The Experts below are selected from a list of 159 Experts worldwide ranked by ideXlab platform
G. Campochiaro - One of the best experts on this subject based on the ideXlab platform.
-
hertel 7 Fracture of the Humeral Head can two different fixation systems diphos php lead to different outcomes a retrospective study
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Stefano Gumina, P. Baudi, V. Candela, G. CampochiaroAbstract:Abstract Objective To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 Humeral Head Fractures treated with two different locking plates. Materials and Methods A total of 52 patients with type 7 Humeral Head Fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded. Results The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p > 0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p > 0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the Humeral Head in each group, and a secondary screw perforation in a patient treated with Diphos. Conclusions In patients with Hertel 7 proximal Humeral Fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of Fracture.
-
Hertel 7 Fracture of the Humeral Head. Can two different fixation systems (Diphos/PHP) lead to different outcomes? A retrospective study.
Injury, 2016Co-Authors: S. Gumina, P. Baudi, V. Candela, G. CampochiaroAbstract:To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 Humeral Head Fractures treated with two different locking plates. A total of 52 patients with type 7 Humeral Head Fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded. The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p>0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p>0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the Humeral Head in each group, and a secondary screw perforation in a patient treated with Diphos. In patients with Hertel 7 proximal Humeral Fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of Fracture. Copyright © 2016. Published by Elsevier Ltd.
-
Hertel 7 Fracture of the Humeral Head. Can two different fixation systems (Diphos/PHP) lead to different outcomes? A retrospective study.
Injury, 2016Co-Authors: Stefano Gumina, P. Baudi, V. Candela, G. CampochiaroAbstract:Abstract Objective To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 Humeral Head Fractures treated with two different locking plates. Materials and Methods A total of 52 patients with type 7 Humeral Head Fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded. Results The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p > 0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p > 0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the Humeral Head in each group, and a secondary screw perforation in a patient treated with Diphos. Conclusions In patients with Hertel 7 proximal Humeral Fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of Fracture.
David E Asprinio - One of the best experts on this subject based on the ideXlab platform.
-
Humeral Head Fracture dislocation with displacement into the mediastinum a case report
Journal of Bone and Joint Surgery American Volume, 2021Co-Authors: Avinesh Agarwalla, Nathaniel Rawicki, Tracey L Weigel, David E AsprinioAbstract:CASE A 70-year-old woman pedestrian struck by a motor vehicle presented with multiple orthopaedic injuries including a Humeral Head Fracture dislocation with a large segment of Humeral Head located in the mediastinum. Thoracic surgery personnel performed a minimally-invasive video-assisted thoracoscopic extraction of the Humeral Head, and the patient underwent subsequent reverse total shoulder arthroplasty. CONCLUSION Intramediastinal displacement of the Humeral Head is a rare, yet serious traumatic injury that necessitates early recognition and comanagement with cardiothoracic or thoracic surgery. Early thoracic intervention to extract the Humeral Head and replacement arthroplasty is an effective treatment modality.
Franz Kralinger - One of the best experts on this subject based on the ideXlab platform.
-
The effect of in situ augmentation on implant anchorage in proximal Humeral Head Fractures.
Injury, 2012Co-Authors: Stefan Unger, Stefanie Erhart, Franz Kralinger, Michael Blauth, Werner SchmoelzAbstract:Abstract Introduction Fracture fixation in patients suffering from osteoporosis is difficult as sufficient implant anchorage is not always possible. One method to enhance implant anchorage is implant/screw augmentation with PMMA-cement. The present study investigated the feasibility of implant augmentation with PMMA-cement to enhance implant anchorage in the proximal humerus. Materials and methods A simulated three part Humeral Head Fracture was stabilised with an angular stable plating system in 12 pairs of humeri using six Head screws. In the augmentation group the proximal four screws were treated with four cannulated screws, each augmented with 0.5 ml of PMMA-cement, whereas the contra lateral side served as a non-augmented control. Specimens were loaded in varus-bending or axial-rotation using a cyclic loading protocol with increasing load magnitude until failure of the osteosynthesis occurred. Results Augmented specimens showed a significant higher number of load cycles until failure than non-augment specimens (varus-bending: 8516 (SD 951.6) vs. 5583 (SD 2273.6), P = 0.014; axial-rotation: 3316 (SD 348.8) vs. 2050 (SD 656.5), P = 0.003). Non-augmented specimens showed a positive correlation of load cycles until failure and measured bone mineral density (varus-bending: r = 0.893, P = 0.016; axial-rotation: r = 0.753, P = 0.084), whereas no correlation was present in augmented specimens (varus-bending: r = 0,258, P = 0.621; axial-rotation r = 0.127, P = 0.810). Conclusion These findings suggest that augmentation of cannulated screws is a feasible method to enhance implant/screw anchorage in the Humeral Head. The improvement of screw purchase is increasing with decreasing bone mineral density.
-
Predicting failure after surgical fixation of proximal humerus Fractures
Injury, 2011Co-Authors: Dietmar Krappinger, Nicola Bizzotto, Stephan Riedmann, Christian Kammerlander, Clemens Hengg, Franz KralingerAbstract:Abstract Background Several studies reported high failures rates after internal fixation of proximal humerus Fractures. Loss of reduction and screw cut-out are the most common reasons for revision surgery. Several risk factors for failure have been described in the literature. The aim of the present study was to assess risk factors for failure after surgical fixation of unstable proximal humerus Fractures in a multivariate setup. Methods Two different surgical techniques (PHILOS locking plate and Humerusblock) were used. In the PHILOS group, every kind of postoperative relative movement between the implant and the Humeral Head or shaft was defined as failure. In the Humerusblock group, postoperative movement between the Humeral Head and the shaft in terms of angulation or translational displacement was defined as failure. The following parameters were assessed: age, gender, cancellous bone mineral density (BMD) of the Humeral Head, Fracture type, medial metaphyseal comminution, medial metaphyseal Head extension, initial angulation of the Humeral Head in the frontal plane, initial anteversion of the Humeral Head, medial hinge displacement, maximum displacement of the tuberosities with respect to the Head, surgical technique, anatomic reconstruction and restoration of the medial cortical support. Results The following parameters were found to have a significant influence on the failure rate: age, local BMD, anatomic reduction, and restoration of the medial cortical support. The failure rate significantly increased with the number of risk factors. Conclusion Preoperative assessment of the local BMD and the patients’ biological age as well as intraoperative anatomic reduction and restoration of the medial cortical support are the essentials for successful surgical fixation of proximal humerus Fractures. Multifragmentary Fracture patterns in old patients with low local BMD are prone for fixation failure. If the surgeon is not able to achieve anatomic reduction and restoration of the medial cortical support intraoperatively in this situation, adjustments such as augmentation or primary arthroplasty should be considered.
Gertraud Gradl - One of the best experts on this subject based on the ideXlab platform.
-
Locking plate fixation of Humeral Head Fractures with a telescoping screw. A comparative biomechanical study versus a standard plate
Injury, 2011Co-Authors: Thomas Mittlmeier, Hans-werner Stedtfeld, Michael M. Morlock, Kay Sellenschloh, Klaus Püschel, Gertraud GradlAbstract:Abstract Objectives Locking plate fixation of Humeral Head Fractures bares the risk of glenoHumeral screw penetration. In order to circumvent this problem it is recommended to insert shorter locking screws having at least a 6 mm distance to the Humeral Head cortex. This in turn may reduce fixation stability and may lead to early varus displacement. One second frequent failure mechanism is cranial displacement of the greater tubercle. The study evaluates the biomechanical properties of a locking plate employing an additional telescoping screw that may enhance resistance to varus displacement. Screw in screw fixation of the greater tubercle may reduce the rate of cranial displacement. Methods In four paired fresh-frozen human cadaver humeri (age > 70 years) a Neer IV/3 Fracture was created with a 5 mm osteotomy gap simulating metaphyseal comminution. Limbs were randomly assigned to receive plate fixation with an additional telescoping screw (Humerus Tele Screw: HTS) and on the contralateral limb Philos plate fixation before biomechanical evaluation (MTS-Bionix 858.2). Standard locking screws were placed in both groups 6 mm below the radiological Head circumference; the telescoping screw was placed in the subchondral layer. The greater tubercle was fixed with an additional screw in both techniques, in the HTS group the screw was anchored in the sleeve of the telescrew (screw in screw fixation). Findings Fixation stability with a mean stiffness of 300.9 ± 28.8 N/mm in the HTS plate group proved to be significantly higher than in the Philos plate group (184.2 ± 23.4 N/mm; p = 0.006). The HTS plate also resisted higher loads in terms of fixation failure with loss of reduction at 290 ± 58.6 N in comparison to 205 ± 8.6 N for the Philos plate (p = 0.2). Displacement of the greater tubercle occurred in no case of the HTS plate group and in two out of four cases in the Philos plate group. Interpretation The HTS plate provides high fixation stability in an in vitro Humeral Head Fracture model and securely prevents displacement of the greater tubercle.
Markus S. Kuster - One of the best experts on this subject based on the ideXlab platform.
-
The position and number of screws influence screw perforation of the Humeral Head in modern locking plates: a cadaver study.
Journal of Orthopaedic Trauma, 2012Co-Authors: Johannes Erhardt, Karl Stoffel, Jorg Kampshoff, Nicole Badur, Piers Yates, Markus S. KusterAbstract:Objectives:Screw perforation of the Humeral Head in locking plate osteosynthesis occurs in up to 30% of cases. The current study compared different fixation possibilities (eg, number and position of screws) to reduce screw perforation in the Humeral Head.Methods:A Humeral Head Fracture with a missin
-
The position and number of screws influence screw perforation of the Humeral Head in modern locking plates: a cadaver study.
Journal of orthopaedic trauma, 2012Co-Authors: Johannes B Erhardt, Karl Stoffel, Jorg Kampshoff, Nicole Badur, Piers Yates, Markus S. KusterAbstract:Screw perforation of the Humeral Head in locking plate osteosynthesis occurs in up to 30% of cases. The current study compared different fixation possibilities (eg, number and position of screws) to reduce screw perforation in the Humeral Head. A Humeral Head Fracture with a missing medial support was created in 30 fresh-frozen cadavers and fixed with a polyaxial locking plate (NCB PH; Zimmer, Warsaw, IN). The constructs were loaded with increasing force and the number of cycles until screw perforation was recorded. Four different fixation methods were tested: group 1 five screws with fixed angle, group 2 five screws in polyaxial position according to bone strength, group 3 three screws, and group 4 five screws with 1 as an inferomedial support screw. More screws in the Humeral Head significantly increased the number of cycles before screw perforation. An inferomedial support screw further increased the number of cycles. Polyaxial screw placement compared with fixed-angle placement had no effect on the screw perforation phenomenon. We recommend to position an inferomedial support screw, and at least 5 screws in the Head fragment, when using a locking plate in proximal humerus Fractures with disrupted medial hinge.