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Surena Namdari - One of the best experts on this subject based on the ideXlab platform.
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outcomes of open reduction and internal fixation of Proximal Humerus Fracture dislocations
Journal of Shoulder and Elbow Surgery, 2021Co-Authors: Eric M Padegimas, Thema Nicholson, Gerard Chang, Jonah Hebertdavies, Surena NamdariAbstract:Abstract Introduction Proximal humeral Fracture with associated glenohumeral dislocation (PHFD) is a challenging clinical problem. Outcomes of open reduction, and internal fixation (ORIF) of these injuries has not been widely reported. The purpose of this analysis is to report our experience with ORIF of PHFD. Methods Retrospective review of our two institutions’ shoulder surgery databases was conducted to identify all PHFDs that were treated with ORIF from 2008 through 2017. Radiographs were reviewed for Fracture healing by twelve weeks postoperatively. All reoperations were recorded. Patient-reported outcomes Simple Shoulder Test [SST] and American Shoulder and Elbow Surgeons [ASES] score at minimum two-year follow-up were recorded. Results There were twenty PHFDs identified: they were 50% male, 55.8±10.3-years-old (range 31.3-66.3), and BMI 29.3±8.2 (15.2-47.8). Seven (35%) patients experienced varus collapse, nonunion, or avascular necrosis and six (30%) patients underwent reoperation. Of the 17 patients that did not go onto revision or arthroplasty, 14 (82.3%) had patient-reported outcomes at 4.9±2.2 years (2.3-8.8) follow-up. These patients had an average SST 8.0±4.0 yes responses (0-12) and ASES of 71.6±20.4 (20.2-94.9). Conclusion ORIF of PHFD carries a high rate of reoperation. In patients who achieve healing, functional scores are satisfactory. This information is important for proper patient counseling prior to surgery.
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outcomes of open reduction and internal fixation of Proximal Humerus Fracture dislocations
Journal of Shoulder and Elbow Surgery, 2021Co-Authors: Eric M Padegimas, Thema Nicholson, Gerard Chang, Jonah Hebertdavies, Surena NamdariAbstract:Introduction Proximal humeral Fracture with associated glenohumeral dislocation (PHFD) is a challenging clinical problem. Outcomes of open reduction and internal fixation (ORIF) of these injuries have not been widely reported. The purpose of this analysis is to report our experience with ORIF of PHFD. Methods A retrospective review of our 2 institutions’ shoulder surgery databases was conducted to identify all PHFDs that were treated with ORIF from 2008 through 2017. Radiographs were reviewed for Fracture healing by 12 weeks postoperatively. All reoperations were recorded. Patient-reported outcomes using Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores at a minimum 2-year follow-up were recorded. Results There were 20 PHFDs identified: they were 50% male, 55.8 ± 10.3 years old (range 31.3-66.3), and had a body mass index of 29.3 ± 8.2 (15.2-47.8). Seven (35%) patients experienced varus collapse, nonunion, or avascular necrosis and 6 (30%) patients underwent reoperation. Of the 17 patients who did not go on to revision or arthroplasty, 14 (82.3%) had patient-reported outcomes at a mean follow-up of 4.9 ± 2.2 years (2.3-8.8). These patients had an average SST 8.0±4.0 yes responses (0-12) and ASES scores of 71.6 ± 20.4 (20.2-94.9). Conclusion ORIF of PHFD carries a high rate of reoperation. In patients who achieve healing, functional scores are satisfactory. This information is important for proper patient counseling prior to surgery.
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failure to restore the calcar and locking screw cross threading predicts varus collapse in Proximal Humerus Fracture fixation
Journal of Shoulder and Elbow Surgery, 2020Co-Authors: Eric M Padegimas, Gerard Chang, Kamran Namjouyan, Surena NamdariAbstract:Background Varus collapse is a common failure mode of Proximal Humerus Fracture (PHF) fixation. The purpose of this study was to analyze predictors of varus collapse of PHF after open reduction, internal fixation (ORIF). Methods All patients who underwent ORIF of a PHF from January 2008 to July 2018 were identified. Known predictors of fixation failure were assessed, including calcar distance, calcar ratio, and calcar restoration. Additionally, the presence of cross-threaded screws was determined. The primary outcome analyzed was varus collapse of the Fracture defined as a change in neck shaft angulation to less than 120°. Results There were 112 patients identified who underwent ORIF of a PHF that met inclusion criteria. The population was 75.0% female (84/112), average age was 62.5 ± 10.4 years (range 40.0-87.9), and average body mass index was 28.0 ± 5.5 (17.5-46.4). There were 17 with varus collapse. In 11 of the 17 patients (64.7%), there was screw cross-threading (vs. 31/95 [32.6%] in those that did not collapse); P = .012. In addition, 8 of the 17 (47.1%) did not have restoration of the calcar (vs. 16/95 [16.8%]; P = .005). Conclusion This study identifies 2 surgeon-controlled variables that can contribute to varus collapse after ORIF of PHFs. Cross-threading of locking screws and failure to restore the medial calcar can be a function of implant design, surgeon technical skill, and/or bone quality.
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late onset radial nerve palsy after closed treatment of a periprosthetic Humerus Fracture a case report
Journal of Bone and Joint Surgery American Volume, 2020Co-Authors: Rocco Bassora, Andrew W Beharrie, Vito Christopher Inzerillo, Surena Namdari, Joseph A AbboudAbstract:CASE: A 58-year-old woman underwent successful reverse total shoulder arthroplasty for a Proximal Humerus Fracture. Three years later, she sustained a periprosthetic Humerus Fracture after a fall and was treated conservatively. She healed with an abundance of callus and subsequently developed delayed-onset radial nerve palsy at 3 months, despite minimal change in humeral alignment and avoidance of the use of any compressive external braces or splints. CONCLUSIONS: Minimally displaced periprosethetic Humerus Fractures can lead to delayed radial nerve palsy from callus entrapment, and there should be increased awareness of this potential complication when counseling and treating patients conservatively.
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calcar screw position in Proximal Humerus Fracture fixation don t miss high
Injury-international Journal of The Care of The Injured, 2018Co-Authors: Samir Mehta, Jennifer Sanville, Matthew Chin, Surena Namdari, Michael W HastAbstract:Abstract Introduction In locked plate fixation of Proximal Humerus Fractures, the calcar is an important anchor point for screws providing much-needed medial column support. Most locking plate implants utilize a fixed-trajectory locking screw to achieve this goal. Consequently, adjustments of plate location to account for patient-specific anatomy may result in a screw position outside of the calcar. To date, little is known about the consequences of “missing” the calcar during plate positioning. This study sought to characterize the biomechanics associated with Proximal and distal placement of locking plates in a two-part Fracture model. Materials and methods This experiment was performed twice, first with elderly cadaveric specimens and again with osteoporotic sawbones. Two-part Fractures were simulated and specimens were divided to represent Proximal, neutral, and distal plate placements. Non-destructive torsional and axial compression tests were performed prior to an axial fatigue test and a ramp to failure. Torsional stiffness, axial stiffness, humeral head displacement and stiffness during fatigue testing, and ultimate load were compared between groups. Results Cadavers: Proximal implant placement led to trends of decreased mechanical properties, but there were no significant differences found between groups. Sawbones: Distal placement increased torsional stiffness in both directions (p = 0.003, p = 0.034) and axial stiffness (p = 0.018) when compared to Proximal placement. Distal placement also increased torsional stiffness in external rotation (p = 0.020), increased axial stiffness (p = 0.024), decreased humeral head displacement during fatigue testing, and increased stiffness during fatigue testing when compared to neutral placement. Discussion The distal and neutral groups had similar mechanical properties in many cadaveric comparisons while the Proximal group trended towards decreased construct stiffness. Results from the Sawbones model were more definitive and provided further evidence that Proximal calcar screw placements are undesirable and distal implant placement may provide improved construct stability. Conclusion Successful Proximal Humerus Fracture reconstruction is inherent upon anatomic Fracture reduction coupled with medial column support. Results from this experiment suggest that missing the calcar Proximally is deleterious to fixation strength, while it is safe, and perhaps even desirable, to aim slightly distal to the intended target.
James V Nepola - One of the best experts on this subject based on the ideXlab platform.
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case report and literature review anterior shoulder dislocation with three part Proximal Humerus Fracture and humeral shaft Fracture
The Iowa orthopaedic journal, 2009Co-Authors: John H Flint, Laura M Carlyle, Cory C Christiansen, James V NepolaAbstract:Dislocation of the shoulder and Proximal Humerus Fracture with coexistent humeral shaft Fracture is a rare injury reported in literature. There have been a total of 20 cases reported in the literature since 19401-13 (see Table 1). These injuries often occur as a result of high velocity trauma and most have been treated, at least partially, with invasive or operative management. We present the case of a woman with an anterior dislocation, three-part Proximal Humerus Fracture and concomitant Humerus shaft Fracture and discuss her non-invasive treatment.
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case report and literature review anterior shoulder dislocation with three part Proximal Humerus Fracture and humeral shaft Fracture
The Iowa orthopaedic journal, 2009Co-Authors: John H Flint, Laura M Carlyle, Cory C Christiansen, James V NepolaAbstract:Dislocation of the shoulder and Proximal Humerus Fracture with coexistent humeral shaft Fracture is a rare injury reported in literature. There have been a total of 20 cases reported in the literature since 19401-13 (see Table 1). These injuries often occur as a result of high velocity trauma and most have been treated, at least partially, with invasive or operative management. We present the case of a woman with an anterior dislocation, three-part Proximal Humerus Fracture and concomitant Humerus shaft Fracture and discuss her non-invasive treatment. TABLE 1 This table reviews the reported Proximal Humerus Fracture-dislocations with associated Humerus Fractures, their treatment and outcome.
Eric M Padegimas - One of the best experts on this subject based on the ideXlab platform.
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outcomes of open reduction and internal fixation of Proximal Humerus Fracture dislocations
Journal of Shoulder and Elbow Surgery, 2021Co-Authors: Eric M Padegimas, Thema Nicholson, Gerard Chang, Jonah Hebertdavies, Surena NamdariAbstract:Abstract Introduction Proximal humeral Fracture with associated glenohumeral dislocation (PHFD) is a challenging clinical problem. Outcomes of open reduction, and internal fixation (ORIF) of these injuries has not been widely reported. The purpose of this analysis is to report our experience with ORIF of PHFD. Methods Retrospective review of our two institutions’ shoulder surgery databases was conducted to identify all PHFDs that were treated with ORIF from 2008 through 2017. Radiographs were reviewed for Fracture healing by twelve weeks postoperatively. All reoperations were recorded. Patient-reported outcomes Simple Shoulder Test [SST] and American Shoulder and Elbow Surgeons [ASES] score at minimum two-year follow-up were recorded. Results There were twenty PHFDs identified: they were 50% male, 55.8±10.3-years-old (range 31.3-66.3), and BMI 29.3±8.2 (15.2-47.8). Seven (35%) patients experienced varus collapse, nonunion, or avascular necrosis and six (30%) patients underwent reoperation. Of the 17 patients that did not go onto revision or arthroplasty, 14 (82.3%) had patient-reported outcomes at 4.9±2.2 years (2.3-8.8) follow-up. These patients had an average SST 8.0±4.0 yes responses (0-12) and ASES of 71.6±20.4 (20.2-94.9). Conclusion ORIF of PHFD carries a high rate of reoperation. In patients who achieve healing, functional scores are satisfactory. This information is important for proper patient counseling prior to surgery.
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outcomes of open reduction and internal fixation of Proximal Humerus Fracture dislocations
Journal of Shoulder and Elbow Surgery, 2021Co-Authors: Eric M Padegimas, Thema Nicholson, Gerard Chang, Jonah Hebertdavies, Surena NamdariAbstract:Introduction Proximal humeral Fracture with associated glenohumeral dislocation (PHFD) is a challenging clinical problem. Outcomes of open reduction and internal fixation (ORIF) of these injuries have not been widely reported. The purpose of this analysis is to report our experience with ORIF of PHFD. Methods A retrospective review of our 2 institutions’ shoulder surgery databases was conducted to identify all PHFDs that were treated with ORIF from 2008 through 2017. Radiographs were reviewed for Fracture healing by 12 weeks postoperatively. All reoperations were recorded. Patient-reported outcomes using Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores at a minimum 2-year follow-up were recorded. Results There were 20 PHFDs identified: they were 50% male, 55.8 ± 10.3 years old (range 31.3-66.3), and had a body mass index of 29.3 ± 8.2 (15.2-47.8). Seven (35%) patients experienced varus collapse, nonunion, or avascular necrosis and 6 (30%) patients underwent reoperation. Of the 17 patients who did not go on to revision or arthroplasty, 14 (82.3%) had patient-reported outcomes at a mean follow-up of 4.9 ± 2.2 years (2.3-8.8). These patients had an average SST 8.0±4.0 yes responses (0-12) and ASES scores of 71.6 ± 20.4 (20.2-94.9). Conclusion ORIF of PHFD carries a high rate of reoperation. In patients who achieve healing, functional scores are satisfactory. This information is important for proper patient counseling prior to surgery.
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failure to restore the calcar and locking screw cross threading predicts varus collapse in Proximal Humerus Fracture fixation
Journal of Shoulder and Elbow Surgery, 2020Co-Authors: Eric M Padegimas, Gerard Chang, Kamran Namjouyan, Surena NamdariAbstract:Background Varus collapse is a common failure mode of Proximal Humerus Fracture (PHF) fixation. The purpose of this study was to analyze predictors of varus collapse of PHF after open reduction, internal fixation (ORIF). Methods All patients who underwent ORIF of a PHF from January 2008 to July 2018 were identified. Known predictors of fixation failure were assessed, including calcar distance, calcar ratio, and calcar restoration. Additionally, the presence of cross-threaded screws was determined. The primary outcome analyzed was varus collapse of the Fracture defined as a change in neck shaft angulation to less than 120°. Results There were 112 patients identified who underwent ORIF of a PHF that met inclusion criteria. The population was 75.0% female (84/112), average age was 62.5 ± 10.4 years (range 40.0-87.9), and average body mass index was 28.0 ± 5.5 (17.5-46.4). There were 17 with varus collapse. In 11 of the 17 patients (64.7%), there was screw cross-threading (vs. 31/95 [32.6%] in those that did not collapse); P = .012. In addition, 8 of the 17 (47.1%) did not have restoration of the calcar (vs. 16/95 [16.8%]; P = .005). Conclusion This study identifies 2 surgeon-controlled variables that can contribute to varus collapse after ORIF of PHFs. Cross-threading of locking screws and failure to restore the medial calcar can be a function of implant design, surgeon technical skill, and/or bone quality.
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defining optimal calcar screw positioning in Proximal Humerus Fracture fixation
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Eric M Padegimas, Cassandra Lawrence, Thema Nicholson, Aaron Palmquist, Benjamin Zmistowski, Surena NamdariAbstract:Background Anatomic reduction and placement of an inferior calcar screw are strategies to prevent fixation failure in Proximal Humerus factures. Optimal position of the calcar screw remains unknown. Methods There were 168 shoulders (68.5% female; average age, 63.6 ± 11.5 years) that underwent open reduction and internal fixation of a displaced Proximal Humerus Fracture involving the surgical or anatomic neck. Univariate and multivariate analyses were performed on preoperative clinical, preoperative radiographic, and postoperative radiographic variables to determine association with fixation failure. A receiver operating characteristic curve was performed to determine a maximum distance from the inferior screw to the calcar (“calcar distance”) as well as a maximum ratio of this distance and the head diameter (“calcar ratio”). Results There were 26 of 168 (15.5%) patients with radiographic failures (19 related to fixation failure). Univariate analysis and multivariate analyses found quality of reduction (P Conclusions Quality of reduction, calcar distance, and calcar ratio independently correlated with fixation failure. This study provides optimal distances and ratios for calcar screw placement that can be used clinically.
Hans E Berg - One of the best experts on this subject based on the ideXlab platform.
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operative versus non operative treatment for 2 part Proximal Humerus Fracture a multicenter randomized controlled trial
PLOS Medicine, 2019Co-Authors: Antti P Launonen, Bakir O Sumrein, Aleksi Reito, Vesa Lepola, Juha Paloneva, Kenneth B Jonsson, Olof Wolf, Peter Strom, Hans E BergAbstract:Background Although increasingly used, the benefit of surgical treatment of displaced 2-part Proximal Humerus Fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these Fractures. Methods and findings The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck Proximal Humerus Fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded. Conclusions This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part Fractures of the Proximal Humerus. These results suggest that the current practice of performing surgery on the majority of displaced Proximal 2-part Fractures of the Humerus in older adults may not be beneficial. Trial registration ClinicalTrials.gov NCT01246167.
John H Flint - One of the best experts on this subject based on the ideXlab platform.
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case report and literature review anterior shoulder dislocation with three part Proximal Humerus Fracture and humeral shaft Fracture
The Iowa orthopaedic journal, 2009Co-Authors: John H Flint, Laura M Carlyle, Cory C Christiansen, James V NepolaAbstract:Dislocation of the shoulder and Proximal Humerus Fracture with coexistent humeral shaft Fracture is a rare injury reported in literature. There have been a total of 20 cases reported in the literature since 19401-13 (see Table 1). These injuries often occur as a result of high velocity trauma and most have been treated, at least partially, with invasive or operative management. We present the case of a woman with an anterior dislocation, three-part Proximal Humerus Fracture and concomitant Humerus shaft Fracture and discuss her non-invasive treatment.
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case report and literature review anterior shoulder dislocation with three part Proximal Humerus Fracture and humeral shaft Fracture
The Iowa orthopaedic journal, 2009Co-Authors: John H Flint, Laura M Carlyle, Cory C Christiansen, James V NepolaAbstract:Dislocation of the shoulder and Proximal Humerus Fracture with coexistent humeral shaft Fracture is a rare injury reported in literature. There have been a total of 20 cases reported in the literature since 19401-13 (see Table 1). These injuries often occur as a result of high velocity trauma and most have been treated, at least partially, with invasive or operative management. We present the case of a woman with an anterior dislocation, three-part Proximal Humerus Fracture and concomitant Humerus shaft Fracture and discuss her non-invasive treatment. TABLE 1 This table reviews the reported Proximal Humerus Fracture-dislocations with associated Humerus Fractures, their treatment and outcome.
