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A prognostic classification of proximal humerus fractures: the cephalic extension staging

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Recent publications emphasized the role of dorsomedial metaphyseal extension of humeral head as predictor of ischemia after complex proximal humerus fractures (PHFs). We evaluated on preoperative 3D CT scan of PHFs the surface of this metaphyseal extension and its prognostic value on the occurrence of avascular necrosis (AVN).

Methods

We followed a series of 25 fixations of complex PHF which had a preoperative 3D CT scan and measured the surface area of the posterior metaphyseal extension (PME) of the head. Using approximations, we calculated the ratio between the PME surface area (PMS) and the articular surface area of the head (HS). The PMS/HS ratio was analyzed against the risk of AVN.

Results

The measurement of the PMS/HS ratio emphasizes the significance of PME. The incidence of AVN is correlated with the magnitude of PME. Therefore, we include the PME as a fifth element in the characterization of complex PHFs and we propose a 4-stage prognostic classification based on the number of extensions of the humeral head. The head may have 3 extensions: posteromedial (PME), lesser tuberosity (LTE) and greater tuberosity (GTE). The risk of AVN decreases with the number of extensions of the head.

Conclusion

Our study demonstrates a correlation between the occurrence of AVN and the size of PME in complex PHF cases. We propose a four-stage classification system to facilitate treatment decision-making between fixation and prosthesis.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France

    Levon Doursounian & Anne Miquel

  2. Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, 93000, Bobigny, France

    Thomas Gregory

Authors
  1. Levon Doursounian
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Correspondence to Levon Doursounian.

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This study comply with the ethical standards of the medical institution where it was conducted (Assistance Publique-Hôpitaux de Paris). This study was carried out and written in compliance with the rules of professional and scientific ethics.

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Doursounian, L., Gregory, T. & Miquel, A. A prognostic classification of proximal humerus fractures: the cephalic extension staging. Eur J Orthop Surg Traumatol 34, 143–153 (2024). https://doi.org/10.1007/s00590-023-03626-7

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  • DOI: https://doi.org/10.1007/s00590-023-03626-7

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