Seventysix patients with proximal humerus fractures requiring surgery were randomized to receive a fixedangle plate made out of. Proximal humerus fractures are the third most common osteoporotic fracture type observed in elderly patients, after wrist. Outcomes after percutaneous reduction and fixation of. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures. Percutaneous plating can be a good solution to treat some of these fractures using a minimally invasive technique. There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus.
The full text of this article is available in pdf format. Open reduction, retention, and fixation of proximal humeral fractures. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. The proximal humerus is the upper part of the arm bone. In patients who have reducible but unstable 2part proximal humeral fractures, we have found the technique of closed reduction and percutaneous screw fixation to provide adequate fixation for.
The treatment of proximal humerus fracture using internal fixation. Closed reduction and percutaneous fixation is a viable treatment option for displaced twopart, threepart, and valgusimpacted fourpart proximal humerus fractures. Treatment for proximal humeral fractures with percutaneous. Louis leesa galatz washington university school of medicine in st. What are the signs and symptoms of a proximal humerus fracture. More than this, it is the goal to gently manipulate a strongly displaced fracture to correctly align the fragments among each other and revert the fracture into an only minimally displaced one. Reverse shoulder arthroplasty is superior to plate. Miniopen reduction and percutaneous fixation of proximal humeral fractures historically results in good outcomes and a low prevalence of osteonecrosis reported with shortterm followup.
Outcome of locking plate fixation for proximal humerus fractures. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Surgical technique locking proximal humerus plate depuy synthes 9 3. All other proximal humerus fractures, compromising mainly of the two and threepart surgical neck and. The stability of percutaneous fixation of proximal humeral.
Surgical treatment of three and fourpart proximal humeral fractures. The overall female to male ratio has been reported to be 3. The remaining 20% present a therapeutic challenge because surgical stabilization is necessary to ensure healing and to optimize function. Fractures of the proximal humerus account for approximately 4% to 5% of all fractures. We have nowadays many different surgical solutions, ranging from percutaneous pinning to shoulder arthroplasty. Proximal humerus fracture east sussex healthcare nhs trust. Closed reduction and percutaneous fixation of proximal. Sudkamp n, bayer j, hepp p, voigt c, oestern h, kaab m, luo c, plecko m, wendt k, kostler w, konrad g. The most useful rehabilitation protocol is the threephase system. P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial.
The delphi trial is a randomized controlled trial comparing reverse tsa with orif for displaced proximal humeral fractures otaao types 11b2 and 11c2 in elderly patients 65 to 85. If a fracture or fracture repair is stable, then therapy should be started early. The aim of this study was to investigate the epidemiology of proximal humerus fractures. Pin fixation of salterii proximal humeral fractures in adolescents approaching skeletal maturity has potential complications that can be avoided with singlescrew fixation. Jul 17, 2017 lateral approach to proximal humerus fracture fixation simple orthopaedics. Three and fourpart fractures of the proximal humerus are usually treated surgically. Intermediate outcomes following percutaneous fixation of proximal humeral fractures. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate.
Open reduction with internal fixation orif is the method of choice in younger patients. Despite biomechanical studies demonstrating inferior stability compared with plate and intramedullary nail constructs, percutaneous fixation offers a minimally invasive approach with potential clinical advantages. Intermediate outcomes following percutaneous fixation of proximal humeral fractures alicia k. Internal fixation with the use of locking plates is the standard surgical treatment for proximal humerus fractures, one of the most common fractures in the elderly. Restoration of a stable boneimplant construct that enables early functional aftertreatment. Due to the problem of kwire migration which often lead to a loss of reduction, this method of fixation had consequently been less favored. Proximal means it is the end of the bone that is closest to the body. The main goal of percutaneous reduction and fixation of a proximal humerus fracture is not necessarily achieving a perfectly anatomical reduction. Conservative treatment, plate fixation, or prosthesis for.
Although they can occur anytime after birth, their incidence increases progressively with age, particularly in women, because of postmenopausal osteoporosis, so that about 80% of affected people older than 50 years are women 1. The use of pkw in proximal humerus fractures has multiple advantages such as minimal blood loss, shorter surgical time, less soft tissues stripping, and less cost, 14. This study included 35 patients from 3 institutions. Proximal humerus fractures account for 6% of all fractures in the western world. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. Fracture fragments are fixed with percutaneous screws. Intermediate outcomes following percutaneous fixation of. Proximal humerus fractures in children and adolescents emconsulte. The procedure begins with an understanding of the fracture fragments and deforming forces, as the minimally invasive technique does not allow direct inspection. Pdf percutaneous pinning of proximal humerus fractures. We hypothesize that polaris nail fixation of 2 and 3part proximal humerus fractures results in high rates of both varus malunion and unsatisfactory clinical. 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.
Jun 04, 2017 the main goal of percutaneous reduction and fixation of a proximal humerus fracture is not necessarily achieving a perfectly anatomical reduction. Proximal humerus fractures current treatment options. Percutaneous fixation of unstable proximal humeral. However, the increasing popularity of biologic fixation and advances in the design of locking plate systems have affected the surgical approaches for fracture management. Eleven consecutive patients with threeand fourpart proximal humeral fracture dislocations eight anterior, three posterior dislocations were treated this way. Proximal humerus fracture you have sustained a fracture to your shoulder. Nevertheless, pkw techniques are also associated with complications like pintract infection, poor reduction, malunion, and pin migration 14. Percutaneous fixation of proximal humerus fractures request pdf. Should this trend continue, the fracture rate would triple over the next three decades. Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. Orthopedics ttype intercondylar fractures of the distal humerus are rare injuries in skeletally immature patients. Percutaneous annulated screw fixation, first described by chen et al. The continuing role of hemiarthroplasty in the treatment of proximal.
The dislocation is reduced using a miniopen deltopectoral approach with a horizontal split in subscapularis. Three options exist currently to treat these fractures. Proximal humerus fractures what is a proximal humerus fracture. Percutaneous elastic fixation of proximal humeral fractures. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Fractures of this region are common both with highenergy. Proximal humeral fractures are common injuries accounting for 45% of all fractures and third most common fracture in patients over 65years of age 16. Pdf outcome of proximal humerus fractures treated by philos. Functional outcomes for surgically treated 3 and 4part. Fractures of the proximal humerus occasionally require operative fixation. Percutaneous fixation of proximal humeral fractures ncbi.
Epidemiology of proximal humerus fractures springerlink. The proximal humerus is one of the bones in your shoulder joint. Oct 01, 2011 this study retrospectively evaluated functional outcomes of locked plate fixation vs hemiarthroplasty in 57 patients with 3 and 4part proximal humerus fractures from 2003 to 2005 with a mean. Pdf anatomical considerations for percutaneous proximal. Moar proximal humerus fractures are minimally displaced. Complications of proximal humeral fractures joseph d. Antegrade humeral nailing and open plating through a deltopectoral approach are well known techniques for operative fixation of proximal humeral fractures. The main structures at risk are the main trunk of the axillary nerve and posterior humeral circumflex artery from greater tuberosity pinning, the anterior branch of the axillary. Fractures were pinned using distally threaded dynamic hip screwr guide pins, 2mm kirschner wires.
The purpose of this study is to report the outcomes after closed or percutaneous reduction with percutaneous fixation of displaced proximal humeral fractures. Percutaneous fixation of proximal humeral fractures requires. Pdf proximal humerus fractures treated by percutaneous. Choosing surgical approaches to proximal humerus fractures duration. Percutaneous fixation of proximal humeral fractures involves careful patient selection and appropriate timing of the fixation. Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position displaced. Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the humerusblock. Position plate the proximal humeral locking plate is usually positioned 5 mm caudal to the proximal end of the greater tuberosity and 10mm dorsal to the posterior border of the intertubercular sulcus. For complex and unstable fractures locking proximal humerus plate. They are usually preceded by a low energy fall and for those that are minimally displaced conservative treatment yields positive results with return to a functional shoulder 4, 5. Proximal humeral fractures are common upper extremity fractures, particularly in older patients, and can result in significant disability.
Introduction ractures of the proximal humerus are an increasingly common injury, accounting for 4% to 5% of all fractures 11, 16 and 45% of all humeral fractures 19. The majority of both proximal and midshaft humeral fractures are nondisplaced and can be treated conservatively ie, nonsurgically. Results of a prospective, multicenter, observational study. Percutaneous pin fixation of the j bone joint surg 1997. Percutaneous treatment of proximal humerus fractures. Pdf closed reduction and minimally invasive percutaneous. Percutaneous fixation of proximal humerus fractures. Harrison ak, gruson ki, zmistowski b, keener j, galatz l, williams g et al. Percutaneous pinning an overview sciencedirect topics. Incidence of proximal fractures increases with age, with about 75% of cases occurring among people over the age of 60.
The percutaneous approach to proximal humeral fixation emphasizes minimum dissection with the goal of preserving vascularity of the articular segments and. Operative fixation may be performed to treat displaced fractures of the distal humerus. The incidence sharply increases in the elderly, with 71% of all proximal humerus fractures occurring in patients over the age of 60 years. Surgical treatment of displaced proximal humerus fractures with a. Intramedullary nailing versus percutaneous pin fixation of. Outcomes of 188 proximal humeral fractures treated with a. Current concepts in locking plate fixation of proximal. Proximal humerus fractures what to do in young active patients. A technique of percutaneous pinning of proximal humerus fractures had already been described in 1962. Yewlett ad, king ac, brooks fm, evans ro, williams rw 2016 what is the single most important technical aspect when fixing a proximal humeral fracture with a philos plate. Intramedullary locking nail fixation of proximal humerus. Complications of proximal humeral fractures musculoskeletal key. Current concepts in locking plate fixation of proximal humerus.
If the fragments are shifted out of position, surgery is usually required. The incidence of proximal humerus fractures is 4% to 5% of 1all fractures. The classification of proximal humerus fractures has always suffered from poor intra and interobserver reliability 6, 7. Current concepts in locking plate fixation of proximal humerus fractures christoph j. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken. Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or it involves. Proximal humeral fractures occur most commonly in older adults, and their incidence is increasing. Century with internal fixation for displaced fractures. Warner, md p roximal humerus fractures are common, and about 80% are well managed nonsurgically. Internal fixation of proximal humerus fractures using the. Proximal humeral fracture radiology reference article. Displaced and unstable two to fourpart fractures of the proximal humerus.
Proximal humeral fractures account for 5% of all fractures and constitute the third most frequent fracture in elderly patients, with substantial economic effect on health care systems 14. Internal fixation of proximal humeral fractures with locking. Open reduction internal fixation for proximal humerus fractures. Evaluation and management of pediatric proximal humerus fractures. Internal fixation of fractures of the proximal humerus with. Treatment of a pediatric ttype intercondylar humerus. Results of treatment of proximal humerus fractures using locking plates.
This is an enhanced pdf from the journal of bone and joint surgery. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures article in journal of pediatric orthopedics 316. Werner1, hanspeter simmen1 and georg osterhoff1 abstract. Proximal humerus fractures account for 45% of all fractures 1,2 71% of these occur in patients over the age of 60 3,4 highenergy trauma is the most common cause in. Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. The purpose of the current study is to evaluate the technique of closed reduction and percutaneous pinning of proximal humeral fractures and to determine whether this technique provides enough stability to permit early active range of motion and subsequent fracture healing. Finite elementpredicted effects of screw configuration in. Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Epidemiology proximal humeral fractures represent around 5% of all fractures they are most common in. Feb 03, 2020 a proximal humerus fracture is a crack or break in the top of your upper arm bone. To analyze the clinical results after proximal humerus fracture fixation using blocked plates and screws. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries.
A fracture of the proximal humerus can separate one, two, or three of the four major segments from the rest, therefore codman classified proximal humerus fractures as 2part, 3part and 4part fractures. Surgical reduction and fixation of tibial spine fractures in. Outcome of proximal humerus fractures treated by philos plate internal fixation experience of a district general hospital article pdf available in acta orthopaedica belgica 745. Outcome of locking plate fixation for proximal humerus fractures neil rohra1, jimmy chokshi1, rishi sanghavi2 methods. Pdf percutaneous elastic fixation of proximal humeral. Percutaneous fixation of proximal humeral fractures.
What is the single most important technical aspect when. Among proximal fractures, 80% are onepart, 10% are twopart, and the remaining 10% are three and fourpart. Hemiarthroplasty, plate fixation, proximal humeral fracture, reverse arthroplasty, shoulder fracture view abstract download pdf. Fractures of the proximal humerus are common injuries, accounting for 4% to 5% of all fractures.
Proximal humerus fractures account for 45% of all fractures and are the third most common fracture in the elderly behind fractures of the distal radius and hip horak and nilsson, 1975, baron et al. Open reduction and locking plate fixation for proximal humerus fractures. The stability of percutaneous fixation of proximal humeral fractures article in the journal of bone and joint surgery 92 suppl 2. Long term results of percutaneous fixation of proximal. Open reduction, retention, and fixation of proximal humeral fractures using a locking plate. The most used classification of these fractures was. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone.
Closed reduction and percutaneous annulated screw fixation. Lateral approach to proximal humerus fracture fixation youtube. Pathologic fractures are our only indication for intramedullary fixation of these fractures. We present a clinical prospective study evaluating this implant for proximal.
The most common location of proximal fractures is at the surgical neck of the humerus. Fractures of the proximal humerus represent 4%5% of all fractures. Therefore, compressing inter fracture fragments is of great importance for restoring postoperative motor function. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. The shoulder is a ball and socket joint and you have fractured just below the ball part. Sep 25, 2017 especially in fractures with medial comminution, the following principles have become important in order to increase the stability of locking plate fixation of proximal humerus fractures. Three and fourpart fractures hemiarthroplasty of the proximal humerus is indicated in older patients for the treatment of most fourpart and head split fractures, and selected threepart fractures with moderate comminution and osteoporosis. Proximal humeral fractures are witnessed mainly in the elderly population, with the highest prevalence being 405 per 100,000 in those patients aged over 70 years. Proximal humeral fractures account for 4% to 5% of all fractures, particularly afflicting osteoporotic elderly patients after lowenergy trauma. Introduction proximal humerus fractures have an incidence of 5% among all the fractures. Locked and minimallyinvasive plating is a promising treatment option. Posterior humeral circumflex artery provides 64% of the blood supply to the humeral head possible explanation for relatively low rates of avn with displaced proximal humerus fractures. The purpose of this study was to determine the midterm results of our multicenter case series of proximal humeral fractures treated with percutaneous fixation. Fractures of the proximal humerus extending in the humeral diaphysis use a long nail.
Multiple basic science studies have demonstrated the dangers of percutaneous pinning of proximal humerus fractures kamineni et al. Gruson albert einstein college of medicine benjamin zmistowski the rothman institute jay keener washington university school of medicine in st. Zuckerman and douglas murray complications associated with proximal humerus fractures can occur at the time of injury or during treatment. Internal fixation of proximal humeral fractures using the. The restoration of a painless shoulder with satisfactory function is the goal of treatment. Our hypothesis was that reverse total shoulder arthroplasty tsa yields better clinical results compared with open reduction and internal fixation orif using an angular stable plate. There were 21 type ii, 16 type iii, and four type iv fractures. The operative or nonoperative management of these complications is determined by the symptoms attributed to the complication itself.
It is the most common fracture of the shoulder region. Proximal humerus, paediatric patient, retrograde elastic stable intramedullary nailing. Surgical fixation of proximal humerus fractures is typically a hospital. Proximal humerus fractures are common injuries in the elderly. Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. Percutaneous fixation of proximal humeral fractures youtube. Proximal humerus fracturedislocation managed by miniopen. Like all bones in the body, the proximal end of the humerus will break if sufficient force is directed towards it. Percutaneous treatment of proximal humerus fractures peter j. Fractures of the humerus can occur proximally, in the shaft diaphysis, or distally. Four part fractures of the neck of the ler7 for adolescent proximal humeral epiphyseal humerus. Screw cutout through weak cancellous bone of the humeral head, which ultimately results in collapse of the fixed fracture, is the leading cause of failure and revision surgery. Index terms locking compression plate, fractures fixation, proximal humerus fracture, internal fixation, osteoporosis i. Jun 28, 2017 by jack kazanjian, do, faoao, clinical assistant professor of orthopaedic surgery, pcom from the 9th annual philadelphia orthopaedic trauma symposium june 9, 2017, lewis katz school of medicine at.
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