The results of open reduction and plate fixation with angular stability of the proximal humerus fractures in patients with osteoporosis

Authors

  • Mykola Korzh Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0002-0489-3104
  • Vasyl Makarov Municipal non-profit enterprise «City Clinical Hospital № 16» of the Dnipro City Council. Ukraine, Ukraine https://orcid.org/0000-0003-0936-7039
  • Alexander Sabsay SE «Specialized Multidisciplinary Hospital № 1 of the Ministry of Health of Ukraine», Dnipro, Ukraine
  • Оleksiy Tankut Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
  • Olga Pidgayska Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0002-5025-977X

DOI:

https://doi.org/10.15674/0030-59872020344-53

Keywords:

proximal humerus fractures, plate with angular stability PHILOS, 3D polylactide implants, osteoporosis, reverse total shoulder arthroplasty

Abstract

Objective: a retrospective study of anatomical and functional results of open reduction and plate osteosynthesis in patients older than 50 years with of the proximal humerus fractures type AO/OTA 11-B, 11-C and osteoporosis, who were treated with plate PHILOS taking into account the surgical treatment of adverse results with reverse total shoulder arthroplasty (RTSA). Methods: we analyzed case histories of 58 patients (age older 50 years) with osteoporosis and three- and four-fragment fractures of the proximal umerus according to the Neer classification (type AO/OTA 11-B, 11-C). In group I — 20 patients (age from 50 to 76 years, 8 men and 12 women) — we made open reduction, ORIF with plate PHILOS; II — 38 patients (aged 54 to 78 years, all women) — had surgeries ORIF with PHILOS plate and 3D polylactide implants. Results: according to the Constant Murley Shoulder Score system in 11 (55 %) patients of group I excellent and good results were obtained, in 5 (25 %) — satisfactory, in 4 cases (20%) are unsatisfactory. At the last cases we made RTSA in terms from 6 to 12 months after the primary surgery, one of them had revision RTSA due to fracture of the humeral shaft and instability of the stem implant. According to the Constant Murley Shoulder Score system, the average score after 12 months in group I was 78, in II — 87. No signs of avascular necrosis of the humeral head were observed. Conclusions: the use of PHILOS plates with additional reinforcement with 3D polylactide implants allowed us to obtain positive results in 34 (89.5 %) patients after 6–12 months after the surgery with a lower complications rate compare to known techniques. If ORIF method gives an unfavorable result then RTSA gives the possibility to achieve positive results within 3 years after the surgery.

Author Biographies

Mykola Korzh, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, Prof. in Traumatology and Orthopaedics

Vasyl Makarov, Municipal non-profit enterprise «City Clinical Hospital № 16» of the Dnipro City Council. Ukraine

PhD in Orthopaedics and Traumatology

Olga Pidgayska, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

PhD in Traumatology and Orthopaedics

References

  1. Sumrein, B. O., Huttunen, T. T., Launonen, A. P., Berg, H. E., Felländer-Tsai, L., & Mattila, V. M. (2016). Proximal humeral fractures in Sweden—a registry-based study. Osteoporosis International, 28(3), 901-907. doi: 10.1007/s00198-016-3808-z
  2. Lowry, V., Bureau, N. J., Desmeules, F., Roy, J.-S., & Rouleau, D. M. (2017). Acute proximal humeral fractures in adults. Journal of Hand Therapy, 30(2), 158–166. doi: 10.1016/j. jht.2017.05.005
  3. McLean, A. S., Price, N., Graves, S., Hatton, A., & Taylor, N. (2019). Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. Journal of Shoulder and Elbow Surgery, 28(11), 2072–2078. doi: 10.1016/j.jse.2019.03.034
  4. Klug, A., Gramlich, Y., Wincheringer, D., Schmidt-Horlohé, K., & Hoffmann, R. (2019). Trends in surgical management of proximal humeral fractures in adults: A nationwide study of records in Germany from 2007 to 2016. Archives of Orthopaedic and Trauma Surgery, 139(12), 1713-1721. doi: 10.1007/s00402-019-03252-1
  5. Maier, D., Jаger, M., Strohm, P. C., & Sudkamp, N. P. (2012). Treatment of proximal humeral fractures — a review of current concepts enlightened by basic principles. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, 79(4), 307–316
  6. Jo, Y., Lee, K., & Lee, B. (2019). Surgical trends in elderly patients with proximal humeral fractures in South Korea: A population-based study. BMC Musculoskeletal Disorders, 20(1). doi: 10.1186/s12891-019-2515-2
  7. Campochiaro, G., Rebuzzi, M., Baudi, P., & Catani, F. (2015). Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis. Musculoskeletal Surgery, 99(S1), 9-15. doi: 10.1007/s12306-015-0358-z
  8. Archer, L. A., & Furey, A. (2016). Rate of avascular necrosis and time to surgery in proximal humerus fractures. Musculoskeletal Surgery, 100(3), 213-216. doi: 10.1007/s12306-016-0425-0
  9. Boesmueller, S., Wech, M., Gregori, M., Domaszewski, F., Bukaty, A., Fialka, C., & Albrecht, C. (2016). Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures. Injury, 47(2), 350-355. doi: 10.1016/j.injury.2015.10.001
  10. Helfen, T., Siebenbürger, G., Mayer, M., Böcker, W., Ockert, B., & Haasters, F. (2016). Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-a3) in the elderly: Cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®. BMC Musculoskeletal Disorders, 17(1). doi: 10.1186/s12891-016-1302-6
  11. Laux, C. J., Grubhofer, F., Werner, C. M., Simmen, H., & Osterhoff, G. (2017). Current concepts in locking plate fixation of proximal humerus fractures. Journal of Orthopaedic Surgery and Research, 12(1). doi: 10.1186/s13018-017-0639-3
  12. Korzh, M. O., Shidlovsky, M. S., Makarov, V. B., Zakhovaiko, A. A., Tankut, O. V., Karpinsky, M. Yu., Karpinska, O. D., & Chuprina, D. O. (2019). Experimental study of mechanical properties of polylactide. Trauma, 20(6), 5–11. doi: 10.22141/1608-1706.6.20.2019.186029. [in Ukrainian]
  13. Makarov, V. B., Dedukh, N. V., & Nikolchenko, O. A. (2018). Osteoreparation around polylactide implanted in the metadiaphyseal defect of the femur (experimental study). Orthopedics, Traumatology and Prosthetics, 2, 102–107. doi: 10.15674/0030-598720182102-107. [in Russian]
  14. Den Hartog, D., Van Lieshout, E. M., Tuinebreijer, W. E., Polinder, S., Van Beeck, E. F., Breederveld, R. S., … & Schep, N. W. (2010). Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): A multicenter randomized controlled trial. BMC Musculoskeletal Disorders, 11(1). doi: 10.1186/1471-2474-11-97
  15. Verbeek, P. A., van den Akker-Scheek, I., Wendt, K. W., & Diercks, R. L. (2012). Hemiarthroplasty versus angle-stable locking compression plate osteosynthesis in the treatment of three- and four-part fractures of the proximal humerus in the elderly: design of a randomized controlled trial. BMC Musculoskeletal Disorders, 13, 16. doi: 10.1186/1471-2474-13-16
  16. Boileau, P., Watkinson, D. J., Hatzidakis, A. M., & Balg, F. (2005). Grammont reverse prosthesis: design, rationale, and biomechanics. Journal of Shoulder and Elbow Surgery, 14(1 Suppl. S), 147S–161S. doi: 10.1016/j. jse.2004.10.006
  17. Kazley, J. M., Cole, K. P., Desai, K. J., Zonshayn, S., Morse, A. S., & Banerjee, S. (2019). Prostheses for reverse total shoulder arthroplasty. Expert Review of Medical Devices, 16(2), 107-118. doi: 10.1080/17434440.2019.1568237
  18. Smith, G. C., Bateman, E., Cass, B., Damiani, M., Harper, W., Jones, H., … & Harris, I. A. (2017). Reverse shoulder arthroplasty for the treatment of proximal humeral fractures in the elderly (Reshape trial): Study protocol for a multicentre combined randomised controlled and observational trial. Trials, 18(1). doi: 10.1186/s13063-017-1826-6
  19. Shannon, S. F., Wagner, E. R., Houdek, M. T., Cross, W. W., & Sánchez-Sotelo, J. (2016). Reverse shoulder arthroplasty for proximal humeral fractures: Outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis. Journal of Shoulder and Elbow Surgery, 25(10), 1655-1660. doi: 10.1016/j.jse.2016.02.012
  20. Ernstbrunner, L., Rahm, S., Suter, A., Imam, M. A., Catanzaro, S., Grubhofer, F., & Gerber, C. (2020). Salvage reverse total shoulder arthroplasty for failed operative treatment of proximal humeral fractures in patients younger than 60 years: Long-term results. Journal of Shoulder and Elbow Surgery, 29(3), 561-570. doi: 10.1016/j.jse.2019.07.040
  21. Grubhofer, F., Wieser, K., Meyer, D. C., Catanzaro, S., Schürholz, K., & Gerber, C. (2017). Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. Journal of Shoulder and Elbow Surgery, 26(1), 92-100. doi: 10.1016/j.jse.2016.05.020.
  22. Neer, C. S. (1970). Displaced proximal humeral fractures. The Journal of Bone & Joint Surgery, 52(6), 1077-1089. doi:10.2106/00004623-197052060-00001
  23. Brorson, S., Eckardt, H., Audigé, L., Rolauffs, B., & Bahrs, C. (2013). Translation between the neer- and the AO/OTA-classification for proximal humeral fractures: Do we need to be bilingual to interpret the scientific literature? BMC Research Notes, 6(1). doi:10.1186/1756-0500-6-69
  24. Korzh, N. A., Makarov, V. B., Tankut, A. V., & Podgayskaya, O. A. (2019). Results of clinical approbation of implants made of polylactide in osteosynthesis of fractures of the proximal humerus in patients with osteoporosis. Orthopedics, Traumatology and Prosthetics, 4, 26–36. doi: 10.15674/0030-59872019426-36. [in Russian]
  25. Osterhoff, G., Diederichs, G., Tami, A., Theopold, J., Josten, C., & Hepp, P. (2011). Influence of trabecular microstructure and cortical index on the complexity of proximal humeral fractures. Archives of Orthopaedic and Trauma Surgery, 132(4), 509-515. doi: 10.1007/s00402-011-1446-7
  26. Den Teuling, J., Pauwels, B., Janssen, L., Wyers, C., Janzing, H. M., Van den Bergh, J., & Morrenhof, J. W. (2017). The influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus. Bone & Joint Research, 6(10), 584-589. doi:10.1302/2046-3758.610.bjr-2017-0080
  27. Ban, I., Troelsen, A., Christiansen, D. H., Svendsen, S. W., & Kristensen, M. T. (2013). Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders. Danish Medical Journal, 60(4), A4608
  28. Murena, L., Canton, G., Ratti, C., Hoxhaj, B., Giraldi, G., Surace, M. F., & Grassi, F. A. (2020). Indications and results of osteosynthesis for proximal humerus fragility fractures in elderly patients. Orthopedic Reviews, 12(1). doi:10.4081/or.2020.8559
  29. Orman, S., Mohamadi, A., Serino, J., Murphy, J., Hanna, P., Weaver, M. J., … & Keudell, A. V. (2019). Comparison of surgical and non-surgical treatments for 3- and 4-part proximal humerus fractures: A network meta-analysis. Shoulder & Elbow, 12(2), 99-108. doi:10.1177/1758573219831506
  30. Du, S., Ye, J., Chen, H., Li, X., & Lin, Q. (2017). Interventions for treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials. International Journal of Surgery, 48, 240-246. doi:10.1016/j.ijsu.2017.09.002
  31. Gupta, A. K., Harris, J. D., Erickson, B. J., Abrams, G. D., Bruce, B., McCormick, F., … & Romeo, A. A. (2015). Surgical management of complex proximal humerus fractures—A systematic review of 92 studies including 4500 patients. Journal of Orthopaedic Trauma, 29(1), 54-59. doi:10.1097/bot.0000000000000229
  32. Hertel, R., Hempfing, A., Stiehler, M., & Leunig, M. (2004). Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. Journal of Shoulder and Elbow Surgery, 13(4), 427-433. doi:10.1016/j.jse.2004.01.034
  33. Katthagen, J. C., Huber, M., Grabowski, S., Ellwein, A., Jensen, G., & Lill, H. (2017). Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level-1 trauma center. Journal of Orthopaedics and Traumatology, 18(3), 265-274. doi:10.1007/s10195-017-0457-8
  34. Boileau, P., Trojani, C., Walch, G., Krishnan, S. G., Romeo, A., & Sinnerton, R. (2001). Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. Journal of Shoulder and Elbow Surgery, 10(4), 299-308. doi:10.1067/mse.2001.115985
  35. Cadet, E. R., & Ahmad, C. S. (2012). Hemiarthroplasty for three- and four-part proximal humerus fractures. American Academy of Orthopaedic Surgeon, 20(1), 17-27. doi:10.5435/00124635-201201000-00003
  36. Moineau, G., McClelland, W. B., Trojani, C., Rumian, A., Walch, G., & Boileau, P. (2012). Prognostic factors and limitations of anatomic shoulder arthroplasty for the treatment of posttraumatic cephalic collapse or necrosis (type-1 proximal humeral fracture sequelae). The Journal of Bone and Joint Surgery-American Volume, 94(23), 2186-2194. doi:10.2106/jbjs.j.00412

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How to Cite

Korzh, M., Makarov, V., Sabsay, A., Tankut О., & Pidgayska, O. (2023). The results of open reduction and plate fixation with angular stability of the proximal humerus fractures in patients with osteoporosis. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 44–53. https://doi.org/10.15674/0030-59872020344-53

Issue

No. 3 (2020)

Section

ORIGINAL ARTICLES

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Copyright (c) 2020 Mykola Korzh, Vasyl Makarov, Alexander Sabsay, Оleksiy Tankut, Olga Pidgayska

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