Background: The treatment of a displaced proximal humeral fracture is still a matter of controversy. Minimally invasive techniques are considered promising options. The purpose of this study was to report outcomes at medium to long-term follow-up after surgical treatment with pins stabilized with an external fixator.
Methods: A total of 235 patients (average age, 64 years [95% confidence interval (CI), 62 to 65 years]) were treated with closed or open reduction and fixation with pins stabilized by an external fixator specifically designed for proximal humeral fractures. The pins were inserted using a "pins-crossing-fracture" or a "pins-bridging-fracture" technique. One hundred and eighty-eight patients had a minimum radiographic and clinical follow-up of 2 years. Outcomes were assessed using the Oxford Shoulder Score (OSS), the subjective shoulder value (SSV), a visual analog scale (VAS) for pain, and, for 155 patients, the Constant score.
Results: Eighty-one (43%) of the 188 patients had a 2-part fracture, 60 (32%) had a 3-part fracture, and 47 (25%) had a 4-part fracture. The reduction was performed with percutaneous maneuvers in 120 shoulders or a deltopectoral approach, in 68. The external fixator was applied using a "pins-crossing-fracture" technique in 133 shoulders and using a "pins-bridging-fracture" technique in 55. At last follow-up, mean clinical scores were as follows: OSS, 42.6 (95% CI, 42 to 44); SSV, 85.5 (95% CI, 83 to 88); and VAS for pain, 1 (95% CI, 0.7 to 1.2). The complication rate at 3 months was 16% (37 of 235). The most frequent complication was pin-track infection (19 of 235, 8%). A total of 50 patients had ≥1 complication (50 of 188, 27%) and 6 (3%) underwent revision surgery. More complications were observed with the "pins-crossing-fracture" technique.
Conclusions: In our experience, the use of the external fixator has been a valuable option in the treatment of proximal humeral fractures. The complication and revision rates were acceptable. Most of the complications encountered were manageable without revision surgery.
Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.2106/JBJS.18.00734 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative).
Osteoporos Int
January 2025
Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
Unlabelled: Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures.
View Article and Find Full Text PDFShape-matching-based fracture reduction aid concept exemplified on the proximal humerus-a pilot study.
Int J Comput Assist Radiol Surg
January 2025
AO Research Institute Davos, Davos, Switzerland.
Purpose: Optimizing fracture reduction quality is key to achieve successful osteosynthesis, especially for epimetaphyseal regions such as the proximal humerus (PH), but can be challenging, partly due to the lack of a clear endpoint. We aimed to develop the prototype for a novel intraoperative C-arm-based aid to facilitate true anatomical reduction of fractures of the PH.
Methods: The proposed method designates the reduced endpoint position of fragments by superimposing the outer boundary of the premorbid bone shape on intraoperative C-arm images, taking the mirrored intact contralateral PH from the preoperative CT scan as a surrogate.
A Case Report: Interposition Arthroplasty for Post-traumatic Elbow Arthritis.
J Orthop Case Rep
January 2025
Department of Orthopaedics, Dr. KNS Memorial Institute of Medical Sciences, Barabanki, Uttar Pradesh, India.
Introduction: Post-traumatic arthritis of elbow is a crippling condition that frequently develops after a serious joint injury. The condition is characterized by pain, rigidity, and diminished functionality, considerably affecting the quality of life of those impacted. Despite advancements in surgical and conservative management, the optimal treatment strategy remains elusive.
View Article and Find Full Text PDFGiant Cell Tumor of Distal Radius Treated with Wide Local Excision and Reconstruction with Ipsilateral Proximal Fibular Autograft - A Follow-Up.
J Orthop Case Rep
January 2025
Department of Orthopaedics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Introduction: Giant cell tumour or osteoclastoma is benign, locally aggressive tumor with bone destruction and with malignant potential. It accounts for 5% of all primary bone tumor and occurs in skeletally mature individuals in the age group of 30 to 45 with peak incidence in the 3rd decade. GCT is more common in females.
View Article and Find Full Text PDF5-Year Mortality After Complex Displaced Proximal Humerus Fractures in Elderly Patients: Conservative Versus Reverse Total Shoulder Arthroplasty.
J Clin Med
December 2024
Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv 6423906, Israel.
The mortality rate following proximal humerus fractures (PHFs) in elderly patients is increased, but currently, there are no medium-term studies comparing mortality following treatment with Reverse Total Shoulder Arthroplasty (RTSA) to non-surgical treatment. This retrospective study compares two groups of elderly patients (aged 75 to 95 at the time of injury) who were diagnosed with PHFs. A total of 79 patients (mean age: 83.
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!