SURGICAL TREATMENT OF THE PROXIMAL HUMERUS FRACTURES IN PATIENTS WITH OSTEOPOROSIS. PROBLEMATIC ISSUES AND DEVELOPMENT PROSPECTS

Authors

DOI:

https://doi.org/10.15674/0030-59872023186-99

Keywords:

Рroximal humerus fracture, open reduction and internal fixation, plates with angular stability, LCP, intramedullary locking nails, cement augmentation, fibula allograft and autograft

Abstract

Fractures of the proximal part of the humerus (FPPH) are the third most common in the elderly after fractures of the femur and radius. Objective. On the basis of analysis of the literature to identify problematic issues of surgical treatment of patients with FPPH and osteoporosis and prospects for improving implants and algorithms treatment. Methods. The material of the study was the scientific papers available in Google search engines, PubMed,
Medline, published in specialized sources. Results. It is shown that are used today there are Neer and AO/OTA classifications of FPPH. Conservatively manage of FPPH in 80 % of patients with two-fragmentary fractures according to Neer or type A2/A3 according to AO/OTA. The remaining 20 % patients have threeand four-segment FPPH (types B and C according to AO/OTA), the conservative treatment of which consists of problem, especially
in patients with osteopenia and osteoporosis. Surgical treatment of FPPH is recommended in case of fractures types 11B2-3, 11C2-3 in young patients or in the elderly age that requires significant
functionality of the upper extremity. Positive results of treatment of FPPH types 11B3, 11C2-3 on the background of osteoporosis obtained after installation LCP-plates with allo- or autograft
from the fibula bones, as well as support screws, filling of cavities in the humerus head fragments with bone cement, or using free bone implants are most often used. These methods achieve and
support to enable stable repositioning of even complex type fractures 11C2-3. Blocked intramedullary nails of the third generation
have improved mechanisms for attaching proximal screws and specific fixation of bone fragments, as well as straight geometry. Primary reverse shoulder arthroplasty in case of type 11С2, 11С3
fractures according to AO/OTA enables to obtain positive results in most patients. Conclusions. Surgical treatment of patients with FPPH is advisable for active patients, it is possible to improve
functional results compared to conservative manage and avoid the most complications of it.

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

MD, PhD in Orthopaedics and Traumatology

References

  1. Passaretti, D., Candela, V., Sessa, P., & Gumina, S. (2017). Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. Journal of Shoulder and Elbow Surgery, 26(12), 2117–2124. https://doi.org/10.1016/j.jse.2017.05.029
  2. McLean, A. S., Price, N., Graves, S., Hatton, A., & Taylor, F. J. (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. https://doi.org/10.1016/j.jse.2019.03.034
  3. 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. https://doi.org/10.1007/s00402-019-03252-1
  4. Patel, A. H., Wilder, J. H., Ofa, S. A., Lee, O. C., Savoie, F. H., O’Brien, M. J., & Sherman, W. F. (2022). Trending a decade of proximal humerus fracture management in older adults. JSES International, 6(1), 137–143. https://doi.org/10.1016/j.jseint.2021.08.006
  5. Iglesias-Rodríguez, S., Domínguez-Prado, D. M., García-Reza, A., Fernández-Fernández, D., Pérez-Alfonso, E., García-Piñeiro, J., & Castro-Menéndez, M. (2021). Epidemiology of proximal humerus fractures. Journal of Orthopaedic Surgery and Research, 16(1). https://doi.org/10.1186/s13018-021-02551-x
  6. Martinez-Huedo, M. A., Jiménez-García, R., Mora-Zamorano, E., Hernández-Barrera, V., Villanueva-Martinez, M., & Lopez-de-Andres, A. (2017). Trends in incidence of proximal humerus fractures, surgical procedures and outcomes among elderly hospitalized patients with and without type 2 diabetes in Spain (2001–2013). BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1892-7
  7. Launonen, A. P., Sumrein, B. O., Reito, A., Lepola, V., Paloneva, J., Jonsson, K. B., Wolf, O., Ström, P., Berg, H. E., Felländer-Tsai, L., Jansson, K.-Å., Fell, D., Mechlenburg, I., Døssing, K., Østergaard, H., Märtson, A., Laitinen, M. K., & Mattila, V. M. (2019). Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. PLOS Medicine, 16(7), e1002855. https://doi.org/10.1371/journal.pmed.1002855
  8. Relvas Silva, M., Linhares, D., Leite, M. J., Nunes, B., Torres, J., Neves, N., & Ribeiro Silva, M. (2022). Proximal humerus fractures: epidemiology and trends in surgical management of hospital-admitted patients in Portugal. JSES International, 6 (3), 380‒384. https://doi.org/10.1016/j.jseint.2021.12.003
  9. Leino, O. K., Lehtimäki, K. K., Mäkelä, K., Äärimaa, V., & Ekman, E. (2022). Proximal humeral fractures in Finland. The Bone & Joint Journal, 104-B(1), 150–156. https://doi.org/10.1302/0301-620x.104b1.bjj-2021-0987.r1
  10. 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. https://doi.org/10.1007/s00402-019-03252-1
  11. McLean, A. S., Price, N., Graves, S., Hatton, A., & Taylor, F. J. (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. https://doi.org/10.1016/j.jse.2019.03.034
  12. Spross, C., Meester, J., Mazzucchelli, R. A., Puskás, G. J., Zdravkovic, V., & Jost, B. (2019). Evidence-based algorithm to treat patients with proximal humerus fractures—a prospective study with early clinical and overall performance results. Journal of Shoulder and Elbow Surgery, 28(6), 1022–1032. https://doi.org/10.1016/j.jse.2019.02.015
  13. Spross, C., Zdravkovic, V., Manser, M., Farei-Campagna, J. M., Jacxsens, M., & Jost, B. (2021). Outcomes of Management of Proximal Humeral Fractures with Patient-Specific, Evidence-Based Treatment Algorithms. Journal of Bone and Joint Surgery, Publish Ahead of Print, 103 (20), https://doi.org/10.2106/jbjs.20.01309
  14. 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. https://doi.org/10.1007/s00198-016-3808-z
  15. W. W. Schairer, B. U. Nwachukwu, S. Lyman, L. V. (2017). Gulotta Arthroplasty treatment of proximal humerus fractures: 14-year trends in the United States. The Physician and Sportsmedicine, 45 (2), 92-96. https://doi.org/10.1080/00913847.2017.1311199
  16. Walter, N., Lowenberg, D. W., Kurtz, S. M., Alt, V., Lau, E. C., & Rupp, M. (2022). Revision Rates and Associated Risk Factors after Shoulder Arthroplasty. Journal of Clinical Medicine, 11(24), 7256. https://doi.org/10.3390/jcm11247256
  17. Codman, E. A. (1934). The shoulder: Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. T. Todd Company; Arlington, TX, USA.
  18. NEER, C. S. (1970). Displaced Proximal Humeral Fractures. The Journal of Bone & Joint Surgery, 52(6), 1077–1089. https://doi.org/10.2106/00004623-197052060-00001
  19. Carrerra, E. d. F., Wajnsztejn, A., Lenza, M., & Archetti Netto, N. (2012). Reproducibility of three classifications of proximal humeral fractures. Einstein (São Paulo), 10(4), 473–479. https://doi.org/10.1590/s1679-45082012000400014 (in English, Portuguese)
  20. Bougher, H., Buttner, P., Smith, J., Banks, J., Na, H. S., Forrestal, D., & Heal, C. (2020). Inter-and intra-observer agreement of 3D printed models for the classification of proximal humeral fractures. JSES International. https://doi.org/10.1016/j.jseint.2020.10.019
  21. Muller, M. E. (1990). The comprehensive classification of fractures of long bones. Springer; Berlin/Heidelberg, Germany.
  22. Müller, U., Grützner, P.A., Studier-Fischer, S. (2020). Orthopаdie und Unfallchirurgie update. GeJorg. Thieme Verl.,15, 127–140. https://doi.org/10.1055/a-0816-1543.
  23. Majed, A., Macleod, I., Bull, A. M. J., Zyto, K., Resch, H., Hertel, R., Reilly, P., & Emery, R. J. H. (2011). Proximal humeral fracture classification systems revisited. Journal of Shoulder and Elbow Surgery, 20(7), 1125–1132. https://doi.org/10.1016/j.jse.2011.01.020
  24. Sukthankar, A. V., Leonello, D. T., Hertel, R. W., Ding, G. S., & Sandow, M. J. (2013). A comprehensive classification of proximal humeral fractures: HGLS system. Journal of Shoulder and Elbow Surgery, 22(7), e1-e6. https://doi.org/10.1016/j.jse.2012.09.018
  25. Har¬rison, J. W., Howcroft, D. W., Warner, J. G., Hodgson, S. P. (2007). Internal fixation of proximal humeral fractures. Acta orthopaedica Belgica, 73 (1), 1‒11.
  26. 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. https://doi.org/10.1016/j.jse.2004.01.034
  27. Schumaier, A., & Grawe, B. (2018). Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient. Geriatric Orthopaedic Surgery & Rehabilitation, 9, 215145851775051. https://doi.org/10.1177/2151458517750516
  28. Resch, H., Tauber, M., Neviaser, R. J., Neviaser, A. S., Majed, A., Halsey, T., Hirzinger, C., Al-Yassari, G., Zyto, K., & Moroder, P. (2016). Classification of proximal humeral fractures based on a pathomorphologic analysis. Journal of Shoulder and Elbow Surgery, 25(3), 455–462. https://doi.org/10.1016/j.jse.2015.08.006
  29. Foruria, A. M., Martinez-Catalan, N., Pardos, B., Larson, D., Barlow, J., & Sanchez-Sotelo, J. (2022). Classification of Proximal Humerus Fractures According to Pattern Recognition is Associated with High Intraobserver and Interobserver Agreement. JSES International, 6 (4), 563‒568. https://doi.org/10.1016/j.jseint.2022.03.005
  30. Foroohar, A., Tosti, R., Richmond, J. M., Gaughan, J. P., & Ilyas, A. M. (2011). Classification and treatment of proximal humerus fractures: inter-observer reliability and agreement across imaging modalities and experience. Journal of Orthopaedic Surgery and Research, 6(1), 38. https://doi.org/10.1186/1749-799x-6-38
  31. Neer, C. S. (2002). Four-segment classification of proximal humeral fractures: Purpose and reliable use. Journal of Shoulder and Elbow Surgery, 11(4), 389–400. https://doi.org/10.1067/mse.2002.124346
  32. Samborski, S. A., Haws, B. E., Karnyski, S., Soles, G., Gorczyca, J. T., Nicandri, G., Voloshin, I., & Ketz, J. P. (2022). Outcomes for Type C Proximal Humerus Fractures in the Adult Population: Comparison of Nonoperative Treatment, Locked Plate Fixation, and Reverse Shoulder Arthroplasty. JSES International, 6 (5), 755‒762. https://doi.org/10.1016/j.jseint.2022.05.006
  33. 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. https://doi.org/10.1007/s00198-016-3808-z
  34. Patel, A. H., Wilder, J. H., Ofa, S. A., Lee, O. C., Iloanya, M. C., Savoie, F. H., & Sherman, W. F. (2022). How age and gender influence proximal humerus fracture management in patients older than fifty years. JSES International, 6(2), 253–258. https://doi.org/10.1016/j.jseint.2021.11.007
  35. Beks, R. B., Ochen, Y., Frima, H., Smeeing, D. P. J., van der Meijden, O., Timmers, T. K., van der Velde, D., van Heijl, M., Leenen, L. P. H., Groenwold, R. H. H., & Houwert, R. M. (2018). Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. Journal of Shoulder and Elbow Surgery, 27(8), 1526–1534. https://doi.org/10.1016/j.jse.2018.03.009
  36. Jawa, A., & Burnikel, D. (2016). Treatment of Proximal Humeral Fractures. JBJS Reviews, 4(1). https://doi.org/10.2106/jbjs.rvw.o.00003
  37. Court-Brown, C., Cattermole, M. H., McQueen, M. M. (2002). Impacted Valgus Fractures (B1.1) of the proximal humerus. the results of non-operative treat¬ment. The Journal of bone and joint surgery. British volume, 84 (4), 504–508. https://doi.org/10.1302/0301- 620x.84b4.12488.
  38. Rangan, A., Handoll, H., Brealey, S., Jefferson, L., Keding, A., Martin, B. C., Goodchild, L., Chuang, L.-H., Hewitt, C., & Torgerson, D. (2015). Surgical vs Nonsurgical Treatment of Adults With Displaced Fractures of the Proximal Humerus. JAMA, 313(10), 1037. https://doi.org/10.1001/jama.2015.1629
  39. Beks, R. B., Ochen, Y., Frima, H., Smeeing, D. P. J., van der Meijden, O., Timmers, T. K., van der Velde, D., van Heijl, M., Leenen, L. P. H., Groenwold, R. H. H., & Houwert, R. M. (2018). Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. Journal of Shoulder and Elbow Surgery, 27(8), 1526–1534. https://doi.org/10.1016/j.jse.2018.03.009
  40. Dheenadhayalan, J., Prasad, V. D., Devendra, A., & Rajasekaran, S. (2019). Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: A study of 127 cases. Journal of Orthopaedic Surgery, 27(2), 230949901984816. https://doi.org/10.1177/2309499019848166
  41. Lin, C. C., Karlin, E., Boin, M. A., Dankert, J. F., Larose, G., Zuckerman, J. D., & Virk, M. S. (2022). Operative Treatment of Proximal Humeral Fractures with Reverse Total Shoulder Arthroplasty in Patients ≥65 Years Old. JBJS Reviews, 10(5). https://doi.org/10.2106/jbjs.rvw.21.00245
  42. Jo, Y.-H., Lee, K.-H., & Lee, B.-G. (2019). Surgical trends in elderly patients with proximal humeral fractures in South Korea: a population-based study. BMC Musculoskeletal Disorders, 20(1). https://doi.org/10.1186/s12891-019-2515-2
  43. Ju, J., Ma, M., Zhang, Y., Ding, Z., Fu, Z., & Chen, J. (2022). Fracture Line Morphology of Greater Tuberosity Fragments of Neer Three‐ and Four‐Part Proximal Humerus Fractures. Orthopaedic Surgery. https://doi.org/10.1111/os.13523
  44. Taskesen, A., Göçer, A., Uzel, K., & Yaradılmış, Y. U. (2020). Effect of Osteoporosis on Proximal Humerus Fractures. Geriatric Orthopaedic Surgery & Rehabilitation, 11, 215145932098539. https://doi.org/10.1177/2151459320985399
  45. Chelli, M., Gasbarro, G., Lavoué, V., Gauci, M.-O., Raynier, J.-L., Trojani, C., & Boileau, P. (2022). The reliability of the Neer classification for proximal humerus fractures: a survey of orthopedic shoulder surgeons. JSES International, 6 (3), 331‒337. https://doi.org/10.1016/j.jseint.2022.02.006
  46. Mischler, D., Babu, S., Osterhoff, G., Pari, C., Fletcher, J., Windolf, M., Gueorguiev, B., & Varga, P. (2020). Comparison of optimal screw configurations in two locking plate systems for proximal humerus fixation - a finite element analysis study. Clinical Biomechanics, 78, 105097. https://doi.org/10.1016/j.clinbiomech.2020.105097
  47. Fletcher, J. W. A., Windolf, M., Grünwald, L., Richards, R. G., Gueorguiev, B., & Varga, P. (2019). The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations. Archives of Orthopaedic and Trauma Surgery, 139(8), 1069–1074. https://doi.org/10.1007/s00402-019-03175-x
  48. Sun, Q., Wu, X., Wang, L., & Cai, M. (2020). The plate fixation strategy of complex proximal humeral fractures. International Orthopaedics, 44(9), 1785–1795. https://doi.org/10.1007/s00264-020-04544-7
  49. Laux, C. J., Grubhofer, F., Werner, C. M. L., Simmen, H.-P., & Osterhoff, G. (2017). Current concepts in locking plate fixation of proximal humerus fractures. Journal of Orthopaedic Surgery and Research, 12(1). https://doi.org/10.1186/s13018-017-0639-3
  50. Barlow, J. D., Logli, A. L., Steinmann, S. P., Sems, S. A., Cross, W. W., Yuan, B. J., Torchia, M. E., & Sanchez-Sotelo, J. (2020). Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. Journal of Shoulder and Elbow Surgery, 29(8), 1689–1694. https://doi.org/10.1016/j.jse.2019.11.026
  51. Kim, H., Chung, Y.-G., Jang, J. S., Kim, Y., Park, S. B., & Song, H. S. (2020). Why locking plates for the proximal humerus do not fit well. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1007/s00402-020-03676-0
  52. Gonzalez-Hernandez, E., Pietrzak, W. S., Jain, S., & Lapica, H. E. (2020). Cross-elements to enhance fixation in osteoporotic bone with application to proximal humeral locking plates: a biomechanical study. Journal of Shoulder and Elbow Surgery, 29(8), 1606–1614. https://doi.org/10.1016/j.jse.2019.12.017
  53. Macy, J. (2017). Fixation of a Proximal Humeral Fracture Using a Novel Intramedullary Cage Construct following a Failed Conservative Treatment. Case Reports in Orthopedics, 2017, 1–4. https://doi.org/10.1155/2017/4347161
  54. Goodnough, L. H., Campbell, S. T., Githens, T. C., DeBaun, M. R., Bishop, J. A., & Gardner, M. J. (2020). Intramedullary Cage Fixation for Proximal Humerus Fractures Has Low Reoperation Rates at 1 Year. Journal of Orthopaedic Trauma, 34(4), 193–198. https://doi.org/10.1097/bot.0000000000001712
  55. Hudgens, J. L., Jang, J., Aziz, K., Best, M. J., & Srikumaran, U. (2019). Three- and 4-part proximal humeral fracture fixation with an intramedullary cage: 1-year clinical and radiographic outcomes. Journal of Shoulder and Elbow Surgery, 28(6), S131—S137. https://doi.org/10.1016/j.jse.2019.05.002
  56. Favorito, P., Kohrs, B., & Donnelly, D. (2021). Proximal humeral fractures treated with an intramedullary cage and plate: clinical and radiographic outcomes at a minimum of 1 year postoperatively. Journal of Shoulder and Elbow Surgery, 30 (12), 2786‒2794. https://doi.org/10.1016/j.jse.2021.05.001
  57. Neviaser, A. S., Hettrich, C. M., Beamer, B. S., Dines, J. S., & Lorich, D. G. (2011). Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates. Clinical Orthopaedics and Related Research®, 469(12), 3300–3306. https://doi.org/10.1007/s11999-011-1949-0
  58. Hsiao, C.-K., Tsai, Y.-J., Yen, C.-Y., Lee, C.-H., Yang, T.-Y., & Tu, Y.-K. (2017). Intramedullary cortical bone strut improves the cyclic stability of osteoporotic proximal humeral fractures. BMC Musculoskeletal Disorders, 18(1). https://doi.org/10.1186/s12891-017-1421-8
  59. Kulkamthorn, N., Rungrattanawilai, N., Tarunotai, T., Chuvetsereporn, N., Chansela, P., & Phruetthiphat, O.-a. (2022). The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study. Journal of Orthopaedic Surgery and Research, 17(1). https://doi.org/10.1186/s13018-021-02892-7
  60. Somasundaram, K., Huber, C. P., Babu, V., & Zadeh, H. (2013). Proximal humeral fractures: The role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates. Injury, 44(4), 481–487. https://doi.org/10.1016/j.injury.2012.10.030
  61. Kammerlander, C., Doshi, H. K., Böcker, W., & Gosch, M. (2016b). Fragility Fracture Care and Orthogeriatric Comanagement. BioMed Research International, 2016, 1. https://doi.org/10.1155/2016/2056376
  62. Scola, A., Gebhard, F., Weckbach, S., Dehner, C., Schwyn, R., Fliri, L., & Röderer, G. (2013). Mechanical Quantification of Local Bone Quality in the Humeral Head: A Feasibility Study. The Open Orthopaedics Journal, 7(1), 172–176. https://doi.org/10.2174/1874325001307010172
  63. Dall'Oca, C., Maluta, T., Cavani, F., Morbioli, G. P., Bernardi, P., Sbarbati, A., Degl'Innocenti, D., & Magnan, B. (2014). The biocompatibility of porous vs non-porous bone cements: a new methodological approach. European Journal of Histochemistry, 58(2). https://doi.org/10.4081/ejh.2014.2255
  64. Maluta, T., Lavagnolo, U., Segalla, L., Elena, N., Bernardi, P., Degl'Innocenti, D., Sbarbati, A., & Magnan, B. (2022). Evaluation of biocompatibility, osteointegration and biomechanical properties of the new Calcemex® cement: An «in vivo» study. European Journal of Histochemistry, 66(1). https://doi.org/10.4081/ejh.2022.3313.
  65. Jabran, A., Peach, C., & Ren, L. (2018). Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review. BioMedical Engineering OnLine, 17(1). https://doi.org/10.1186/s12938-018-0479-3
  66. Anglin, C., Wyss, U. P., & Pichora, D. R. (2000). Glenohumeral contact forces. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 214(6), 637–644. https://doi.org/10.1243/0954411001535660
  67. Bergmann, G., Graichen, F., Bender, A., Kääb, M., Rohlmann, A., & Westerhoff, P. (2007). In vivo glenohumeral contact forces—Measurements in the first patient 7 months postoperatively. Journal of Biomechanics, 40(10), 2139–2149. https://doi.org/10.1016/j.jbiomech.2006.10.037
  68. Hristov, S., Visscher, L., Winkler, J., Zhelev, D., Ivanov, S., Veselinov, D., Baltov, A., Varga, P., Berk, T., Stoffel, K., Kralinger, F., & Gueorguiev, B. (2022). A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients. Medicina, 58(10), 1424. https://doi.org/10.3390/medicina58101424
  69. Knierzinger, D., Crepaz-Eger, U., Hengg, C., & Kralinger, F. (2020). Does cement augmentation of the screws in angular stable plating for proximal humerus fractures influence the radiological outcome: a retrospective assessment. Archives of Orthopaedic and Trauma Surgery, 140(10), 1413–1421. https://doi.org/10.1007/s00402-020-03362-1
  70. Schliemann, B., Seifert, R., Rosslenbroich, S. B., Theisen, C., Wähnert, D., Raschke, M. J., & Weimann, A. (2015). Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. Journal of Shoulder and Elbow Surgery, 24(12), 1968–1973. https://doi.org/10.1016/j.jse.2015.06.028
  71. Schliemann, B., Risse, N., Frank, A., Müller, M., Michel, P., Raschke, M. J., & Katthagen, J. C. (2019). Screws with larger core diameter and lower thread pitch increase the stability of locked plating in osteoporotic proximal humeral fractures. Clinical Biomechanics, 63, 21–26. https://doi.org/10.1016/j.clinbiomech.2019.02.006
  72. Yang, P., Zhang, Y., Liu, J., Xiao, J., Ma, L. M., Zhu, C. R. (2015). Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis / // Acta orthopaedica et traumatologica turcica, 49 (2), 203‒209. https://doi.org/10.3944/AOTT.2015.14.0204.
  73. Mehta, S., Chin, M., Sanville, J., Namdari, S., & Hast, M. W. (2018). Calcar screw position in proximal humerus fracture fixation: Don’t miss high! Injury, 49(3), 624–629. https://doi.org/10.1016/j.injury.2018.02.007
  74. Xing, B., Zhang, Y., Hou, X., Li, Y., Li, G., & Han, G. (2021). Digital analysis of external fixation area of proximal humerus fractures in elderly patients. BMC Musculoskeletal Disorders, 22(1),991. https://doi.org/10.1186/s12891-021-04826-0
  75. Li, D., Lv, W., Chen, W., Meng, J., Liu, S., Duan, Z., & Yu, B. (2022). Application of a lateral intertubercular sulcus plate in the treatment of proximal humeral fractures: a finite element analysis. BMC Surgery, 22(1). https://doi.org/10.1186/s12893-022-01557-4
  76. Biermann, N., Prall, W. C., Böcker, W., Mayr, H. O., & Haasters, F. (2019). Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Archives of Orthopaedic and Trauma Surgery, 139(8), 1075–1099. https://doi.org/10.1007/s00402-019-03162-2
  77. Seyhan, M., Kocaoglu, B., Nalbantoglu, U., Aydin, N., & Guven, O. (2012). Technique of Kirschner Wire Reduction and Fixation of Displaced Two-Part Valgus Angulated Proximal Humerus Fractures at the Surgical Neck. Journal of Orthopaedic Trauma, 26(6), Стаття e46-e50. https://doi.org/10.1097/bot.0b013e3182254ecc
  78. Simionato, I. F., Brunelli, J. P. F., Ferreira, M. T., Matsumoto, F. Y., Britto, A. G., & Mothes, F. C. (2020). Avaliação radiográfica da consolidação das fraturas desviadas do colo cirúrgico do úmero tratadas com fixação percutânea (Radiographic evaluation of the consolidation of humerus surgical neck fractures treated with percutaneous fixation). Revista Brasileira de Ortopedia, 55(03), 347–352. https://doi.org/10.1055/s-0039-3402463
  79. Baig, M., Diack, M., Murphy, B., & Kaar, K. (2020). A Novel Technique of Proximal Humerus Fixation. Cureus, 12 (4), е7706. https://doi.org/10.7759/cureus.7706
  80. Hao, K. A., Patch, D. A., Reed, L. A., Spitler, C. A., Horneff, J. G., Ahn, J., Strelzow, J. A., Hebert-Davies, J., Little, M. T. M., Krause, P. C., Johnson, J. P., & King, J. J. (2021). Factors Influencing Surgical Management of Proximal Humerus Fractures: Do Shoulder and Trauma Surgeons Differ? Journal of Shoulder and Elbow Surgery, 31 (6), e259–e269. https://doi.org/10.1016/j.jse.2021.11.016
  81. Carbone, S., Moroder, P., Arceri, V., Postacchini, R., & Gumina, S. (2014). The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device. International Orthopaedics, 38(7), 1451–1459. https://doi.org/10.1007/s00264-014-2327-9
  82. Bogner, R., Ortmaier, R., Moroder, P., Karpik, S., Wutte, C., Lederer, S., Auffarth, A., & Resch, H. (2016). Minimally Invasive Treatment of Displaced Proximal Humeral Fractures in Patients Older Than 70 Years Using the Humerusblock. BioMed Research International, 2016, 1–6. https://doi.org/10.1155/2016/6451849
  83. Tauber, M., Hirzinger, C., Hoffelner, T., Moroder, P., & Resch, H. (2015). Midterm outcome and complications after minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock. Injury, 46(10), 1914–1920. https://doi.org/10.1016/j.injury.2015.05.017
  84. Sobel, A. D., Shah, K. N., & Paxton, E. S. (2017). Fixation of a Proximal Humerus Fracture With an Intramedullary Nail. Journal of Orthopaedic Trauma, 31, S47—S49. https://doi.org/10.1097/bot.0000000000000909
  85. Gradl, G., Dietze, A., Kääb, M., Hopfenmüller, W., & Mittlmeier, T. (2009). Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation? Clinical Orthopaedics and Related Research®, 467(11), 2986–2993. https://doi.org/10.1007/s11999-009-0916-5
  86. Congia, S., Palmas, A., Marongiu, G., & Capone, A. (2020). Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures? MUSCULOSKELETAL SURGERY, 104(2), 179–185. https://doi.org/10.1007/s12306-019-00610-5
  87. Gomes, G. R., Maciel, R. A., Almeida Neto, J. I. D., Toledo, D. C. D., Machado, C. J., & Bomfim, L. D. S. (2022). Antegrade Nailing Versus Locking Plate Of 2-And 3-Part Proximal Humerus Fractures. Acta Ortopédica Brasileira, 30(5). https://doi.org/10.1590/1413-785220223005e256113
  88. Gadea, F., Favard, L., Boileau, P., Cuny, C., d’Ollone, T., Saragaglia, D., & Sirveaux, F. (2016). Fixation of 4-part fractures of the proximal humerus: Can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases. Orthopaedics & Traumatology: Surgery & Research, 102(8), 963–970. https://doi.org/10.1016/j.otsr.2016.09.015
  89. Bu, G., Sun, W., Li, J., Yang, T., Li, M., & Wei, W. (2021). MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly. Geriatric Orthopaedic Surgery & Rehabilitation, 12, 215145932110439. https://doi.org/10.1177/21514593211043961
  90. Bai, X., Zhu, Z., Chang, Z., Sun, L., Tang, P., & Chen, H. (2022). Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults. BMC Musculoskeletal Disorders, 23(1). https://doi.org/10.1186/s12891-022-05998-z
  91. Gracitelli, M. E. C., Malavolta, E. A., Assunção, J. H., Ferreira Neto, A. A., Silva, J. S., & Hernandez, A. J. (2017). Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures. Expert Review of Medical Devices, 14(9), 733–739. https://doi.org/10.1080/17434440.2017.1364624
  92. Sun, Q., Ge, W., Li, G., Wu, J., Lu, G., Cai, M., & Li, S. (2018). Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis. International Orthopaedics, 42(3), 641–650. https://doi.org/10.1007/s00264-017-3683-z
  93. Ge, W., Sun, Q., Li, G., Lu, G., Cai, M., & Li, S. (2017). Efficacy comparison of intramedullary nails, locking plates and conservative treatment for displaced proximal humeral fractures in the elderly. Clinical Interventions in Aging, Volume 12, 2047–2054. https://doi.org/10.2147/cia.s144084
  94. Hättich, A., Harloff, T. J., Sari, H., Schlickewei, C., Cramer, C., Strahl, A., Frosch, K.-H., Mader, K., & Klatte, T. O. (2022). Influence of Fracture Reduction on the Functional Outcome after Intramedullary Nail Osteosynthesis in Proximal Humerus Fractures. Journal of Clinical Medicine, 11(22), 6861. https://doi.org/10.3390/jcm11226861
  95. Beks, R. B., Ochen, Y., Frima, H., Smeeing, D. P. J., van der Meijden, O., Timmers, T. K., van der Velde, D., van Heijl, M., Leenen, L. P. H., Groenwold, R. H. H., & Houwert, R. M. (2018). Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. Journal of Shoulder and Elbow Surgery, 27(8), 1526–1534. https://doi.org/10.1016/j.jse.2018.03.009.
  96. Koval, K. J., Gallagher, M. A., Marsicano, J. G., Cuomo, F., McShinawy, A., & Zuckerman, J. D. (1997). Functional Outcome after Minimally Displaced Fractures of the Proximal Part of the Humerus*. The Journal of Bone & Joint Surgery, 79(2), 203–7. https://doi.org/10.2106/00004623-199702000-00006
  97. Cummings, S. R., & Melton, L. J. (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet, 359(9319), 1761–1767. https://doi.org/10.1016/s0140-6736(02)08657-9
  98. Volgas, D. A., Stannard, J. P., & Alonso, J. E. (2004). Nonunions of the Humerus. Clinical Orthopaedics and Related Research, 419, 46–50. https://doi.org/10.1097/00003086-200402000-00008
  99. Dey Hazra, R.-O., Illner, J., Szewczyk, K., Warnhoff, M., Ellwein, A., Blach, R. M., Lill, H., & Jensen, G. (2022). Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate. Journal of Clinical Medicine, 11(2), 408. https://doi.org/10.3390/jcm11020408
  100. Dey Hazra, R.-O., Blach, R. M., Ellwein, A., Katthagen, J. C., Lill, H., & Jensen, G. (2021). Latest Trends in the Current Treatment of Proximal Humeral Fractures – an Analysis of 1162 Cases at a Level-1 Trauma Centre with a Special Focus on Shoulder Surgery. Zeitschrift für Orthopädie und Unfallchirurgie, 160 (3), 287‒298. https://doi.org/10.1055/a-1333-3951 (in English, German)
  101. 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. https://doi.org/10.1007/s10195-017-0457-8

Downloads

How to Cite

Korzh, M. ., & Makarov, V. . (2023). SURGICAL TREATMENT OF THE PROXIMAL HUMERUS FRACTURES IN PATIENTS WITH OSTEOPOROSIS. PROBLEMATIC ISSUES AND DEVELOPMENT PROSPECTS. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 86–99. https://doi.org/10.15674/0030-59872023186-99

Issue

No. 1 (2023)

Section

DIGESTS AND REVIEWS

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.

Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.

The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).