and tendons of the shoulder joint, rupture of the rotator cuff, strain fractures (author's transl)].

Traumatic lesions of the soft tissues in the region of the rotatory cuff of the shoulder and disinsertion of the tendons in the region of the shoulder joint are rare. They are seen in older patients and--without injury--in tendons which are damaged through degeneration. The diagnosis of such disinsertions is very difficult. Therefore, special diagnostic methods are described. Disinsertions, strain fractures and traumatic lesions of the rotator cuff can be treated surgically. The operation should be done only in case of adequate indication. Function, age and clinical symptoms should be carefully considered.

Adolescent↗
PubMed2006

[Comparison of open versus percutaneous treatment for humeral head fracture].

BACKGROUND: The hypothesis of this study was that percutaneous techniques lower the risk of post-traumatic avascular necrosis. MATERIALS AND METHODS: In this retrospective study 83 patients were followed up clinically and radiologically for signs of avascular necrosis and nonunion after open or percutaneous treatment of proximal humerus fractures. Mean age was 50 years. Fractures were classified in 22 patients (26.5%) as two part, in 21 patients (25.3%) as three part, in 39 patients (47%) as four part, and in 1 patient (1.2%) as fracture dislocation (Neer classification). Fractures were treated in 12 patients (14.5%) by ORIF (open reduction and internal fixation) and in 71 patients (85.5%) by CRPF (closed reduction and percutaneous fixation). Both groups were statistically equally distributed according to fracture type (Mann-Whitney U, p=0.267) and age (One-way-Annova, p=0.740). The postoperative regime did not differ between the two groups. RESULTS: Patients suffered significantly more avascular necrosis after open treatment [five patients (50%) versus eight patients (12.7%) in the percutaneous group, Mann-Whitney, p=0.004]. The risk for avascular necrosis and nonunion increased with age. Mean age of patients with avascular necrosis was 57 years, and the age of patients with nonunion was 67 years. CONCLUSION: Percutaneous treatment of humeral head fractures seems to be a reliable method for lowering the risk of avascular necrosis in young patients.

Adult↗
PubMed1996

[Hemi-arthroplasty--primary or secondary measure for 3- and 4-fragment fractures of the proximal humerus in the elderly?].

Successful treatment of three- and four-part proximal humerus fractures is a therapeutic challenge to the surgeon, particularly in the case of elderly patients. Open reduction and internal fixation have been advocated, but have not consistently produced acceptable results. The results of humeral head replacement as a salvage procedure after non-union or failed open reduction and internal fixation are less predictable. The outcome of hemiarthroplasty (Neer II) performed for three- and four-part proximal humerus fractures in elderly patients was studied. The average patient follow-up was 42.9 months (range 5-98). Eighteen women and eight men with an average age of 64.5 years were evaluated according to the UCLA. Constant-Murley and HSS Score. A Visual Score (0-100 points) was also used. Hemiarthroplasty was performed in 11 patients within 4 weeks of trauma and in 15 patients after 4 weeks. Fair, good, or excellent results were achieved in 80% (UCLA and Visual), 73% (HSS) and 46% (Constant-Murley) of the patients, respectively. Ninety-six percent of the patients reported only slight or no pain. The range of motion was limited in almost all cases. The outcome was not significantly influenced by age, sex and follow-up time. However, there was a significant correlation between the outcome and the length of time between injury and humeral head replacement (r = -0.5). The outcome after early hemiarthroplasty was better than after late humeral head replacement (UCLA: 27.1 +/- 4.6 vs 22.5 +/- 5.6 P = 0.04; Constant-Murley: 65.6 +/- 18.5 vs 47.5 +/- 18.6, P = 0.02; HSS: 74.0 +/- 14.4 vs 63.5 +/- 17.6, P = 0.17). Self-assessment did not differ between these two groups. After early hemiarthroplasty, active forward flexion was significantly better. This study indicates that early humeral head replacement for three- and four-part proximal humerus fractures in elderly patients achieved better functional outcome than delayed humeral head replacement. The decision to perform prosthetic humeral head replacement in these cases should be made as early as possible after trauma.

Aged↗
PubMedDate not supplied

Proximal humerus fractures sustained during the use of restraints in adolescents.

Injuries to skeletally immature individuals sustained during restraints have been rarely documented. The authors report a series of five proximal humerus fractures in skeletally immature patients (average age 15.3 years) that occurred during restraint with handcuffs. A similar mechanism of injury was identified in all of the cases. All five injuries were Salter-Harris type I or II, and three of the five required operative intervention. At short-term follow-up, all patients are doing well without evidence of growth disturbances. To the authors' knowledge, this is a unique mechanism of injury that could be avoided with proper education.

Adolescent↗
PubMed2004

The prognosis following acute primary glenohumeral dislocation.

We have studied 105 patients with 107 acute, primary, dislocations of the glenohumeral joint seen between January 1, 1991 and July 1, 1994. The mean time of follow-up was 71 months (46 to 91). In 34% the injury occurred during a sports activity and in 28% at home. The bias toward sport was even greater in patients less than 40 years of age, and in men. In patients older than 40 years of age, and in women, the dislocation occurred more often at home. The overall probability of recurrence within four years was 26%. Age was the most significant prognostic factor in recurrence which took place in 64% of patients less than 20 years of age and in 6% of those older than 40 years. Statistically, there was no difference between the rates of recurrence in patients who were active in sport and those who were not. The mean Rowe score for the whole group was 87 (15 to 100). Associated fractures were found in 20 patients (19%) and nerve injuries in 22 (21%). None of those in whom a fracture of the greater tuberosity was seen subsequently suffered a recurrent dislocation. At follow-up we found that 36 patients (34%) had not returned to their former employment but in only 2% was this owing to the injured shoulder.

Accidents, Home↗
PubMed2002

[Internal fixation of proximal humerus fracture by "palm tree" pinning].

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

Adolescent↗
PubMed1993

Fractures of the scapula associated with traumatic paralysis: a pathomechanical indicator.

In this study, 25 cases of fracture of the scapula associated with traumatic paralysis were reviewed. The vast majority of the patients were young males, victims of high-speed traffic accidents. Of the vertebral injuries in this population, 76 per cent occurred in the thoracic region, 20 per cent in the lower cervical region and only one in the lumbar region. Complete paralysis was documented in 84 per cent of the patients. The characteristics of spinal column failure are determined by the anatomical configuration and the direction and energy of the impact. Important information about the latter can be extrapolated from careful analysis of the associated fractures.

Accidents, Traffic↗
PubMed2000

[Prevalence of rotator cuff defects in dislocated fractures of the humerus head in elderly patients].

Humeral head fractures are commonly found in elderly patients. A high rate of spontaneous rotator cuff tears in this patient group may endanger good results following surgical treatment. 70 patients > 65 years with dislocated humeral head fractures were prospectively studied and treated surgically following a standardised treatment protocol. In all cases the rotator cuff was examined intraoperatively. A tear of the rotator cuff was documented in 4 cases (5%). The prevalence of rotator cuff tears in elderly patients with dislocated humeral head fractures is significantly smaller than expected referring to magnetic resonance-, sonographic and cadaveric studies of same-age patients without fracture. Therefore the rotator cuff may serve as retention anchor for the surgical treatment of dislocated humeral head fractures in elderly patients.

Aged↗