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Proximal Humeral Fractures—Current Trends and Innovations
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Proximal Humeral Fractures—Current Trends and Innovations

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 8527

Special Issue Editor

Prof. Dr. J. Christoph Katthagen

E-Mail Website
Guest Editor
Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
Interests: proximal humeral fracture; shoulder biomechanics; glenoid concavity; public health; elbow injuries; pelvis trauma; complex traumatology

Special Issue Information

Dear Colleagues,

Proximal humeral fractures are among the most challenging and fascinating entities in traumatology. Each individual treatment path leads along a narrow ridge, between the risk of impaired shoulder function and potential complications on one hand, and improved quality of life on the other. One of the big challenges is identifying which patient and fracture is best suited to, and will most benefit from, non-operative or surgical treatment. In case of surgical treatment, the decision between humeral head preserving surgery and fracture arthroplasty must be made thoughtfully. Owing to the particular anatomy of the proximal humerus, soft tissue management is crucial. Furthermore, fracture fixation often demands additional augmentation. Double plating, fibular strut grafts, screw augmentation and bone void filling are only a few of the recent developments in fracture fixation. In case of humeral head replacement, use of reverse total shoulder arthroplasty is increasing. A critical evaluation of its indication is needed. This Special Issue aims to be a forum for high-quality publications that inform on current trends and developments in proximal humeral fracture treatment.

Prof. Dr. J. Christoph Katthagen
Guest Editor

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Keywords

  • proximal humeral fracture
  • non-operative treatment
  • double plating
  • reverse total shoulder arthroplasty
  • augmentation
  • risk assessment
  • complications
  • rotator cuff
  • long head of the biceps tendon
  • avascular necrosis

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Published Papers (4 papers)

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Research

12 pages, 263 KiB  
Article
Assessment of Complication Risk in the Treatment of Proximal Humerus Fractures: A Retrospective Analysis of 4019 Patients
by Ralf Henkelmann, Pierre Hepp, Bastian Mester, Marcel Dudda, Philipp-Johannes Braun, Sebastian Kleen, Johannes Zellner, Michael Galler, Matthias Koenigshausen, Thomas A. Schildhauer, Tim Saier, Inga Trulson, Rony-Orijit Dey Hazra, Helmut Lill, Richard Glaab, Basil Bolt, Marcus Wagner, Michael J. Raschke and Jan Christoph Katthagen
J. Clin. Med. 2023, 12(5), 1844; https://doi.org/10.3390/jcm12051844 - 25 Feb 2023
Cited by 3 | Viewed by 2414
Abstract
(1) Background: The treatment of proximal humeral fractures (PHFs) is debated controversially. Current clinical knowledge is mainly based on small single-center cohorts. The goal of this study was to evaluate the predictability of risk factors for complications after the treatment of a PHF [...] Read more.
(1) Background: The treatment of proximal humeral fractures (PHFs) is debated controversially. Current clinical knowledge is mainly based on small single-center cohorts. The goal of this study was to evaluate the predictability of risk factors for complications after the treatment of a PHF in a large clinical cohort in a multicentric setting. (2) Methods: Clinical data of 4019 patients with PHFs were retrospectively collected from 9 participating hospitals. Risk factors for local complications of the affected shoulder were assessed using bi- and multivariate analyses. (3) Results: Fracture complexity with n = 3 or more fragments, cigarette smoking, age over 65 years, and female sex were identified as predictable individual risk factors for local complications after surgical therapy as well as the combination of female sex and smoking and the combination of age 65 years or older and ASA class 2 or higher. (4) Conclusion: Humeral head preserving reconstructive surgical therapy should critically be evaluated for patients with the risk factors abovementioned. Full article
(This article belongs to the Special Issue Proximal Humeral Fractures—Current Trends and Innovations)
13 pages, 15510 KiB  
Article
A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications
by Sebastian Kwisda, Jan-Philipp Imiolczyk, Tankred Imiolczyk, Magdalena Werth and Markus Scheibel
J. Clin. Med. 2023, 12(3), 1216; https://doi.org/10.3390/jcm12031216 - 3 Feb 2023
Cited by 2 | Viewed by 2459
Abstract
The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This [...] Read more.
The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications. Full article
(This article belongs to the Special Issue Proximal Humeral Fractures—Current Trends and Innovations)
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12 pages, 1359 KiB  
Article
Specific Radiologic Risk Factors for Implant Failure and Osteonecrosis of the Humeral Head after Interlocking Nailing with the Targon PH+ of Proximal Humeral Fractures in a Middle to Old Population
by Maximilian Willauschus, Linus Schram, Michael Millrose, Johannes Rüther, Kim Loose, Hermann Josef Bail and Markus Geßlein
J. Clin. Med. 2022, 11(9), 2523; https://doi.org/10.3390/jcm11092523 - 30 Apr 2022
Cited by 4 | Viewed by 2466
Abstract
Background: Operative management of proximal humeral fractures is still challenging. While antegrade nailing has become a valid option in fracture fixation, risk factors for adverse events, and failure have not been sufficiently clarified. Methods: All patients of a single trauma center undergoing surgery [...] Read more.
Background: Operative management of proximal humeral fractures is still challenging. While antegrade nailing has become a valid option in fracture fixation, risk factors for adverse events, and failure have not been sufficiently clarified. Methods: All patients of a single trauma center undergoing surgery for proximal humeral fractures with the Targon PH+ nail between 2014 and 2021 were evaluated retrospectively. This included complications, revisions, and failures. Pre- and postoperative radiographic imaging were assessed regarding fracture’s complexity, anatomic reduction, reconstruction of the medial hinge, metaphyseal head extension, and fixation of the implant in the calcar region. Follow-up was at a minimum of 12 months. Results: A total number of 130 patients with a mean age of 74.5 years (range 63–94, SD ± 8.2) are included in this study. Two- and three-part fractures were found in 58 patients, while 14 patients showed four-part fractures. Overall, a complication rate of 34.2% and an implant failure rate of 15.4% was found. Four-part fractures showed a significantly higher complication rate than two- and three-part fractures. Four-part fractures also showed significantly higher revisions (p = 0.005) and implant failures (p = 0.008). The nonsufficient anatomical reduction was found to be a risk factor for complications (p < 0.0001), implant failures (p < 0.0001), and later humeral head osteonecrosis (p < 0.0001). Insufficiently reconstructed medial hinges (p = 0.002) and a metaphyseal head extension of under 8 mm (p = 0.005) were also demonstrated as risk factors for osteonecrosis of the humeral head. Conclusions: Four-part fractures in an elderly population show high complication, revision, and implant-failure rates. Therefore, demonstrated radiologic risk factors should be evaluated for improvements. Anatomical reduction and fixation near the calcar proved to be vital for successful antegrade nailing of complex fractures. To prevent osteonecrosis of the humeral head, reconstruction of the medial hinge and metaphyseal head extension should be evaluated. Full article
(This article belongs to the Special Issue Proximal Humeral Fractures—Current Trends and Innovations)
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10 pages, 3455 KiB  
Article
Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate
by Rony-Orijit Dey Hazra, Johanna Illner, Karol Szewczyk, Mara Warnhoff, Alexander Ellwein, Robert Maximillian Blach, Helmut Lill and Gunnar Jensen
J. Clin. Med. 2022, 11(2), 408; https://doi.org/10.3390/jcm11020408 - 14 Jan 2022
Cited by 8 | Viewed by 4449
Abstract
Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this [...] Read more.
Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65–89 years, FU: 25 months) and Group 2 of 37 patients (28–64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors. Full article
(This article belongs to the Special Issue Proximal Humeral Fractures—Current Trends and Innovations)
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