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Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series

Abstract

Objective

To report the functional and radiological results of unusual comminuted fractures of the proximal humerus, treated with ‘closed reduction and external fixation’ (CREF) using hybrid-type unilateral external fixators (EFs).

Patients and methods

Between January 2012 and June 2013, eight patients (mean age 62.6; range 48–84 years) with comminuted proximal humeral fractures extending to the humeral head and one-third proximal diaphysis were treated with CREF using hybrid-type EFs. Functional results were evaluated in terms of shoulder ranges of movement, Constant, DASH, and VAS scores, and radiological results were evaluated using antero-posterior and lateral radiograms of the treated humerus.

Results

The mean follow-up was 16.6 (range 12–28) months. The mean fixator time was 84 (range 63–118) days. The mean range of forward flexion, internal rotation, external rotation, and abduction were 145°, 61.2°, 65°, and 115°, respectively. The mean Constant, DASH, and VAS scores were 79.8, 10, and 1.75, respectively. Seven of the eight patients (87.5 %) healed radiologically. Two complications were observed in two patients: non-union and superficial pin site infection.

Conclusions

In the treatment of unusual, comminuted proximal diaphyseal humeral fractures, CREF using a hybrid-type EF is a minimally invasive, advantageous procedure with acceptable rates of healing, low risk of surgical site infection, and early range of motion.

Level of evidence

Level IV, case series.

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References

  1. Brunner A, Thormann S, Babst R (2012) Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS). J Shoulder Elbow Surg 21(8):1056–1063. doi:10.1016/j.jse.2011.05.016

    Article  PubMed  Google Scholar 

  2. Handoll HH, Gibson JN, Madhok R (2003) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 4:CD000434. doi:10.1002/14651858.CD000434

  3. Flatow E (2001) Fractures of the proximal humerus. In: Bucholz R, Heckman JD (eds) Fractures in adults, 5th edn. Lippincot Williams & Wilkins, Philadelphia, pp 997–1040

    Google Scholar 

  4. Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M (2011) Humeral shaft fractures: a review. J Shoulder Elbow Surg 20(5):833–844. doi:10.1016/j.jse.2010.11.030

    Article  PubMed  Google Scholar 

  5. Broadbent MR, Quaba O, Hadjucka C, McQueen MM (2003) The epidemiology of multifocal upper limb fractures. Scand J Surg 92(3):220–223

    CAS  PubMed  Google Scholar 

  6. Lewicky YM, Sheppard JE, Ruth JT (2007) The combined olecranon osteotomy, lateral paratricipital sparing, deltoid insertion splitting approach for concomitant distal intra-articular and humeral shaft fractures. J Orthop Trauma 21(2):133–139. doi:10.1097/01.bot.0000245988.23684.79

    Article  PubMed  Google Scholar 

  7. O’Donnell TM, McKenna JV, Kenny P, Keogh P, O’Flanagan SJ (2008) Concomitant injuries to the ipsilateral shoulder in patients with a fracture of the diaphysis of the humerus. J Bone Joint Surg Br Vol 90(1):61–65. doi:10.1302/0301-620X.90B1.19215

    Article  Google Scholar 

  8. Garnavos C, Lasanianos N (2010) Intramedullary nailing of combined/extended fractures of the humeral head and shaft. J Orthop Trauma 24(4):199–206. doi:10.1097/BOT.0b013e3181b2b74d

    Article  PubMed  Google Scholar 

  9. Heim D, Herkert F, Hess P, Regazzoni P (1993) Surgical treatment of humeral shaft fractures: the Basel experience. J Trauma 35(2):226–232

    Article  CAS  PubMed  Google Scholar 

  10. An Z, He X, Zeng B (2009) A comparative study on open reduction and plating osteosynthesis and minimal invasive plating osteosynthesis in treating mid-distal humeral shaft fractures. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi =Chin J Reparative Reconstr Surg 23(1):41–44

    Google Scholar 

  11. Stedtfeld HW, Biber R (2014) Proximal third humeral shaft fractures: a fracture entity not fully characterized by conventional AO classification. Injury 45(Suppl 1):S54–S59. doi:10.1016/j.injury.2013.10.030

    Article  PubMed  Google Scholar 

  12. Hasegawa T, Inufusa A, Imai Y, Mikawa Y, Lim TH, An HS (2005) Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J 5(3):239–243. doi:10.1016/j.spinee.2004.11.010

    Article  PubMed  Google Scholar 

  13. Neer CS 2nd (1987) Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res 223:3–10

    PubMed  Google Scholar 

  14. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium—2007: orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133

    Article  CAS  PubMed  Google Scholar 

  15. Maresca A, Pascarella R, Bettuzzi C, Amendola L, Politano R, Fantasia R, Del Torto M (2014) Multifocal humeral fractures. Injury 45(2):444–447. doi:10.1016/j.injury.2013.10.010

    Article  CAS  PubMed  Google Scholar 

  16. Benetos IS, Karampinas PK, Mavrogenis AF, Romoudis P, Pneumaticos SG, Vlamis J (2012) External fixation for displaced 2-part proximal humeral fractures. Orthopedics 35(12):e1732–e1737. doi:10.3928/01477447-20121120-17

    Article  PubMed  Google Scholar 

  17. Ziran BH, Smith WR, Anglen JO, Tornetta P III (2008) External fixation: how to make it work. Instr Course Lect 57:37–49

    PubMed  Google Scholar 

  18. Catagni MA (2003) Atlas for the insertion of transosseous wires and half-pins Ilizarov method. In: Malocchi AB (ed) Medi Surgical Video. Italy, Milan

    Google Scholar 

  19. Moroni A, Faldini C, Pegreffi F, Giannini S (2004) HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures. Clin Orthop Relat Res 425:87–92

    Article  PubMed  Google Scholar 

  20. Crates J, Whittle AP (1998) Antegrade interlocking nailing of acute humeral shaft fractures. Clin Orthop Relat Res 350:40–50

    Article  PubMed  Google Scholar 

  21. Modabber MR, Jupiter JB (1998) Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res 347:93–104

    Article  PubMed  Google Scholar 

  22. Ingman AM, Waters DA (1994) Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. J Bone Joint Surg Br Vol 76(1):23–29

    CAS  Google Scholar 

  23. Reimer B (1998) Humeral shaft fractures-intramedullary nailing. In: Wiss D (ed) Master techniques in orthopaedic surgery. Lippincott-Raven, Philadelphia, pp 81–94

    Google Scholar 

  24. Chiu FY, Chen CM, Lin CF, Lo WH, Huang YL, Chen TH (1997) Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma 43(6):947–951

    Article  CAS  PubMed  Google Scholar 

  25. Castella FB, Garcia FB, Berry EM, Perello EB, Sanchez-Alepuz E, Gabarda R (2004) Nonunion of the humeral shaft: long lateral butterfly fracture—a nonunion predictive pattern? Clin Orthop Relat Res 424:227–230

    Article  PubMed  Google Scholar 

  26. Yang KH (2005) Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury 36(1):75–80. doi:10.1016/j.injury.2004.03.023

    Article  PubMed  Google Scholar 

  27. Mostafavi HR, Tornetta P 3rd (1997) Open fractures of the humerus treated with external fixation. Clin Orthop Relat Res 337:187–197

    Article  PubMed  Google Scholar 

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Correspondence to Fatih Yıldız.

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Uzer, G., Yıldız, F., Elmadağ, M. et al. Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series. Eur J Orthop Surg Traumatol 25, 683–687 (2015). https://doi.org/10.1007/s00590-014-1579-9

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  • DOI: https://doi.org/10.1007/s00590-014-1579-9

Keywords

  • Humerus
  • Fracture
  • Comminuted
  • Closed reduction
  • External fixator