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Choice of Management and Techniques of Proximal Humeral Fixation

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Surgery for Osteoporotic Fractures

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Abstract

Proximal humerus fracture is the third most common fracture in patients with osteoporosis. Most of such fractures can be treated conservatively. Surgical intervention allows anatomical reduction and rigid fixation to enable early mobilization, however, a high reoperation rate is reported. Special techniques and tricks in the fixation of proximal humerus fractures, with plating, or proximal humerus nails, are demonstrated in this chapter to enhance the readers’ ability to tackle this challenging fracture, such as reverse shoulder arthroplasty for irreparable fractures.

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References

  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–7.

    Article  PubMed  Google Scholar 

  2. Calvo E, et al. Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elb Surg. 2011;20(5):795–801.

    Article  Google Scholar 

  3. Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res. 2006;442:100–8.

    Article  PubMed  Google Scholar 

  4. Harrison JW, et al. Internal fixation of proximal humeral fractures. Acta Orthop Belg. 2007;73(1):1–11.

    PubMed  Google Scholar 

  5. Brunner F, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23(3):163–72.

    Article  PubMed  Google Scholar 

  6. Hirschmann MT, et al. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma. 2011;25(5):286–93.

    Article  PubMed  Google Scholar 

  7. Krappinger D, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42(11):1283–8.

    Article  PubMed  Google Scholar 

  8. Agudelo J, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma. 2007;21(10):676–81.

    Article  PubMed  Google Scholar 

  9. Barvencik F, et al. Age- and sex-related changes of humeral head microarchitecture: histomorphometric analysis of 60 human specimens. J Orthop Res. 2010;28(1):18–26.

    Article  PubMed  Google Scholar 

  10. Hepp P, et al. Where should implants be anchored in the humeral head? Clin Orthop Relat Res. 2003;415:139–47.

    Article  Google Scholar 

  11. Saitoh S, et al. Distribution of bone mineral density and bone strength of the proximal humerus. J Shoulder Elb Surg. 1994;3(4):234–42.

    Article  CAS  Google Scholar 

  12. Tingart MJ, et al. Three-dimensional distribution of bone density in the proximal humerus. Calcif Tissue Int. 2003;73(6):531–6.

    Article  CAS  PubMed  Google Scholar 

  13. Yamada M, et al. Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elb Surg. 2007;16(5):596–602.

    Article  Google Scholar 

  14. Mather J, et al. Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. J Shoulder Elb Surg. 2013;22(6):732–8.

    Article  Google Scholar 

  15. Spross C, et al. Deltoid Tuberosity Index: a simple radiographic tool to assess local bone quality in proximal humerus fractures. Clin Orthop Relat Res. 2015;473(9):3038–45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rangan A, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313(10):1037–47.

    Article  CAS  PubMed  Google Scholar 

  17. O’Donnell JA, Gage MJ. Proximal humerus geriatric fracture care: fix, replace, or nonoperative treatment? J Orthop Trauma. 2021;35(Suppl 5):S6–S10.

    Article  PubMed  Google Scholar 

  18. Franz Kralinger MB. Proximal humerus. In: Michael Blauth SLK, Nicholas JA, editors. Osteoporotic fracture care. New York: Thieme; 2018.

    Google Scholar 

  19. Thanasas C, et al. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elb Surg. 2009;18(6):837–44.

    Article  Google Scholar 

  20. Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elb Surg. 1998;7(6):586–90.

    Article  CAS  Google Scholar 

  21. Hettrich CM, et al. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am. 2010;92(4):943–8.

    Article  PubMed  Google Scholar 

  22. Hertel R, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg. 2004;13(4):427–33.

    Article  CAS  Google Scholar 

  23. Strasser S, et al. Nail Versus Plate: a biomechanical comparison of a locking plate versus an intramedullary nail with an angular stable locking system in a shoulder simulator with active muscle forces using a two-part fracture model. J Orthop Trauma. 2021;35(3):e71–6.

    Article  PubMed  Google Scholar 

  24. Fuchtmeier B, et al. Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg. 2007;127(6):441–7.

    Article  CAS  PubMed  Google Scholar 

  25. Yoon RS, et al. A comprehensive update on current fixation options for two-part proximal humerus fractures: a biomechanical investigation. Injury. 2014;45(3):510–4.

    Article  PubMed  Google Scholar 

  26. Gracitelli ME, et al. Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial. J Shoulder Elb Surg. 2016;25(5):695–703.

    Article  Google Scholar 

  27. Plath JE, et al. Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial. BMC Musculoskelet Disord. 2019;20(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhu Y, et al. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am. 2011;93(2):159–68.

    Article  PubMed  Google Scholar 

  29. Laux CJ, et al. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res. 2017;12(1):137.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Boileau P, et al. Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing. J Shoulder Elb Surg. 2019;28(2):276–87.

    Article  Google Scholar 

  31. Lopiz Y, et al. Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails. J Shoulder Elb Surg. 2014;23(3):369–76.

    Article  Google Scholar 

  32. Konrad G, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1):85–95.

    Article  PubMed  Google Scholar 

  33. Bai L, et al. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study. J Orthop Trauma. 2014;28(8):452–7.

    Article  PubMed  Google Scholar 

  34. Zhang W, et al. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures. PLoS One. 2014;9(8):e103297.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hodgson S. Proximal humerus fracture rehabilitation. Clin Orthop Relat Res. 2006;442:131–8.

    Article  PubMed  Google Scholar 

  36. Platzer P, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma. 2008;65(4):843–8.

    PubMed  Google Scholar 

  37. Sun Q, et al. Plate fixation versus arthroscopic-assisted plate fixation for isolated medium-sized fractures of the greater tuberosity: a retrospective study. Orthop Surg. 2020;12(5):1456–63.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Young AA, Hughes JS. Locked intramedullary nailing for treatment of displaced proximal humerus fractures. Orthop Clin North Am. 2008;39(4):417–28.

    Article  PubMed  Google Scholar 

  39. Rothstock S, et al. Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. Clin Biomech. 2012;27(7):686–91.

    Article  Google Scholar 

  40. Boileau P, et al. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elb Surg. 2002;11(5):401–12.

    Article  CAS  Google Scholar 

  41. Boileau P, et al. Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elb Surg. 2013;22(11):1495–506.

    Article  Google Scholar 

  42. Austin DC, et al. 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. J Orthop Trauma. 2019;33(1):49–57.

    Article  PubMed  Google Scholar 

  43. Gillespie RJ, et al. Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes. Orthop Clin North Am. 2015;46(1):49–56.

    Article  PubMed  Google Scholar 

  44. Levigne C, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2008;17(6):925–35.

    Article  Google Scholar 

  45. Melis B, et al. An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg Br. 2011;93(9):1240–6.

    Article  CAS  PubMed  Google Scholar 

  46. Sabharwal S, Bale S. The biomechanics of reverse shoulder arthroplasty. J Arthrosc Joint Surg. 2021;8(1):7–12.

    Article  Google Scholar 

  47. Simovitch RW, et al. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89(3):588–600.

    Article  PubMed  Google Scholar 

  48. Kempton LB, et al. A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2011;20(6):968–74.

    Article  Google Scholar 

  49. Edwards TB, et al. Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study. J Shoulder Elb Surg. 2012;21(5):641–6.

    Article  Google Scholar 

  50. Patel M, et al. Inferior tilt of the glenoid leads to medialization and increases impingement on the scapular neck in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2021;30(6):1273–81.

    Article  Google Scholar 

  51. Helmkamp JK, et al. The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2018;27(11):2099–107.

    Article  Google Scholar 

  52. Boileau P, et al. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011;469(9):2558–67.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Berhouet J, Garaud P, Favard L. Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(2):151–8.

    Article  Google Scholar 

  54. Berhouet J, Garaud P, Favard L. Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study. Orthop Traumatol Surg Res. 2013;99(8):887–94.

    Article  CAS  PubMed  Google Scholar 

  55. de Wilde LF, et al. Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010;81(6):719–26.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Werthel JD, et al. Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop. 2019;43(10):2349–60.

    Article  PubMed  Google Scholar 

  57. Langohr GD, et al. The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion. J Shoulder Elb Surg. 2015;24(6):972–9.

    Article  Google Scholar 

  58. Lädermann A, et al. Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Int Orthop. 2015;39(11):2205–13.

    Article  PubMed  Google Scholar 

  59. Erickson BJ, et al. The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2015;24(6):988–93.

    Article  Google Scholar 

  60. Kontaxis A, et al. Humeral version in reverse shoulder arthroplasty affects impingement in activities of daily living. J Shoulder Elb Surg. 2017;26(6):1073–82.

    Article  Google Scholar 

  61. Bonnevialle N, et al. Should the supraspinatus tendon be excised in the case of reverse shoulder arthroplasty for fracture? Eur J Orthop Surg Traumatol. 2020;30(2):231–5.

    Article  PubMed  Google Scholar 

  62. SiebenbĂĽrger G, et al. Supraspinatus tenotomy in reverse shoulder arthroplasty for fractures: a comparative cohort study. Geriatr Orthopaed Surg Rehabil. 2021;12:21514593211019973.

    Article  Google Scholar 

  63. Matthewson G, et al. The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review. J Shoulder Elb Surg. 2019;28(5):989–97.

    Article  Google Scholar 

  64. Yat YCS, Lau CFF. Surgeon-designed patient-specific instrumentation improves glenoid component screw placement for reverse total shoulder arthroplasty in patients with small glenoid dimensions. Int Orthop. 2021;47(5):1267–75.

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong

    Dennis King Hang Yee, Tak Man Wong & Christian Fang

Authors
  1. Dennis King Hang Yee
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  2. Tak Man Wong
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  3. Christian Fang
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Correspondence to Dennis King Hang Yee .

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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong

    Frankie Leung

  2. Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokulam, Hong Kong, Hong Kong

    Tak Wing Lau

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Yee, D.K.H., Wong, T.M., Fang, C. (2024). Choice of Management and Techniques of Proximal Humeral Fixation. In: Leung, F., Lau, T.W. (eds) Surgery for Osteoporotic Fractures. Springer, Singapore. https://doi.org/10.1007/978-981-99-9696-4_4

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  • DOI: https://doi.org/10.1007/978-981-99-9696-4_4

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  • Online ISBN: 978-981-99-9696-4

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