Fractures of the proximal humerus constitute approximately 5% of all fractures. Shoulder joint injuries without any external mechanical impact during seizures with the occurrence of spasms occur only sporadically. The occurrence rate is reported in approximately 0.4% of patients. Very rarely they occur in the form of epileptic seizure-induced dorsal fracturedislocation impacting both sides. The case report describes a case of a 48-year-old woman with no treatment for epileptic seizures in her medical history. During the first seizure she sustained a bilateral dorsal fracture-dislocation caused by a muscle spasm, without any other mechanical impact. The fractures were classified as a 3-fragment fracture on the right side and a 4-fragment fracture on the left side. After the patient's admission to the inpatient emergency department, reduction under anaesthesia was attempted. Subsequently, after preparation, open reduction and osteosynthesis using an angularly stable plate were performed as a two-stage surgery. No complications were observed postoperatively Currently, at 3 years after surgeries, the female patient has full mobility of her shoulder joints with no subjective difficulties. Key words: epilepsy, seizure, dorsal fracture-dislocation of the proximal humerus.
- MeSH
- dislokovaná fraktura chirurgie MeSH
- epilepsie etiologie MeSH
- fraktury proximálního humeru * chirurgie komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace ramenního kloubu chirurgie etiologie MeSH
- vnitřní fixace fraktury metody MeSH
- záchvaty etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
Fractures of the proximal humerus present a unique challenge in orthopedic practice due to the complex anatomy and biomechanical complexity of this region. The spectrum of injuries occurring here ranges from nondisplaced stable fractures to complex displaced fractures or fracture-dislocations. Historically, the treatment of these fractures has been the subject of much debate and treatment modalities have mainly involved a conservative approach, with surgical management being relatively rare. In recent decades, there has been a paradigm shift in the treatment of proximal humerus fractures not only due to advances in surgical techniques, but especially with the development of new types of angular-stable implants and modern total arthroplasties. The development and availability of high-quality imaging techniques have enabled better understanding of the nature of fractures and precise planning of surgical interventions. The main goals of treatment include restoration of function, pain relief and prevention of complications such as prolonged healing or non-healing and avascular necrosis. An individualized approach to each individual patient, considering all factors that affect the final outcome, appears to be essential in the choice of treatment. The aim of this review article is to provide an up-to-date overview of the current concept of treatment of proximal humerus fractures. Trends in nonoperative and operative treatment strategies, indications for each type of treatment, operative techniques, outcomes, and complications associated with each approach are summarized.
- Klíčová slova
- Arthroplasty, fracture, osteoporosis, proximal humerus, trauma, upper limb,
- MeSH
- fraktury proximálního humeru * chirurgie diagnostické zobrazování terapie MeSH
- lidé MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY Unsatisfactory functional results following hemiarthroplasty (HA) are seen in the treatment of 3- and 4-part proximal humeral fractures due to tuberosity healing problems and rotator cuff tears. Reverse shoulder arthroplasty (RSA) has been popular for improving functional outcomes. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures in the elderly. MATERIAL AND METHODS Patients over 60 years of age with three- or four-part proximal humeral fractures were included in the study. Twenty-five patients were treated with HA and 33 patients with RSA. The patients were evaluated with/using the American Shoulder and Elbow Surgeons (ASES) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements of HA and RSA patients were compared. RESULTS The mean age of the patients was 66 (60-85) years in the HA group and 73 (60-83) years in the RSA group. The mean ASES and Constant scores were 44.6 and 70 (p=0.06), 24 and 49 (p=0.022), respectively. The mean active abduction was measured as 50° and 90° (p=0.001), flexions as 70° and 120° (p=0.02), and external rotation as 30° and 50° (p=0.210), respectively. CONCLUSIONS In the treatment of three- or four-part proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. Key words: proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty.
- MeSH
- artroplastika ramenního kloubu * MeSH
- fraktury proximálního humeru * chirurgie MeSH
- hemiartroplastika * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- ramenní kloub * chirurgie MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Intramedullary nailing is already established technique for the treatment of two and three-part fractures of proximal humerus. The aim of the study was to prospectively evaluate the efficacy and functional outcome after treatment of four-part fractures of proximal humerus with Multiloc proximal humeral nail. DESIGN: prospective monocentric cohort study. SETTING: single level 1 traumacenter. MATERIALS AND METHODS: From February 2011 to March 2016, 40 patients with displaced four-part proximal humeral fractures were treated with intramedullary nail inserted through anterolateral approach. Minimum one year follow up completed 35 patients and were involved into the study. RESULTS: After mean follow up period of 25.8 months 29 of 35 fractures healed. Average absolute Constant score in all 35 patients reached 57.7 points, relative side related Constants score 66.8% of contralateral extremity. Together there were 20 complications. in 6 cases (17%) developed complete avascular necrosis of the head. One deep infection was treated by implantation of antibiotic cement discs. Twelve secondary surgeries were performed, mostly for avascular necrosis development. Function and pain were significantly influenced by the quality of fracture reduction (p < 0.05) and development of complete AVN (p = 0.001). Group of 29 patients without AVN reached relative Constant score 73% of contralateral extremity. CONCLUSIONS: Intramedullary nailing can be used as possible fixation technique for the treatment of four-part fractures of proximal humerus. In experienced hands provides nailing osteosynthesis similar results as reconstruction with locking plates. Appropriate reduction of fracture fragments is the key for good functional result. LEVEL OF EVIDENCE: Level 2b - monocentric prospective cohort study.
- Klíčová slova
- Four-Part fracture, Intramedullary nailing, Multiloc PHN, Proximal humerus,
- MeSH
- dospělí MeSH
- fraktury proximálního humeru diagnostické zobrazování patologie chirurgie MeSH
- hojení fraktur fyziologie MeSH
- intramedulární fixace fraktury metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteonekróza diagnostické zobrazování patologie MeSH
- prospektivní studie MeSH
- rentgendiagnostika MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Treatment of comminuted three- and four-part displaced proximal humerus fractures continues to be discussed in daily trauma practice. In fractures with metaphyseal comminuted fractures the anatomical reconstruction is often technically unfeasible. For cases of comminuted metaphyseal proximal humerus fractures we proposed the so called non-anatomical reconstruction with simple osteosynthesis. Even today, when nailing and plating are commonly used in osteosynthesis, the non-anatomical reconstruction plays an irreplaceable role. Its application is conditioned by at least partially preserved vascular blood supply of the head fragment. This paper describes our original technique to manage these fractures and provides an evaluation of results of the group of patients in whom this procedure was performed. MATERIAL AND METHODS Our group included a total of 72 patients (who underwent surgery in the period from 1 January 1989 to 22 March 2016), of whom 57 were clinically assessed (8 patients died, 7 patients failed to be traced back). The mean age at the time of procedure was 53.61 years (range 19-81 years). The mean follow-up was 14.3 years (range 0.3-26.3 years) after the surgery. The method consists in removing the comminution zone, impacted modified diaphyseal fragment to head spongiosis and osteosynthesis of greater and lesser tubercle or their remainders to diaphyseal fragment using tensile cerclage. RESULTS The mean post-operative Constant score was 81.4 (range 30-100 points). The mean abduction was 120.4 degrees (range 60-165 degrees) and ventral flexion was 129.2 degrees (range 70-170 degrees). Excellent clinical outcome according to the Constant score was achieved in 19 patients, good outcome in 23 patients, fair in 8 patients and poor in 7 patients. DISCUSSION We have been using our original method for 27 years. Compared to osteosynthesis by locking plates, minimally invasive procedures and trauma shoulder joint replacement, our method helps achieve very good clinical outcomes. Its main advantage, however, is the fact that by this technique the specific type of fractures can be treated, otherwise manageable exclusively by arthroplasty. CONCLUSIONS At our clinic, the non-anatomical reconstruction belongs to irreplaceable methods for treating certain proximal humerus fractures. The clinical outcomes of this method can be described as very good. The method of non-anatomical reconstruction eliminates the disadvantages and risks of arthroplasty. Nonetheless, it shall be stressed that this method can be successful exclusively when applied to precisely indicated types of fractures and when performed with technical precision. Its another advantage are the minimal financial requirements. Key words: non-anatomical reconstruction, osteosynthesis, proximal humerus, cerclage.
- MeSH
- fraktury proximálního humeru * diagnóza patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace diagnóza MeSH
- poranění ramene * diagnostické zobrazování chirurgie MeSH
- ramenní kloub patofyziologie chirurgie MeSH
- rozsah kloubních pohybů MeSH
- tříštivé fraktury MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
INTRODUCTION: A typical feature of inferior glenoid fractures is a distal fragment separated from the glenoid fossa. In most cases, the inferior glenoid fractures are associated with a fracture of the scapular body. However, there are no detailed studies of inferior glenoid fractures, and only brief mentions can be found in the literature in this respect. MATERIAL AND METHODS: The basic group comprised 42 patients, with the mean age of 48 years, who sustained 42 fractures of the inferior glenoid. In this group, the scapular fracture anatomy was evaluated, based on 3D CT reconstructions. A total of 29 patients operated on were followed up for 12 to 128 months after injury (average, 52 months), three patients were lost to follow up. The results of the operative treatment, including complications, were assessed radiologically and functionally. RESULTS: Fracture anatomy was described from various aspects, i.e., the size of the articular surface carried by the separated glenoid fragment, the existence of multiple articular fragments, the size of the separated glenoid fragment and the extent of injury to the scapular body. All 29 operatively treated fractures radiologically healed within three months. Full and pain-free range of motion was restored in 18 patients; in eight patients it was limited by 20 degrees and in three patients by more than 40 degrees. The mean Constant score was 82. CONCLUSION: Fractures of the inferior glenoid fossa requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment.
- Klíčová slova
- Glenoid fossa fractures, Inferior glenoid, Operative treatment, Scapular fractures,
- MeSH
- dospělí MeSH
- fraktury proximálního humeru diagnostické zobrazování chirurgie MeSH
- kloubní jamka lopatky diagnostické zobrazování zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie metody MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky metody MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Treatment algorithms of proximal humerus fractures are still controversially discussed. The enthusiasm towards operative treatment after the introduction of locking implants, has not been justified by the functional results in the elderly population. The majority of those fractures in the geriatric patients can be successfully treated conservatively. Thorough clinical and radiological examination for fracture analysis, dynamic stability control with the use of an image intensifier, and meticulous reduction, in addition with the appropriate orthesis for its retention and rehabilitation, are the keys for the successful treatment of the proximal humerus fracture in the elderly patient. The present review reports on the main treatment aspects of proximal humerus fractures in the geriatric population and proposes a treatment algorithm.
- MeSH
- algoritmy MeSH
- fixace fraktur metody MeSH
- fraktury proximálního humeru diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- protetické prostředky MeSH
- senioři MeSH
- vylepšení rentgenového snímku metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
INTRODUCTION: Chronic osteomyelitis is a serious chronic condition that frequently results in permanent after-effects. Treatment is complex, lengthy and costly. MATERIAL AND METHODS: Between the beginning of 2003 and the end of 2010, 438 operations of the proximal humerus were performed at our department using either angle-stable osteosynthesis or hemiarthroplasty. In four cases out of this group of patients, deep tissue infection affecting the bone developed. These four patients were treated with arthrodesis of the shoulder joint using an external fixation device. Arthrodesis was also the treatment method in a patient who previously received conservative treatment but developed chronic osteomyelitis. RESULTS: Healing of the infectious focus along with the formation of stable, painless shoulder was achieved in all five patients, with the arthrodesis offering full support for the limbs periphery. CONCLUSION: The above method represents an alternative to reverse arthroplasty of the shoulder joint usually performed after infection is cured. While function of the limb usually worsens after arthrodesis, the risk of recurring inflammation is substantially lower.
- MeSH
- artrodéza metody MeSH
- dospělí MeSH
- externí fixátory * MeSH
- fixace fraktur metody MeSH
- fraktury proximálního humeru chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ramenní kloub chirurgie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Locking Compression Plate (LCP) has the advantageous feature that screws can be locked in the plate leaving an angular stable construct. There is no need to have contact between the plate and the bone to achieve stability resulting from friction of the plate-bone-construct. Therefore the plate does not need to be contoured exactly to the bone and the healing bone's periosteal blood supply is not affected. The LCP is used as a bridging plate to gain relative stability in multi-fragmentary, diaphyseal or metaphyseal fractures. Depending on the fracture, the combination hole can also allow the LCP to achieve absolute stability similar to conventional fixation techniques. Osteoporotic fractures have significant impact on morbidity and mortality. Proximal humeral and distal radius fractures are typical examples. These osteoporotic and often comminuted fractures are ideal settings/indications for LCP utilization in the upper extremity. However, the data quality is due to mostly small study populations not so powerful. Unquestionably there has been a clear and fashionable trend to choose operative treatment for these fractures, because the angular stability allows stable fixation and early functional mobilization.
- MeSH
- fraktury humeru chirurgie MeSH
- fraktury proximálního humeru chirurgie MeSH
- fraktury vřetenní kosti chirurgie MeSH
- kostní destičky * MeSH
- kostní šrouby MeSH
- lidé MeSH
- osteoporotické fraktury chirurgie MeSH
- poranění paže chirurgie MeSH
- tříštivé fraktury chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Fractures of the proximal humerus commonly affect elderly patients. The vast majority of proximal humeral fractures result from low-energy trauma in presence of osteoporosis. Incidence of proximal humeral fractures dramatically increased over the last decades. Recent epidemiological studies expect a rather stagnant incidence. Diversity of fracture types attenuates reliability of available classification systems. Even though, predictive morphologic criteria have been detected enabling a prognostic assessment. A short or absent metaphyseal head extension and disruption of the medial periosteal hinge reliably predict ischemia of the humeral head fragment. Still, humeral head necrosis may be prevented in early reduction and fixation. The range of treatment options consists of non-operative therapy, minimal-invasive osteosynthesis, open reduction and plate fixation, intramedullary nailing and primary arthroplasty. Most proximal humeral fractures in the elderly are stable injuries and can be successfully treated by non-operative means. Operative treatment of displaced, unstable fractures should resort to the least invasive procedure providing adequate reduction and fixation stability. To date, open reduction and locking plate osteosynthesis represents the standard operative procedure in displaced three- and four-part fractures. However, a number of risk factors may promote fixation failure or impair functional outcome, most important low local bone mineral density, residual varus displacement of the humeral head, insufficient restoration of medial calcar support, humeral head ischemia and insufficient fracture reduction. Innovation of fixation techniques (e. g. angular stable locking systems and bone augmentation) will further expand indications for operative fracture treatment. Outcome of hemiarthroplasty is closely related to anatomical tuberosity healing and restoration of rotator cuff function. Reverse shoulder arthroplasty may provide satisfactory shoulder function in geriatric patients, rotator cuff dysfunction or failure of first-line treatment. Choice of treatment should be individualized and base on careful evaluation of patient-specific, fracture-specific and surgeon-specific aspects.
