Fixation Of Proximal Humerus Fractures Research Articles

Fracture fixation in extremity trauma with carbon fiber-reinforced polyetheretherketone (CFR-PEEK) plates: evidence today

PurposeTo compare the CFR-PEEK plates with conventional plates in fracture fixation with regards to clinical and radiological outcomes and complications.MethodsA systematic literature search was conducted in four online databases independently by two reviewers using the Cochrane methodology for systematic reviews. The identified relevant studies were assessed against predetermined inclusion/exclusion criteria. Independent data extraction and assessment of risk of bias and study quality was carried out.ResultsNine studies (patient n = 361) out of 6594 records were included for analysis: 2 RCTs (n = 63), 3 prospective cohort studies (n = 151), and 4 retrospective cohort studies (n = 147). Studies were grouped per anatomic area of fixation. Four studies (n = 200) examined fixation of proximal humerus fractures. Two studies (n = 74) examined fixation of distal radius fractures. Two studies (n = 53) assessed outcomes of fixation of distal femur fractures. One study (n = 87) assessed the outcomes of fixation of ankle fractures. All nine studies reported very high union rates (from 91% in distal femur to 100% in upper limb) for the CFR-PEEK plate groups and low complication rates. There was no significant difference in clinical outcomes, and rate of complications as compared to the conventional plate groups.ConclusionCFR-PEEK plates have high union rates in extremity fracture fixation similar to conventional plates with comparable good clinical outcomes and a very low and comparable rate of complications. Considering their advantages, CFR-PEEK plates seem to be valid alternative to conventional plating.

Locking Plates on Femoral Fractures: A Systematic Review

Femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed. The PubMed and EMBASE databases were used to perform a systematic review of the English literature to assess the functional results and complications associated with proximal humerus locking plates. All institutional, author, and journal information was concealed to minimize reviewer bias. Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. Further study is needed to determine what technical errors and patient characteristics are risk factors for failure of this now common fixation technique.

No change in outcome ten years following locking plate repair of displaced proximal humerus fractures.

To assess longer-term (> 5years) function and outcome in patients treated with anatomic locking plates for proximal humerus fractures. This retrospective cohort study was conducted at an urban, academic level 1 trauma center and an orthopedic specialty hospital. Patients treated operatively for proximal humerus fractures with an anatomic locking plate by three orthopedic trauma surgeons and two shoulder surgeons from 2003 to 2015 were reviewed. Patient demographics and injury characteristics, disabilities of the arm, shoulder, and hand (DASH) scores, complications, secondary surgeries, and shoulder range of motion were compared at 1year and at latest follow-up. Seventy-five of 173 fractures were eligible for analysis. At a minimum 5years and a mean of 10.0 ± 3.2years following surgery, DASH scores did not differ from one-year compared to long-term follow-up (16.3 ± 17.4 vs. 15.1 ± 18.2, p = 0.555). Shoulder motion including: active forward flexion (145.5 vs. 151.5 degrees, p = 0.186), internal rotation (T10 vs. T9, p = 0.204), and external rotation measurements (48.4 vs. 57.9, p = 0.074) also did not differ from one year compared to long-term follow-up. By one year, all fractures had healed. After 1-year post-operatively, four patients underwent reoperation, but none for AVN or screw penetration. Patient-reported functional outcome scores and shoulder range of motion are stable after one year following proximal humerus fracture fixation, and outcomes do not deteriorate thereafter. After one-year, long-term follow-up of fixed proximal humerus fractures may be unnecessary for those without symptoms.

An analysis of functional outcome and complications of proximal humeral interlocking system plating for displaced proximal humeral fractures a prospective study

Background: The study was conducted to assess functional outcome and complications of Proximal Humerus Inter Locking System (PHILOS). Plating in displaced proximal humeral fractures by Constant-Murley (Subjective and Objective) score.Materials and Methods: The study was conducted on 60 patients with displaced proximal humeral fractures operated with Proximal Humerus Inter Locking System. Among 60 patients 24 females, 36 males; mean age 50.64 years range (26-70yrs). All patients were put on same physiotherapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radio graphically at regular intervals of 6 weeks, 12 weeks and 6 months. Functional outcome was assessed using the Constant- Murley score. Complications during the follow-up period were recorded.Results: In our series of 30 patients 2-part fractures were more common accounting 60 % compared to 3-part (20%) and 4-part (20%). Fractures united in all patients. The most frequent complication seen was shoulder stiffness in 6 patients. Excellent functional outcome seen in 18 (30%) cases, good 24 (40%) cases, fair 12(20%) cases, poor 6(10%) casesConclusion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part and 4 part fracture. The complications are high in four part fractures and old age. Good surgical skills and surgeon’s experience are of utmost importance for successful operative treatment.

Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures: A prospective study

Background: The study was conducted to assess functional outcome of Proximal Humerus InterLocking System (PHILOS) plating in displaced proximal humeral fractures by Constant-Murley (Subjective and Objective) score.Materials and Methods: The study was conducted for 30 patients with displaced proximal humeral fractures operated with Proximal Humerus InterLocking System. Among 30 patients 12 females, 18 males; mean age 50.64 years range (26-70yrs). All patients were put on same physiotherapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radiographically at regular intervals of 6 weeks, 12 weeks and 6 months. Functional outcome was assessed using the Constant-Murley score. Complications during the follow-up period were recorded.Results: In our series of 30 patients 2-part fractures were more common accounting 60 % compared to 3-part (20%) and 4-part (20%). Fractures united in all patients. The most frequent complication seen was shoulder stiffness in 6 patients. Excellent functional outcome seen in 9 (30%) cases, good 12 (40%) cases, fair 6(20%) cases, poor 3(10%) cases.Conclusion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part and 4 part fracture. The complications are high in four part fractures and old age. Good surgical skills and surgeon’s experience are of utmost importance for successful operative treatment.

A prospective study on surgical management of neer’s two-part and three-part proximal humerus fractures by philos plating and its functional outcome

Background and Objectives: Fractures of proximal humerus are the second most common fracture of upper limb accounting 4% to 5% of all fractures. There are different modalities of surgical treatment like multiple k-wire fixation, proximal humeral nailing, locking plate osteosynthesis, TBW and Hemiarthroplasty of shoulder. The mode and type of fracture fixation depends on the fracture pattern, bone quality, age and activity of patient. The goal is to achieve near anatomical reduction and stable fixation so as to achieve early mobilization. Method: A Prospective study of 30 cases of surgically managed fractures of Proximal Humerus Using Proximal Humerus (PHILOS) Locking Compression Plates undertaken at Department of Orthopaedics, J.J.M. Medical College, Davangere from 1st August 2019 to 31st July 2021 who follow Inclusion and Exclusion criteria. Post operative functional outcome was assessed by using Constant And Murley Scoring. Result: The most common age group included in our study was between 50-60 years (50%) with mean age group being 47.66 years.20 patients had a fracture of right proximal humerus and10 had of the left side.Our study included 14(47)% patients with 2 part surgical neck fracture, 12(40%) with 3part surgical neck with greater tuberosity, 3(10%) with 3 part surgical neck with lesser tuberosity and 1(3%)patient with 2 Part greater tuberosity fracture. Functional results were 6(20%) patients had excellent result. 18(50%) patients had good, 4 (13.33%) patients had moderate and 2(6.66%) patients had poor result at 1 year follow up. The average Constant And Murley Score being 76.9. Conclusion: PHILOS plate appears to be a new generation promising implant for the internal fixation of proximal humerus fractures. The design provides stable fixation even in osteoporotic bone and allows early mobilization of the joint. It is suitable for two-part, three-part fractures in young and in elderly patients providing that the correct surgical technique is used.

Fracture location impacts opioid demand in upper extremity fracture surgery

IntroductionOpioid sparing protocols should be formulated with appropriate demand. Specific fracture location has been hypothesized as an important predictor of post-operative pain. The purpose of this study is to evaluate the impact of fracture location on perioperative opioid demand after surgery with the hypothesis that this factor would be significantly associated with perioperative opioid demand in upper extremity fracture surgery. MethodsA national database was used to identify1-month pre-operative to 1-year postdischarge opioid demand in oxycodone 5-mg equivalents in 336,493 patients undergoing fracture fixation of the clavicle through distal radius between 2010 and 2020. Three timeframes were evaluated: 1-month pre-op to 90-days post-discharge, 3 months post-discharge to 1-year post-discharge, and 1-month pre-op to 1-year postdischarge. Multivariable main effects linear and logistic regression models were constructed to evaluate the changes in opioids filled, opioid prescriptions, and odds of two or more opioid prescriptions in these timeframes based on fracture location with adjustment for age, sex, obesity, pre-operative opioid usage, and polytrauma. ResultsCompared to distal radius fracture fixation, fixation of elbow, distal humerus, humeral shaft, and proximal humerus fractures were associated with large, significant increases in 1-month pre-op to 1-year post-discharge opioid filling (33.5 – 63.4 additional oxycodone 5-mg equivalents, all p<0.05) and number of filled prescriptions (0.33 – 0.92 additional prescriptions, all p<0.05) compared to patients with other operatively treated upper extremity injuries. DiscussionFracture location was a significant predictor of perioperative opioid demand. Elbow, distal humerus, humeral shaft, and proximal humerus fracture fixation was associated with the largest increases in opioid demand after upper extremity fracture fixation. Patients with these injuries may be at highest risk of extensive opioid consumption. Level of evidenceLevel III, retrospective, observational cohort study

Efficacy of the PHILOS plate in the management and functional outcome of proximal humerus fractures: A prospective study

Proximal humerus fractures management is a challenging task for orthopaedic surgeons due to the high incidence of postoperative complication. PHILOS plate is the recent advancement in locking plate fixation for proximal humerus fractures which provides angular stability and compression that lead to a speedy recovery. The present study was designed to assess the efficacy of the PHILOS plate in the management of displaced fractures to the proximal humerus. A total of 40 cases with displaced proximal humerus fractures admitted in the Department of Orthopedics were recruited. Patients were undergoing Open reduction internal fixation with PHILOS locking plating for the sustained fracture under general anaesthesia. Postoperative follow up appointments were conducted at the end of 2 weeks, 6 weeks, 3 months, 6 months and 12 months. Road traffic accidents were the commonest mode of injury in 72.5% of cases, followed by falling injuries from height (20%) and injuries by falling and slipping (7.5%). The mean constant- murley score was 66.25. The functional outcome was excellent in 20% cases, good in 30% cases, fair in 35% cases and poor in 15% cases. No severe postoperative complications observed. The proximal humerus locking plate is a good treatment option for 2, 3 and 4 part of NEER’s fractures with good functional outcome, good stable fixation with minimal postoperative complications.

Principles of Locking Plate Fixation of Proximal Humerus Fractures.

Proximal humerus fractures are common, particularly in elderly patients and those with osteopenia or osteoporosis. Although nonsurgical management results in satisfactory outcomes for most patients, surgical treatment is indicated in select cases. Despite an increasing trend toward arthroplasty, open reduction and internal fixation of proximal humerus fractures can still provide excellent clinical outcomes. Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy. In particular, understanding reliable regions of biomechanically superior bone can help prevent failure of fixation. Biomechanical studies have shown that locked plating of proximal humerus fractures provides stable fixation. Cadaveric and finite element models underscore the importance of screw placement in the posteromedial metaphysis. When medial column support is challenging to obtain, or when bone quality is poor, augmentation with bone autograft, allograft, and/or synthetic composites can improve the biomechanics of internal fixation constructs. The purpose of this review is to outline the anatomic, biologic, and biomechanical principles of plate fixation for proximal humerus fractures to provide evidence-based recommendations for optimizing fixation and preventing fixation failure.

Outpatient Surgical Fixation of Proximal Humerus Fractures Can Be Performed Without Increased Rates of Short-Term Complications or Readmissions.

To delineate differences in short-term complications between outpatient versus inpatient open reduction and internal fixation (ORIF) of proximal humerus fractures. Retrospective database review. Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. Patients in the National Surgical Quality Improvement Program database with proximal humerus fractures from 2005 to 2017. Proximal humerus fracture ORIF. Thirty-day readmission, reoperation, thromboembolic events, and other complications. In total, 920 outpatient and 2490 inpatient ORIF cases were identified. The proportion of outpatient proximal humerus fracture ORIF increased throughout the years from 6.67% in 2007 to 34.89% in 2017. Each outpatient case was propensity-score-matched with one inpatient case by age, sex, functional status, American Society of Anesthesiologists classification, smoking status, diabetes mellitus type, hypertension, chronic obstructive pulmonary disease, and dyspnea on exertion. After matching, there were 920 outpatient and 920 inpatient cases. Statistical analysis revealed no significant difference in complications including reoperation (1.63% vs. 2.50%), thromboembolic events (0.65% vs. 0.65%), and 30-day readmissions (2.93% vs. 2.69%) between outpatient versus matched inpatient procedures (all P > 0.05). The only significant finding was a lower rate of blood transfusion in outpatient procedures (0.54%) compared with inpatient procedures (4.02%) (P < 0.001). The perioperative outcomes assessed here support the conclusion that ORIF for proximal humerus fractures can be performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient procedures. However, it is worth noting that the majority of outpatient cases were younger than the average geriatric proximal humerus fracture patient. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

How Many Proximal Screws Are Needed for a Stable Proximal Humerus Fracture Fixation?

Purpose:This biomechanical study investigates the optimal number of proximal screws for stable fixation of a 2-part proximal humerus fracture model with a locking plate.Methods:Twenty-four proximal humerus fracture models were included in the study. An unstable 2-part fracture was created and fixed by a locking plate. Cyclic loading and load-to-failure tests were used for the following 4 groups based on the number of screws used: 4-screw, 6-screw, 7-screw, and 9-screw groups. Interfragmentary gaps were measured following cyclic loading and compared. Consequently, the load to failure, maximum displacement, stiffness, and mode of failure at failure point were compared.Results:The interfragmentary gaps for the 4-screw, 6-screw, 7-screw, and 9-screw groups were significantly reduced by 0.24 ± 0.09 mm, 0.08 ± 0.06 mm, 0.05 ± 0.01 mm, and 0.03 ± 0.01 mm following 1000 cyclic loading, respectively. The loads to failure were significantly different between the groups with the 7-screw group showing the highest load to failure. The stiffness of the 7-screw group was superior compared with the 6-screw, 9-screw, and 4-screw groups. The maximum displacement before failure showed a significant difference between the comparative groups with the 4-screw group having the lowest value. The 7-screw group had the least structural failure rate (33.3%).Conclusion:At least 7 screws would be optimal for proximal fragment fixation of proximal humerus fractures with medial comminution to minimize secondary varus collapse or fixation failure.Level of Evidence:Basic science study.

Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal humerus fractures (PHFs) are common upper extremity fractures representing break in humerus bone. Incidences of PHFs increased in last few years due to life style changes and increased road accidents. Appropriate management strategy for PHFs is still uncertain. The aim of current study is to assess the functional outcome following open reduction and internal fixation of proximal humerus fractures using locking compression plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Current study is a descriptive investigation conducted on 31 PHFs patients admitted to baby memorial hospital, calicut, between January 2013 to June 2014. Surgical management of PHFs was done by open reduction and internal fixation using locking compression plates and functional outcomes and complications of the employed treatment modality were investigated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; PHFs were observed to be common in 41-60 years age group, with 65% males being affected. Road accidents and domestic falls were observed to be the most common causes of PHFs in younger and elderly populations respectively. Three parts PHFs were observed to be more prevalent, followed by two and four parts fractures. Results of current study revealed that majority of PHFs united by 8-10 weeks duration with 22.58% cases with excellent and 41.93%, 16.12% and 19.35% cases with good, moderate and poor constant and Murley score respectively. Two patients reported post-operative complication of shoulder stiffness, while one patient each reported plate impingement, varus maluion, infection and varus malunion with intraarticular screw cut-out. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Locking compression plates (PHILOS/PHLP) is an efficient treatment modality for proximal humerus fractures allowing early mobilization and good functional outcome.&lt;/p&gt;

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures.

HypothesisWe hypothesized that the modified Fragility Index (mFI) would predict complications in patients older than 50 years who underwent operative intervention for a proximal humerus fracture.MethodsWe retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a proximal humerus fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates as well as length of stay (LOS) were recorded. Univariate as well as multivariable statistical analyses were performed, controlling for age, sex, body mass index, LOS, and operative time.ResultsWe identified 2,004 patients (median age, 66 years; interquartile range: 59-74), of which 76.2% were female. As mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 2.8% to 6.7% (P-value = .005), rate of discharge to rehabilitation facility increased from 7.1% to 25.3% (P-value < .001), and rates of any complication increased from 6.5% to 13.9% (P-value < .001). Specifically, the rates of renal and hematologic complications increased significantly in patients with mFI of 2 or greater (P-value = .042 and P-value < .001, respectively). Compared with patients with mFI of 0, patients with mFI of 2 or greater were 2 times more likely to be readmitted within 30 days (odds ratio = 2.2, P-value .026). In addition, patients with mFI of 2 or greater had an increased odds of discharge to a rehabilitation center (odds ratio = 2.3, P-value < .001). However, increased fragility was not significantly associated with an increased odds of 30-day reoperation or any complication after controlling for demographic data, LOS, and operative time.ConclusionAn increasing level of fragility is predictive of readmission and discharge to a rehabilitation center after open reduction and internal fixation of proximal humerus fractures. Our data suggest that a simple fragility evaluation can help inform surgical decision-making and counseling in patients older than 50 years with proximal humerus fractures.

Novel Technical Factors Affecting Proximal Humerus Fixation Stability.

Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation. A retrospective radiological study. Level 1 trauma center. Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed. Open reduction and internal fixation with the Synthes Philos locking plate. Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications. Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3). The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Functional outcome of patients treated with proximal humeral internal locking osteosynthesis plate in proximal humeral fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Displaced or unstable proximal humeral fractures fare poorly with non-operative treatment. These are better treated with surgical intervention in order to prevent minimal displacement of tuberosity or articular surface from compromising the long term articular function. The objective was to assess the functional outcome of patients treated with PHILOS (the proximal humeral internal locking osteosynthesis) plate in proximal humerus fracture.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 42 patients age group range between 20 and 80 years 61.9% are male and 38.1% are female treated with philos plate. Functional outcome measured by using Constant and Murley score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 50% were Neer two part fractures, 35.7%, three part fractures, 14.3%, four part fractures. After 6 month follow up functional outcome assessed by using constant and Murley score. Excellent outcome in 1 (2.4%) good outcome in 13 (31%), fair outcome in 19 (45.2%) and poor outcome in 9 (21.4%) noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PHILOS plate fixation of proximal humerus fracture is an effective surgical technique in maintaining stability of fractures and there is significant improvement in functional outcome.&lt;/p&gt;

Are Arthroplasty Procedures Really Better in the Treatment of Complex Proximal Humerus Fractures? A Comprehensive Meta-Analysis and Systematic Review.

A meta-analysis and systematic review was performed to compare outcomes of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA) for complex proximal humerus fractures. Data sources: MEDLINE, Embase, and Cochrane Library databases were screened. Search terms included reverse total shoulder arthroplasty, open reduction internal fixation, hemiarthroplasty, and proximal humerus fracture. English-language studies published within the past 15 years evaluating outcomes of ORIF, rTSA, or HA for complex proximal humerus fractures with minimum of 1-year follow-up were included, resulting in 51 studies with 3064 total patients. Review articles, basic science studies, biomechanical studies, and cadaveric studies were excluded. The methodological quality of evidence was assessed using the Jadad scale and methodological index for nonrandomized studies. Demographic data were compared using the χ2 test. Mean data were weighted by study size and used to calculate composite mean values and confidence intervals. Continuous data were compared using the Metan module with fixed effects. Count data were compared using the Kruskal-Wallis test. Alpha was set at 0.05 for all tests. Patients undergoing rTSA had lower risks of complication (relative risk 0.41) and reoperation (relative risk 0.28) than HA patients. rTSA resulted in higher Constant scores (standard mean difference 0.63) and improved active forward flexion when compared with HA (standard mean difference 0.76). Pooled mean data demonstrated better outcome scores and active forward flexion of ORIF versus HA and rTSA, although the patients were younger and had more simple fracture patterns. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Short term functional outcome of jess (Joshi’s external stabilisation system) in proximal humours fractures in adults: A prospective study

Background and Objective: In patients older than 65 years of age, fractures of the Proximal humerus are the second most common in incidence pertaining upper extremity fracture and are only the third most overall common fracture, after hip fractures and the distal radial fractures. It is well known that Most of the minimally displaced fractures of proximal humerus can be treated conservatively. For displaced fractures, many surgical techniques have been described but no single technique is considered to be the standard care. Optimal reduction and fixation of three and four part fractures of proximal humerus remains a challenge well known. Also in most of the surgical techniques and conservative treatments of proximal humerus fractures, post-operative stiffness due to long periods of immobilization remains a challenging issue, even after fruitful union of the fractures. Our study was undertaken to evaluate the functional outcome of the proximal humerus fractures treated with JESS fixators followed by early range of motion exercises post operatively, to curtail the occurrence of stiff shoulder due to longer immobilization periods of other fixation modalities. The final results of the study was then compared to the data of retrospective studies of different modalities of treating proximal humerus fractures and the incidence of frozen shoulder in their studies. Method: It was a Prospective study of 12months duration including 50 adult patients (>18 yrs) with fractures of the proximal humerus admitted to Hospital, and treated by Joshi’s External Stabilization System(JESS) with early mobilization and start of range of motion and pendulum exercises, from post op day 3. Consequently the patients were evaluated till 2 month post-pin removal period, using Murley shoulder score at the time of Pin removal followed by a gap of two months and were followed up at the outpatient clinic. Results: 50 patients were included in the study. The study had 15 (30%) females and 35 (70%) males. out of total 50 cases 18 (36%) patients had left side involvement and 32 (64%) had right side involvement. In 20 (40%) patients the injury to surgery interval was 1-3 days, in 15 (30%) patients the injury to surgery interval was 4-7 days and in 15 (30%) patients the injury to surgery interval was more than 7 days. Neer’s classification was used for classifying the proximal humerus fractures in our study and 3 part fracture was the most common followed by 2 part fracture. Murley score 2 months after implant removal in relation to final outcome was 50.50 ± 5.62 days in excellent outcome group, 55.65 ± 5.69 days in good outcome group, 64.27 ± 7.93 days in fair outcome group and 71.00 ± 11.27 days in poor outcome group. As the duration of complete pin removal increased the final outcome shifted from excellent to poor. Conclusion: In our study we found that proximal humeral fractures can be satisfactorily treated with JESS fixator which is a simpler and affordable method of proximal humerus fracture fixation, which also provides easy early shoulder mobilization and good gain of functionality in about four months since injury. Early mobilization and proper follow-ups with scheduled exercise regimes are of pivotal importance in bringing a better functionality and to decrease the post-operative incidence of frozen shoulder and these factors can be achieved by our modality.

Fixation of proximal humerus fracture in adult by locking plate: Clinical study

p&gt;Aim: The present study aimed to examine the functional outcome of the locking plate in theproximal humerus fracture treatment. Material and Methods: The study consists of 20 patientsdiagnosed with NEER’s 2 – part, 3- part, and 4 – part proximal humerus fracture. All the includedpatients were treated with internal locking plates. Based on the functional evaluation by Constant-Murley shoulder score and the assessment of radiological union foundation. Results: Excellentresults were obtained in 45% of the patients, a good result was seen in 25%, 20% of the patientshad fair results and the poor result was seen in 10% of the patients. The mean Constant-Murleyshoulder score that was obtained in the present study was 75.04. Conclusion: It’s concluded thatthere is a satisfactory functional outcome with the fixation of the proximal humerus fracture withlocking plates. While using the plate fixation for fracture the plate position is of the utmostimportance. Due to angular stability, the locking plates are the advantageous implants in case ofproximal humeral fracture.

Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study

BackgroundLoss of reduction (LoR) can occur after locking plate fixation of proximal humerus fractures (PHFs). This study determined biomechanical features of fracture fixation associated with preventing LoR postoperatively. One-year reoperation rates were also compared between those with/without LoR.MethodsPopulation-based administrative data for 359 adults treated using a locking plate for PHF between 2010 and 2016 were examined. Two trained assessors reviewed standardized shoulder radiographs. LoR (Yes/No) was defined as any fracture displacement >0.5 cm, and/or >10° change in neck-shaft angle (NSA) alignment relative to intraoperative imaging. Multiple logistic regression assessed how the following affected maintaining reduction: (1) sex, (2) age, (3) Neer classification, (4) shaft impaction (SI), (5) shaft medialization (SM), (6) calcar reduction (CR), (7) NSA alignment, and (8) screw use.ResultsLoR was seen in 79 (22%) patients. LoR was significantly associated with increasing age (odds ratio [OR] = 1.06/yr, P < .001), fracture severity (4-part vs. 2-part fracture; OR = 4.63, P = .001), and varus NSA alignment (<125° vs. ≥145°: OR = 5.6, P = .02; <125° vs. 125-145°, OR = 2.2, P = .02]). Patients achieving simultaneous SI, SM, and CR were significantly less likely (OR = 0.009, P < .001) to lose reduction, after controlling for age, fracture severity, and NSA alignment. If only SI was achieved, patients were still significantly less likely to lose reduction relative to achieving none of these mechanical features (OR = 0.17, P = .006). Reoperations were higher when LoR occurred (n = 26/77 [33.4%]) compared with no LoR (n = 20/276 [7.2%]) (P < .001).ConclusionsSI was strongly associated with preventing LoR in patients treated using a locking plate for PHF. SI with concurrent SM, CR, and a neutral or valgus NSA had the lowest rates of LoR. LoR was associated with higher rates of reoperation.

The value of lateral glenohumeral offset in predicting construct failure in proximal humerus fractures following internal fixation

Proximal humerus fractures are the third most common osteoporosis defining injury in the United States, yet operative fixation of these injuries remains technically challenging. Although several modifiable and nonmodifiable risk factors are correlated with failure of proximal humerus fixation, no study has investigated whether failure to restore glenohumeral offset plays a part in fixation failure. The goals of this study are: (1) to determine if lateral glenohumeral offset (LGHO) and humeral head diameter (HHD) can be measured radiographically with accuracy between observers, (2) to observe whether there is a correlation between failure to operatively restore an anatomic LGHO:HHD ratio and failure of fixation, and (3) if there is a correlation, can any recommendations be made in regard to the ideal LGHO:HHD ratio. Retrospective review found 183 patients meeting inclusion criteria who underwent operative fixation for proximal humerus fractures between 2005 and 2018. Patients suffering construct failure requiring reoperation were compared with clinically successful surgeries on the basis of age, sex, fracture morphology, head-shaft angle, smoking history, presence or absence of a calcar screw, and LGHO:HHD ratio. The groups were compared using a combination of Student t-tests, χ2, and bivariate and multivariate logistic regression analyses where appropriate. The Student t-test and intraclass correlation coefficientwere both used to assess interobserver reliability. We found that LGHO and HHD can be measured by independent observers accurately (intraclass correlation coefficient = 0.80, 95% confidence interval: 0.65-0.89). Patients suffering implant failure had a significantly lower LGHO:HHD ratios compared with those who did not (0.94 vs. 1.03, P ≤ .001). The LGHO:HHD ratio was an independent predictor of implant failure even after controlling for other potential risk factors. Patients with an LGHO:HHD of 1.0 or above have a <10% chance of failure compared with a 20% risk with a ratio of 0.9 and a 40% risk at 0.8. We found the LGHO:HHD ratio to be an independent predictor for construct failure after plate and screw fixation of proximal humerus fractures. Efforts should be made to restore an anatomic ratio of at least 1.0 to minimize the risk of failure.