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Proximal Humerus Fracture

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1. Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis

Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis We sought to compare range of motion, clinical outcome scores, and complications after reverse total shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in geriatric patients with acute proximal humerus fractures.We searched MEDLINE (1946-2017), EMBASE (1947-2017), the Cochrane Central Register (...) of Controlled Trials (1898-2017) and ClinicalTrials.gov in October 2017. No limits were used in the database search. We also manually reviewed reference lists of included studies. We did not restrict studies based on language.We included all randomized controlled trials and cohort studies in which the study population had a mean age of 65 years or older, received RSA or HA to treat an acute proximal humerus fracture, and had a minimum follow-up of 6 months.Two independent reviewers used a standardized data

2019 EvidenceUpdates

2. Randomised controlled trial: No differences between operative and non-operative treatments of proximal humerus fractures

Randomised controlled trial: No differences between operative and non-operative treatments of proximal humerus fractures No differences between operative and non-operative treatments of proximal humerus fractures | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password (...) For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here No differences between operative and non-operative treatments of proximal humerus fractures Article Text Therapeutics/Prevention Randomised controlled trial No differences between

2016 Evidence-Based Medicine (Requires free registration)

3. Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study. (PubMed)

Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study. The aim of this study was to investigate the effectiveness of the proximal humeral internal locking system (PHILOS) plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures.A total of 112 patients with proximal humerus fractures were assigned randomly into 2 groups. Group A (n = 56) was treated (...) observed in mean VAS scores and mean Constant-Murley shoulder assessment scores at 1-day preoperative and postoperative day 3 between groups A and B. However, mean VAS scores and mean Constant-Murley shoulder assessment in group B were significantly improved when compared with group A at postoperative day 30 and the final follow-up. No cases of postoperative infection, loss of reduction, PHILOS break, or vascular nerve injury occurred in either group.Proximal humerus fractures treated

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2019 Medicine

4. [Proximal humeral fractures-Where do we stand today? : Comments on the "Proximal fracture of the humerus evaluation by randomization (PROFHER)" study]. (PubMed)

[Proximal humeral fractures-Where do we stand today? : Comments on the "Proximal fracture of the humerus evaluation by randomization (PROFHER)" study]. The PROFHER study is a multicenter randomized controlled trial of 250 out of 1250 patients assessed for eligibility with dislocated proximal humeral fractures with involvement of the surgical neck. These patients were randomized either for surgery or conservative treatment. Patients with comorbidities that precluded surgery, lack of mental (...) capacity, luxation fractures or clear indications for surgery from the authors' perspective were excluded. To evaluate the outcome, standardized self-assessment methods were used (patient reported outcome [PRO]), including the Oxford shoulder score (OSS). The results showed no differences in the primary and secondary self-assessment outcome scores after both 2 and 5 years. Although no significant differences could be detected between both groups, no clear statement could be deduced from the PROFHER

2018 Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen

5. The effects of intramedullary nail and locking plates in the treatment of proximal humerus fractures: an update systematic review and meta-analysis

The effects of intramedullary nail and locking plates in the treatment of proximal humerus fractures: an update systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

6. Systematic review of tuberosity healing following reverse shoulder arthroplasty for proximal humerus fracture

Systematic review of tuberosity healing following reverse shoulder arthroplasty for proximal humerus fracture Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files

2019 PROSPERO

7. Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan (PubMed)

Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan BACKGROUND Screw perforation and varus collapse are common complications of treatment with a PHILOS (proximal humerus internal locking system) plate for proximal humerus fractures, which are associated with improper screw length selection and lack of medial column support. The purposes of this study were: (1) to measure the proper (...) screws in males than in females, and were positively correlated with body height. Our data can be used as a reference for surgeons to reduce the number of times screws are changed intraoperatively and to reduce operation duration and minimize use of intraoperative fluoroscopy for proximal humerus fractures treated with the PHILOS plate.

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2018 Medical science monitor : international medical journal of experimental and clinical research

8. The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures. (PubMed)

The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures. Hemiarthroplasty of the shoulder is a well established treatment for proximal humerus fractures not amenable to open reduction internal fixation. However, orthopedic surgeons have recently increased utilization of reverse total shoulder arthroplasty (RTSA) in the treatment of these injuries. The purpose of this study was to evaluate the use of hemiarthroplasty and RTSA between 2009 (...) and 2016 for the treatment of proximal humerus fractures within a large United States integrated healthcare system.A descriptive study was conducted using our integrated healthcare system's Shoulder Arthroplasty Registry. Shoulder arthroplasty cases performed for an acute proximal humerus fracture between the years of 2009 and 2016 were identified. Revision rates were determined, as well as changes in age and gender distribution of the cohort during the study period.In 2015, RTSA utilization surpassed

2019 Injury

9. Effect of Tuberosity Healing on Clinical Outcomes in Elderly Patients Treated With a Reverse Shoulder Arthroplasty for 3- and 4-Part Proximal Humerus Fractures. (PubMed)

Effect of Tuberosity Healing on Clinical Outcomes in Elderly Patients Treated With a Reverse Shoulder Arthroplasty for 3- and 4-Part Proximal Humerus Fractures. To evaluate tuberosity union rate and clinical outcome after 3- and 4-part proximal humerus fractures in the elderly.Retrospective, multicenter database cohort study.Level I and Level II trauma centers.Fifty-five patients older than 65 years had insertion of reverse shoulder arthroplasty (RTSA) for OTA/AO 11-B and 11-C proximal humerus (...) - and 4-part proximal humerus fractures in the elderly can result in a high tuberosity union rate. Greater tuberosity healing significantly influences ER and ER-type activities that are not apparent by analysis of the overall metrics studied.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

2019 Journal of Orthopaedic Trauma

10. Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures. (PubMed)

Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures. To determine if uncemented implants would provide similar outcomes while avoiding the complications associated with cement in the treatment of elderly patients with proximal humerus fractures (PHFs) with primary reverse total shoulder arthroplasty (RTSA).Case series SETTING:: A single Level I trauma centerPatients/Participants: A prospectively-obtained cohort of 30 patients who

2019 Journal of Orthopaedic Trauma

11. Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures. (PubMed)

Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures. Fractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking (...) plate fixation and biceps tenodesis for treating proximal humerus fractures.56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40% Neer III, 43% Neer IV) served as control group receiving only interlocking plate

2019 Injury

12. Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. (PubMed)

Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. On the basis of patients' demands, bone quality, and fracture type, we developed an evidence-based treatment algorithm for proximal humerus fractures (PHF) that includes all treatment modalities from open reduction and internal fixation, hemiprosthesis, to reverse total shoulder arthroplasty. This study was done to assess its feasibility and early (...) clinical outcome.Patients with isolated PHF in 2014 and 2015 were included in this prospective study. The quality of life (EQ-5D) and the level of autonomy before injury were recorded. The fractures were classified and local bone quality was measured. When possible, patients were treated according to the algorithm. Radiographic and clinical follow-up-Constant score, subjective shoulder value, and EQ-5D-took place after 3 months and 1 year. The rate of unplanned surgery was analyzed.A total of 192

2019 Journal of Shoulder and Elbow Surgery

13. Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. (PubMed)

Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating. To date, there is a lack of consensus regarding surgical treatment recommendations for complex proximal humerus fracture (PHF) patterns, especially between joint preservation and joint replacement techniques.Between 2012 and 2017, 146 patients (aged 74.1 ± 8.0 years) with complex PHF were treated (...) complication rate was 37.8% for ORIF and 22.0% for RTSA, with a revision rate of 12.1% and 5.1%, respectively, as driven primarily by persistent motion deficits. Multivariate analyses demonstrated no significant differences between the 2 procedures (P = .500). However, age was an independent protective factor against overall complications (P = .018). Risk factors for major complications in ORIF included osteoporosis, varus impaction fractures, posteromedial metaphyseal extensions <8 mm, head-shaft

2019 Journal of Shoulder and Elbow Surgery

14. A comparative retrospective study of locking plate fixation versus a dedicated external fixator of 3- and 4-part proximal humerus fractures: Results after 5 years. (PubMed)

A comparative retrospective study of locking plate fixation versus a dedicated external fixator of 3- and 4-part proximal humerus fractures: Results after 5 years. Fractures of the proximal humerus (PHF) represent a common injury among orthopedic department; especially for three- and four-part fractures no consensus about the best treatment is still achieved. The aim of our study was to compare clinical and radiological outcomes in patients alternatively treated with plates and screws (...) or external fixation system for a type III-IV proximal humerus fracture.Sixty-nine patients went surgery for type III-IV PHF between January 2011 and January 2014. According to the Neer classification, fractures were classified as type III in 50 cases (72,46%) and type IV in 19 cases (24,56%). 45 patients were treated with plates (65%) and 24 external fixators (35%). The patients' mean age was 62 years (range, 31-87 y). At five years, 60 patients (86,9%) were assessed using the visual analog scale (VAS

2019 Injury

15. A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients. (PubMed)

A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients. To summarize and appraise any patient-reported or clinician-measured outcome measures based on their measurement properties in proximal humerus fracture patients.MEDLINE, EMBASE, and CINAHL were searched from January 2000 to August 2018 to identify all studies of proximal humerus fracture patients that reported a measurement property evaluation (...) the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score, Constant Score, University of California, Los Angeles Shoulder Score, and EuroQol 5 Dimension (EQ5D) were evaluated in more than 1 study. The Shoulder Function Index (SFINX), DASH, and EQ5D had the highest EMPRO scores (80, 66, and 58, respectively). The SFINX and DASH consistently scored among the top 3 instruments for each attribute.Evidence on the measurement properties of outcome measures for proximal humerus fracture patients

2019 Journal of Orthopaedic Trauma

16. Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients. (PubMed)

Primary reverse shoulder arthroplasty for acute proximal humerus fractures: A 5-year long term retrospective study of elderly patients. Reverse shoulder arthroplasty (RSA) in complex shoulder fractures is ever more frequently. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures (PHFs) treated with RSA, with and without tuberosities grafting.Between January 2009 and June 2014, 55 patients aged ≥65 years with 3- and 4-part PHFs were treated

2019 Injury

17. Intramedullary nailing of displaced four-part fractures of the proximal humerus. (PubMed)

Intramedullary nailing of displaced four-part fractures of the proximal humerus. Intramedullary nailing is already established technique for the treatment of two and three-part fractures of proximal humerus. The aim of the study was to prospectively evaluate the efficacy and functional outcome after treatment of four-part fractures of proximal humerus with Multiloc proximal humeral nail.prospective monocentric cohort study.single level 1 traumacenter.From February 2011 to March 2016, 40 (...) for the treatment of four-part fractures of proximal humerus. In experienced hands provides nailing osteosynthesis similar results as reconstruction with locking plates. Appropriate reduction of fracture fragments is the key for good functional result.Level 2b - monocentric prospective cohort study.Copyright © 2019 Elsevier Ltd. All rights reserved.

2019 Injury

18. Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. (PubMed)

Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. 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.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

2019 PLoS medicine

19. Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation. (PubMed)

Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation. 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).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°.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

2019 Journal of Shoulder and Elbow Surgery

20. Reverse shoulder arthroplasty for proximal humerus fracture: a more complex episode of care than for cuff tear arthropathy. (PubMed)

Reverse shoulder arthroplasty for proximal humerus fracture: a more complex episode of care than for cuff tear arthropathy. The purpose of this investigation is to identify the in-hospital and 30-day postoperative complications for reverse total shoulder arthroplasty (RTSA) performed because of proximal humerus fracture (PHFx) vs. cuff tear arthropathy (CTA), and determine whether acute fracture is associated with differences in complications after RTSA.The National Surgical Quality Improvement

2019 Journal of Shoulder and Elbow Surgery

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