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Reza Omid - One of the best experts on this subject based on the ideXlab platform.
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Principles of Locking Plate Fixation of Proximal Humerus Fractures.
The Journal of the American Academy of Orthopaedic Surgeons, 2021Co-Authors: Reza Omid, Nicholas A Trasolini, Michael A Stone, Surena NamdariAbstract: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.
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Percutaneous Pinning of Proximal Humerus Fractures: A Technique
Seminars in Arthroplasty, 2011Co-Authors: Reza Omid, Leesa M. GalatzAbstract:Proximal Humerus fractures are commonly seen, yet the treatment of many displaced fractures presents significant challenges. Complications related to humeral head vascularity have caused a recent interest in minimally invasive techniques for fracture fixation. The technique of closed reduction and percutaneous fixation of Proximal Humerus fractures is difficult and demanding, and careful attention must be paid to appropriate indications and technical considerations. This article discusses the indications and techniques for percutaneous fixation of Proximal Humerus fractures.
Dean G. Lorich - One of the best experts on this subject based on the ideXlab platform.
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Open reduction internal fixation of Proximal Humerus fractures.
Current reviews in musculoskeletal medicine, 2013Co-Authors: Marschall B. Berkes, Milton T. M. Little, Dean G. LorichAbstract:The treatment of Proximal Humerus fractures continues to evolve. While the many of these injuries can be managed nonoperatively, a certain percentage require operative treatment. Open reduction internal fixation can offer excellent outcomes when performed in the appropriate patient and utilizing proper techniques. This article reviews the most up-to-date literature regarding all phases of Proximal Humerus fracture osteosynthesis, including diagnosis, imaging, anatomic considerations, surgical indications, fixation, and surgical outcomes.
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Evaluation and Management of Proximal Humerus Fractures
Advances in orthopedics, 2012Co-Authors: Ekaterina Khmelnitskaya, Dean G. Lorich, Lauren E. Lamont, Samuel A. Taylor, David M. Dines, Joshua S. DinesAbstract:Proximal Humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, Proximal Humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the Proximal Humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities.
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Vascular implications of minimally invasive plating of Proximal Humerus fractures.
Journal of orthopaedic trauma, 2006Co-Authors: Michael J. Gardner, James E. Voos, Tony Wanich, David L. Helfet, Dean G. LorichAbstract:Objectives: Open reduction and internal fixation of Proximal Humerus fractures through the anterolateral acromial approach, which uses the anterior deltoid raphe and axillary nerve protection, has recently been advocated as a minimally invasive technique. Several recent reports have indicated variable and unpredictable vascular injuries to the humeral-head blood supply after a Proximal Humerus fracture, and thus a direct approach that minimizes further vascular compromise may be preferable. The purpose of this study was to define the relationship of this surgical interval to the lateral plating zone of the Proximal Humerus and to the penetrating vascular supply of the humeral head. Design: Cadaveric vascular injection study. Setting: Cadaveric dissection laboratory. Patients: Six cadaveric specimens. Intervention: The anterolateral acromial approach was performed on six cadaveric upper-extremity specimens. A locking Proximal Humerus plate was applied to the lateral Proximal Humerus, and the axillary artery was cannulated Proximal to the circumflex humeral arteries. Dyed latex polymer was injected and allowed to harden, and dissection was performed to visualize the vasculature of the Proximal Humerus. Plates were then removed and the specimens were further inspected to examine the blood supply. Main Outcome Measurements: The relationship of the anterolateral acromial approach to the lateral plating zone of the Proximal Humerus and the vascular supply of the humeral head. Results: In all specimens, the filling of the anterior and posterior vessels that supplied the humeral head were undisturbed after use of the anterolateral acromial approach and locked plating. The blood vessels to the head-penetrating vascular branches were not in the surgical field. A bare spot on the lateral Proximal Humerus existed in the region of the greater tuberosity, which was 30 mm wide and between two penetrating humeral-head epiphyseal vessels. The nearest penetrating vessels were close to the plate, 4 mm anterior and 7 mm posterior. The anterior humeral circumflex vessel and its ascending branch, which provides critical blood supply to the humeral head, coursed directly in the region of the deltopectoral approach. Conclusions: Minimally invasive techniques have many potential benefits for fracture healing, but new surgical approaches often must be used to take full advantage of these newer methods. Splitting the anterior deltoid raphe from the acromion distally allowed direct access to the lateral plating zone of the Proximal Humerus. The bare spot in this region may be a safe area for plate application, if the plate is placed appropriately with thorough knowledge of the vascular anatomy. These findings may be of particular importance if the vascular supply to the humeral head has already been partially compromised by preceding trauma. This direct approach to the lateral bare spot on the Proximal Humerus may minimize iatrogenic vascular injury when treating these fractures.
Brian T Feeley - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of locking plate fixation of Proximal Humerus fractures
Injury-international Journal of The Care of The Injured, 2011Co-Authors: Robert C Sproul, Jaicharan J Iyengar, Zlatko Devcic, Brian T FeeleyAbstract:Purpose: Technique for the fixation of two, three, and four part Proximal Humerus fractures has rapidly shifted towards the use of specially contoured Proximal Humerus locking plates. The purpose of this study is to evaluate the short to medium term functional results and common complications associated with the fixation of Proximal Humerus fractures with locking plates. Methods: 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. Our inclusion criteria were Proximal Humerus fracture due to trauma (excluding pathologic fractures), patients greater than 18 years of age, more than 15 patients in the study or subgroup of interest, at least 18 months follow-up, at least one relevant functional outcome score, and quality outcome score of at least 5/10. Studies that did not meet these criteria were excluded. All institutional, author, and journal information was concealed to minimize reviewer bias. Results: Twelve studies including 514 patients met the inclusion criteria. At most recent follow-up patients achieved a mean Constant score of 74 and a mean DASH score of 27. The overall rate of complications was 49% including varus malunion, 33% excluding varus malunion, and reoperation rate was 14%. The most common complications included varus malunion 16%, AVN 10%, screw perforation of the humeral head into the joint 8%, subacromial impingement 6%, and infection 4%. Discussion: 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.
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Evaluation and management of Proximal Humerus fractures.
The Physician and sportsmedicine, 2011Co-Authors: Jaicharan J Iyengar, Brian T FeeleyAbstract:AbstractFractures of the Proximal Humerus occur frequently, and are primarily insufficiency fractures that occur in the elderly. Thorough clinical evaluation is essential in identifying associated neurovascular injury, which warrants emergent surgical referral. Good quality radiographs remain a necessary diagnostic tool in the evaluation of Proximal Humerus injuries. An appreciation of the relevant anatomy and predictable patterns of deformation aid in understanding the basic classification of Proximal Humerus fractures. Most of these fractures are minimally displaced and can be treated nonoperatively with acceptable clinical outcomes. Familiarity with the basic surgical treatment modalities is helpful to physicians involved in the pre- and postoperative management. Significantly displaced Proximal Humerus fractures are typically treated with surgical reduction and internal fixation. Complex fractures in the elderly and fracture dislocations are indications for humeral head prosthetic replacement. Proxima...
Surena Namdari - One of the best experts on this subject based on the ideXlab platform.
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Principles of Locking Plate Fixation of Proximal Humerus Fractures.
The Journal of the American Academy of Orthopaedic Surgeons, 2021Co-Authors: Reza Omid, Nicholas A Trasolini, Michael A Stone, Surena NamdariAbstract: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.
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Operative Treatment of Two-Part Proximal Humerus Fractures
Operative Techniques: Shoulder and Elbow Surgery, 2019Co-Authors: Gerald R. Williams, Surena NamdariAbstract:Displaced Proximal Humerus fractures that are isolated to the greater tuberosity or the surgical neck are commonly treated operatively. While multiple techniques are described that can lead to reliable outcomes, the proficiency of the surgeon to obtain an anatomic reduction remains the most valuable facet of Proximal Humerus fixation. In this chapter, we review the surgical options for 2-part Proximal Humerus fractures and discuss potential pearls and pitfalls of treatment.
Steve A. Hodgson - One of the best experts on this subject based on the ideXlab platform.
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Proximal Humerus fracture rehabilitation : Proximal Humerus symposium
Clinical Orthopaedics and Related Research, 2006Co-Authors: Steve A. HodgsonAbstract:The occurrence of Proximal Humerus fractures will continue to rise with the increasing elderly population. Many patients with Proximal Humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. This predisposes them to future falls and additional fractures. Patients continue to have shoulder problems as a result of the fracture for many years after the injury. Rehabilitation is central to addressing the problems caused by the fracture. The review of the literature on Proximal Humerus rehabilitation suggests that treatment must begin immediately if the harmful effects of immobilization are to be avoided. Electrotherapy or hydrotherapy does not enhance recovery and joint mobilization has limited evidence of its efficacy. In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy. The best available evidence for shoulder rehabilitation emphasizes using advice, exercise, and mobilization of limited joints to restore upper limb function. Placing controlled stresses throughout the fracture site at an early stage will optimize bone repair without increasing complication rates. This approach requires cooperation between the referring surgeon and therapist and will optimize the patient's shoulder function and maintain their functional independence.
