Journal of Musculoskeletal Trauma

Periprosthetic Fracture after Total Shoulder Arthroplasty: Nam Su Cho, Myung Seo Kim, Jae Woo Yang, Jeung Hwan Seo, Dong Won Seo; J Korean Fract Soc 2020;33(2):118-123. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.118

Abstract PDF: Periprosthetic humeral fractures in patients with total shoulder arthroplasty are rare and difficult to treat. With the significant increase in the number of older patients who have undergone total shoulder arthroplasty in recent years, an increase in the number of periprosthetic shoulder fractures can be estimated. The decisions of treatment have to be taken individually, depending on the stability of the prosthesis, fracture location, and bone quality. On the other hand, there are limited data for treatment guidance and outcomes. This paper reviews the risk factors, classification, treatment, and outcomes of periprosthetic humeral fractures.

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How Difficult Is It to Surgically Treat AO-C Type Distal Humerus Fractures for Inexperienced Orthopedic Surgeons?: Seong Ho Yoo, Suk Woong Kang, Moo Ho Song, Young Jun Kim, Hyuck Bae; J Korean Fract Soc 2018;31(2):45-49. Published online April 30, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.2.45

Abstract PDF: PURPOSE
Twenty early surgical management cases of distal humerus type-C fractures were analyzed.
MATERIALS AND METHODS
This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo's functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed.
RESULTS
All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5Â° with a follow-up improvement averaging 120.7Â°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening.
CONCLUSION
Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.

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Conservative Treatment of Proximal Humeral Fracture: Hwansub Hyun, Jonghyun Ahn, Sang Jin Shin; J Korean Fract Soc 2018;31(1):29-35. Published online January 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.1.29

A proximal humeral fracture is an osteoporotic fracture that often occurs in elderly women. Approximately 80% of all proximal humeral fractures are non-displaced fractures, which can be treated with conservative treatment to achieve stable union. The treatment plan for fractures involving displaced and comminuted fractures is controversial. Malunion, avascular necrosis of the humeral head, and shoulder stiffness due to conservative treatment can occur but the functional deterioration is low and the patient satisfaction is high. The indications for the conservative management of proximal humeral fractures include a non-displaced fracture and a 2-part fracture, low-functional demanded 3-part fracture, and operative-limited 4-part fracture. Recently, the surgical indications have expanded as technological advances in surgical fixation methods and functional needs of elderly patients are increasing. Current treatment policy decisions tend to be determined by the personal preference and expert opinion rather than by evidence-based decision-making.

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The Effect of Postoperative Korean Traditional Medicine for the of Proximal Humeral Fracture: A Case Report
Hyun Il Go, Hangyul Choi, Jieun Hong, Nam geun Cho
Journal of Acupuncture Research.2019; 36(1): 50. CrossRef

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Orthogonal Locking Compression Plate Fixation for Distal Humeral Intraarticular Fractures: Hyoung Keun Oh, Suk Kyu Choo, Kyoung Hwan Koh, Ji Woong Yeom; J Korean Fract Soc 2016;29(3):178-184. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.178

Abstract PDF: PURPOSE
To investigate the surgical outcomes of orthogonal locking compression plate fixation for distal humeral intraarticular fractures.
MATERIALS AND METHODS
This study included 18 patients presenting a distal humeral intraarticular fracture who were treated with orthogonal locking compression plate fixation. According to the AO/OTA classification, there were eight C2 and ten C3 fractures. We evaluated radiologic outcomes, clinical results with range of motion, operation-related complications, and functional score by Mayo elbow performance score (MEPS).
RESULTS
The a verage u nion t ime was 3.5 months, and there was no c ase of r eduction l oss of a rticular f racture at t he last follow-up. Additional surgical procedures were needed in the three cases of C3 fractures. There was one case of heterotrophic ossification and one case of K-wire irritation. The average range of motion of elbow joint was 7Â° to 122Â°, and functional results were graded as 14 excellent, three good, and one fair by MEPS.
CONCLUSION
Anatomical reduction and internal fixation with orthogonal locking compression plate could provide satisfactory surgical outcomes for the treatment of distal humeral intraarticular fracture.

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A Retrospective Comparative Study of Internal Fixation with Reconstruction Plate Versus Anatomical Locking Compression Plate in Displaced Intercondylar Fractures of Humerus: Tong Joo Lee, Young Tae Kim, Dae Gyu Kwon, Ju Yong Park; J Korean Fract Soc 2014;27(4):294-300. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.294

Abstract PDF: PURPOSE
To analyze the clinical result of a conventional reconstruction plate (CRP) fixation and locking compressive plate (LCP) fixation on the surgical treatment of an adult's displaced intercondylar fracture of humerus.
MATERIALS AND METHODS
A total of 40 patients enrolled in the study were treated between August 2002 and May 2012. Fixation with a CRP was performed in 20 patients (group A) and anatomical locking compression plate fixation was performed in 20 patients (group B). The clinical and functional evaluation was performed according to the Mayo elbow performance score and Cassebaum classification of elbow range of motion (ROM), disabilities of the arm, shoulder and hand score.
RESULTS
The Mayo elbow functional evaluation scores, eight cases were excellent, 10 cases were good, and two cases were fair in group A, and 12 cases were excellent, seven cases good, and one case fair in group B; both groups showed satisfactory results. The durations of attaining 90 to 120 degrees of the ROM of joints postoperatively were 8.3 days on average (6 to 15 days) in group A and 5.5 days on average (5 to 9 days) in group B, demonstrating a significant difference between the two groups (p=0.04). Although the correlations of clinical results according to the difference of bone mineral densities (BMDs) were not statistically significant between the two groups (p=0.35), loss of fixation occurred due to loosening of screws in two patients with low BMDs in whose operations reconstruction plates were used.
CONCLUSION
The use of locking compressive plate on the surgical treatment of an diaplaced intercondylar fracture of humerus have a good clinical results because that permits early rehabilitation through good fixation and reduces the complications such as loosening of screws.

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The Result of Conservative Treatment of Proximal Humerus Fracture in Elderly Patients: Seung Gil Baek, Chang Wug Oh, Young Soo Byun, Jong Keon Oh, Joon Woo Kim, Jong Pil Yoon, Hyun Joo Lee, Hyung Sub Kim; J Korean Fract Soc 2013;26(4):292-298. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.292

Abstract PDF: PURPOSE
With the increase in the old age population, proximal humerus fractures have been increasing recently. However, complications after operative treatment, such as fixation failure, are common because of osteoporosis. We treated proximal humerus fractures in patients with osteoporosis conservatively, and evaluated the radiographic and functional results by analyzing the factors affecting the results.
MATERIALS AND METHODS
Nineteen out of 30 cases for whom the clinical follow-up was over 1 year were included in this retrospective study. There were 17 females and 2 males, and the mean age was 73.2 years. The causes were slip from a short height (18 cases) and a minor car accident (1 case). We evaluated the union period, nonunion, malunion and the Constant score and analyzed several factors affecting the functional result, such as age, fracture pattern, and malunion.
RESULTS
Seventeen cases (89.5%) obtained union within 12.8 weeks on average. Neck-shaft angle was 125.3degrees on average, with seven cases of malunion. The Constant score was 84.1 on average, and there were excellent scores in 11 cases, good scores in 4 cases, and fair scores in 2 cases. Fracture pattern, neck-shaft angle, or malunion did not affect the functional outcome, and elderly patients showed poorer shoulder function.
CONCLUSION
Proximal humeral fractures with osteoporosis may achieve a high rate of bony union when treated with conservative methods. Despite the common occurrence of malunion, a satisfactory functional outcome may be expected.

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis: Soo Tai Chung, Joo Hak Kim, Hyung Soo Kim, Sang Joon Park; J Korean Fract Soc 2007;20(2):184-189. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.184

Abstract PDF: PURPOSE
To evaluate the usefulness of internal fixation with modified Steinmann pins and tension band wiring technique in comminuted proximal humeral fracture with osteoporosis and the correlations among bone mineral density, age, Neer's score and period of union.
MATERIALS AND METHODS
Twelve cases of comminuted proximal humeral fracture with osteoporosis were surgically treated with modified Steinmann pins and tension band technique, and followed up for an average 20.8 months (range, 6~39 months). Average age was 73.6 years old (range, 59~85 years old). Results were assessed using Neer's evaluation criteria.
RESULTS
Excellent results were noted in eight cases and satisfactory results in four cases. Radiological union was obtained in all cases. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal. One case developed operative wound infection, which were managed by antibiotics therapy, irrigation and secondary closure.
CONCLUSION
Internal fixation using modified Steinmann pins and tension band wiring technique for proximal humeral fracture, with osteoporosis, makes complete union of fracture, minimizes risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

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Humeral Fractures Associated by Forearm Fractures: Ho Jung Kang, Kae Yong Han, Kyu Jyun Yang, Jin Oh Park; J Korean Soc Fract 1998;11(2):405-412. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.405

Abstract PDF: We reviewed fractured patients in Yongdong Severance Hospital for 10 years(1987-96), and collected 42 fractured patients who had concomittent ipsilateral humeral fractures and forearm fractures. The causes of injury were falling down in 21, slipping down in 2, motor vehicle accident in 15, machinery injuries in 2, crushing injury in 1 and ski injury in 1. among them 13 patients were under 15 years old. Nine cases of supracondylar fractures, three cases of lateral condylar fractures and one case of proximal humeral fractures were included. Patterns of combined forearm fractures were diverse. Twenty-three cases were occurred in the age between 16 and 59 years. Fracture patterns were very complicated in both humerus and forearm in this age. Most common humeral fracture was midshaft fracture and forearm was both forearm bone fracture. The fractures were resulted from relatively more severe traumatic event in this age than other ages. Number of patients over 60 years was six. four of them had proximal humeral fractures, one of them distal humeral fracture and one of them humeral medial comdylar fracture. Forearm fracture patterns were various but the olecranon fracture was the most common forearm fracture(4/6) in the aged. We treated fractures by many combinations of operative and conservative means. Generally K-wires were applied to the children when internal fixation was indicated. The shaft of long bones were fixated usually by dynamic compression plate and comminuted articular fractures by Egyre plate or K-wires. The average follow up period was 15 months(5-35 months). 17 complications were resulted. There were 4 nonunions, 3 elbow ankylosises, 1 Volkmann's ischemic contracture, 7 nerve paralysises(4 ulna nerve, 3 radial nerve) and 2 infections.

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The Treatment of the Proximal Humeral Fracture using Bifurcate Blade Plate in Adult: C N Kang, J O Kim, K W Kim, S H Ko, C M Ki, S Y Ahn; J Korean Soc Fract 1996;9(3):767-773. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.767

Abstract PDF: Seven patients, range in age from 30 to 65 years(average 49.7), were evaluated minimal 6 months after open reduction and internal fixation of protimal humeral fracture using the Bifurcate blade plate. According to the Neers classification, there were three 2-part, three 3-part and one 4-part fractures. The methods of threatment and its results were analyzed according to the Neers classification. 1. All fractures were healed. 2. No avascular necrosis was observed at following-up. 3. 6 patients had excellent results, one satisfactory result. 4. The Bifurcate blade plate proved to be an another method for the treatment of proximal humeral fracture. 5. A prosthetic replacement is recommended for eldery patients with severe osteoporosis, severe commimuted fractures.

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Intramedullary nailing of humeral shaft fractures in patients with multiple trauma: Sang Ho Park, Young Chang Kim; J Korean Soc Fract 1992;5(1):82-89. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.82

Abstract PDF: No abstract available.

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Treatment of the Proximal Humeral Fractures: Se Il Suk, Sang Hoon Lee, In Joon Kim, Min Jong Park; J Korean Soc Fract 1989;2(1):1-8. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.1

Abstract PDF: Thirty-four patients with proximal humeral fratures were treated at department of orthopedic surgery, college of medicine, Seoul National University between 1978 and March, 19 99. They were followed up between six months and three and half years with average of 1.2 years. Mean age was 52.9 years and traffic accidents was the most common cause of injury. According to the Neers classification, there were seven one-part(20%), sixteen two-part(48%), seven three-part(20%) and four four-part(12%) fractures or fracture-dislocations. The methods of treatment and its results were analyzed according to the Neers classificatioin and they were summarized as follows; 1. Seven one-part fractures were treated conservatively and showed satisfactory results in all. 2. Sixteen two-part fractures were treated conservatively except tow old cases and showed satisfactory results except one. 3. Seven three-part fractures were tried to be reduced by closed means but unacceptable five cases were treated by open reduction. They showed satisfactory results except one. 4. Four four-part fractures were treated by open reduction in two, by prosthesis in headsplitting and severely comminuted cases. They showed satisfactory results except one.

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