Background: Anatomic reduction and placement of an inferior calcar screw are strategies to prevent fixation failure in proximal humerus factures. Optimal position of the calcar screw remains unknown.
Methods: There were 168 shoulders (68.5% female; average age, 63.6 ± 11.5 years) that underwent open reduction and internal fixation of a displaced proximal humerus fracture involving the surgical or anatomic neck. Univariate and multivariate analyses were performed on preoperative clinical, preoperative radiographic, and postoperative radiographic variables to determine association with fixation failure. A receiver operating characteristic curve was performed to determine a maximum distance from the inferior screw to the calcar ("calcar distance") as well as a maximum ratio of this distance and the head diameter ("calcar ratio").
Results: There were 26 of 168 (15.5%) patients with radiographic failures (19 related to fixation failure). Univariate analysis and multivariate analyses found quality of reduction (P < .001), calcar distance (P < .001), and calcar ratio (P < .001) to be significantly associated with radiographic success. In all patients, receiver operating characteristic analysis found quantifiable thresholds of 12 mm or within the bottom 25% of the humeral head as measures to prevent fixation failure.
Conclusions: Quality of reduction, calcar distance, and calcar ratio independently correlated with fixation failure. This study provides optimal distances and ratios for calcar screw placement that can be used clinically.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jse.2017.05.003 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
[Finite element analysis of influence of humerus torque screw tip distance on stability of proximal humeral fracture plate fixation].
Zhongguo Gu Shang
December 2024
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China.
Objective: To explore changes of humerus torque screw tip distance on stability of proximal humeral internal locking system (PHILOS) by finite element analysis, in order to provide reference for selection of intraoperative plant size.
Methods: The proximal humerus 3D model was constructed based on Synbone artificial bone model in 3D engineering drawing software, and the corresponding 3D model was constructed based on PHILOS bone plate contour. The model was modified to simulate comminuted proximal humerus fracture, and the operation model was simulated after fracture, and the fixed operation model was assembled, the apex distance of humerus moment screw was set as 4, 8, 12 and 16 mm respectively.
Factors associated with failure of locking plate fixation in proximal humerus fractures.
Injury
November 2024
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom.
Background: Locking plate fixation remains the mainstay of surgical fixation of unstable proximal humerus fractures, however rates of failure remain high. The aim of this study was to identify risk factors that could be used to predict the likelihood of fixation failure.
Method: Patients with proximal humerus fractures managed with locking plate fixation between 2010 and 2019 at a Level 1 trauma centre were included.
Article Synopsis
- Intramedullary nailing is the preferred treatment for elderly proximal humeral fractures but often faces issues like secondary reductions due to inadequate stability and stress at the bone-implant interface.
- A new endosteal anatomical support nail (EASN) was developed to improve stability and reduce stress, featuring an anatomical support that better fits the proximal humerus.
- Finite element analysis showed that the EASN provided significantly greater stiffness and less displacement at the fracture site compared to traditional non-EASN constructs under both partial and full weight-bearing conditions.
Predicting cut-out in intertrochanteric fractures fixed with cephalomedullary nails: the role of tip-to-apex distance referenced to calcar (calTAD)--A retrospective analysis of 158 cases.
Eur J Orthop Surg Traumatol
November 2024
Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
Introduction: The optimal positioning of the cephalic screw in intertrochanteric fractures (ITFs) is crucial for minimizing the risk of cut-out. This study assesses the predictive value of the tip-to-apex distance (TAD) and tip-to-apex distance referenced to calcar (calTAD) for cut-outs in patients undergoing fixation with cephalomedullary nails.
Method: We analyzed 158 consecutive patients aged over 65 years (mean 83.
Risk Factors for Early Implant Failure in Geriatric Intertrochanteric Fractures Treated with Twin Interlocking Derotation and Compression Screw Cephalomedullary Nail (InterTAN).
Acta Chir Orthop Traumatol Cech
November 2024
Department of Orthopaedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Purpose Of The Study: Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!