Journal of Musculoskeletal Trauma

Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report: Jae Hyuk Shin, Ho Guen Chang, Young Woo Kim, Nam Kyou Rhee, Yong Bok Park, Yong Kuk Kim; J Korean Fract Soc 2011;24(2):185-190. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.185

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

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Locking compression plate fixation of periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture: A case report
Mei-Ren Zhang, Kui Zhao, Jiang-Long Guo, Hai-Yun Chen
Trauma Case Reports.2022; 37: 100565. CrossRef
Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture
Hiren M. Divecha, Hans A. J. Marynissen
Case Reports in Orthopedics.2013; 2013: 1. CrossRef

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Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture: Doo Sup Kim, Dong Kyu Lee, Chang Ho Yi, Jang Hee Park, Jung Ho Rah; J Korean Fract Soc 2011;24(2):144-150. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.144

Abstract PDF

PURPOSE
Authors compare clinical and radiological results of internal fixation group and hemiarthroplasty group for comminuted proximal humerus fracture to find out which the treatment method have to be chose for comminuted proximal humerus fractures.
MATERIALS AND METHODS
Patients who were treated from March 2005 to March 2007 and available for 2 years follow-up were targets of this study. The internal fixation group had 38 cases, and hemiarthroplasty group included 26 cases. The results were analyzed both clinically and radiologically.
RESULTS
On average, Bone union took 15.6 weeks in the internal fixation group. Constant score between the internal fixation and hemiarthroplasty groups were on average 75+/-6.5 points and 70+/-7.4 points (p=0.034). In 3-part fracture, Constant score between both groups were 78+/-5.4 points from the former and 71+/-2 points, respectively (p=0.028). In 4-part fracture group, Constant score were 72+/-8 points for the internal fixation group and 69+/-9.2 points for the hemiarthroplasty group (p=0.041).
CONCLUSION
Internal plate fixation can gain better outcome than hemiarthroplasty in 4-part fracture as well as 3-part fracture of proximal humerus by careful dissection for preservation of blood supply for humeral head and optimal reduction.

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Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis
Erik Hohmann, Natalie Keough, Vaida Glatt, Kevin Tetsworth
European Journal of Orthopaedic Surgery & Traumatology.2022; 33(6): 2215. CrossRef
Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review
Long Chen, Fei Xing, Zhou Xiang, Ara Nazarian
PLOS ONE.2016; 11(11): e0166801. CrossRef
Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures
Jiezhi Dai, Yimin Chai, Chunyang Wang, Gen Wen
European Journal of Orthopaedic Surgery & Traumatology.2014; 24(3): 305. CrossRef

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Conservative Treatment of Valgus Impacted Four-Part Fracture of the Proximal Humerus: A Case Report: Moon Chan Kim, Jae Lim Cho, Hung Tae Chung, Dong Jun Kim, In Bo Kim; J Korean Fract Soc 2011;24(1):96-99. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.96

Abstract PDF: For valgus impacted four part fracture of the proximal humerus, surgical stabilization and early mobilization of the joint can produce the best clinical outcomes. But, we have experienced a case of conservative treatment and gained good clinical results. We have reported this case and included a review of the relevant literatures.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures: Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong; J Korean Fract Soc 2008;21(3):213-219. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.213

Abstract PDF

PURPOSE
To evaluate the outcome of hemiarthroplasty with bone block graft and low profile prosthesis (Aequalis(R) fracture prosthesis) for the comminuted proximal humerus fractures.
MATERIALS AND METHODS
Sixteen low profile prostheses were used since July 2004, and 11 patients were followed-up for average 19.9 (12~30) months. Their mean age was 67.3 (52~78) years. Pain and satisfaction visual analog scale (VAS), range of motion, and modified UCLA score for hemiarthroplasty were evaluated at every visit. Radiography was also checked for stem position, loosening, and tuberosity union.
RESULTS
Mean pain VAS was 2.7 (0~5), and mean satisfaction VAS was 8.4 (5~10). Mean active forward flexion was 137 degrees (90~170), external rotation at side was 45.5 degrees (25~70), and internal rotation at back was T10 (T7~L1). Modified UCLA score was 19 (12~30) at final visit. All stems were stable, and there were no loosening at the final follow-up. All tuberosities were united except two tuberosity absorptions.
CONCLUSION
The outcome of hemiarthroplasty with bone block graft and low profile prosthesis was comparable to other implants for comminuted proximal humerus fractures. This system had unique advantages for tuberosity union. Further study with more patients and longer follow-up are necessary to clarify the effectiveness of this prosthesis.

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A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus
Sung-Weon Jung
Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
Journal of the Korean Fracture Society.2011; 24(2): 144. CrossRef

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The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring: Kuen Tak Suh, Hyoung Lok Roh, Myung Soo Youn, Jung Sub Lee; J Korean Fract Soc 2006;19(4):424-430. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.424

Abstract

PURPOSE
To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture.
MATERIALS AND METHODS
Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria.
RESULTS
In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results.
CONCLUSION
The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures
Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong
Journal of the Korean Fracture Society.2008; 21(3): 213. CrossRef

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The Treatment of Unstable Proximal Humerus Fracture Using Locking Plate: Eun Sun Moon, Myung Sun Kim, Kyung Soon Park, Jae Yoon Chung, Keun Bae Lee; J Korean Fract Soc 2006;19(2):193-200. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.193

Abstract

PURPOSE
The purpose of this study was to determine the results of internal fixation with locking plate system for the unstable proximal humerus fracture.
MATERIALS AND METHODS
Sixteen cases of unstable proximal humerus fracture were treated using locking plate system between September 2004 and June 2005. Average age of the patients was 55.6 years (range, 22 to 78), male was four patients, female was twelve. The clinical outcomes were evaluated by using Neer's evaluation criteria and Constant socring system. We analyzed the radiological results by bony union time and Paavolainen method. All data was analyzed statistically.
RESULTS
According to Neer's evaluation ciriteria, eleven cases (69%) showed excellent or satisfactory results and according to Constant scoring system, twelve cases (75%) showed excellent or good result. Twelve cases (75%) showed good results by Paavolainen method. In all cases, bony union was obtained in average 12.8 weeks after operation. There were two complications; one screw irritation and one screw loosing.
CONCLUSION
The patients treated using locking proximal humerus plate could exercise earlier due to good initial stability. And the clinical and radiological results were relatively good. The treatment of unstable proximal humerus fracture with locking plate system was considered as a good method.

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Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture
Jin-Oh Park, Jin-Young Park, Sung-Tae Lee, Hong-Keun Park
Journal of the Korean Fracture Society.2007; 20(1): 45. CrossRef

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Fixation Failure of LCP during the Treatment of Proximal Humerus Fractures: Woo Kie Min, Sang Jin Sin, In Ho Jeon, Ki Bong Cha, Chang Wuk Oh, Poong Taek Kim, Sang Ho Cheon; J Korean Fract Soc 2006;19(2):188-192. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.188

Abstract

PURPOSE
To evaluate the causative factors in the catastrophic failure of LCP in the proximal humerus fracture.
MATERIALS AND METHODS
Six patients (6 cases) were collected between October 2003 and July 2005. The mean age was 55.6 years (range: 38~70). The cause of injury was road traffic accident in four, fall down in one and slip down in one. According to the Neer classification, four were 2 part fractures, each one in 3 part fracture and 4 part fracture.
RESULTS
Fixation failure occurred due to back-out of the plate and screw in five and plate breakage in one. Analysis of the preoperative radiographs revealed medial cortical defect in all and no bone graft and tension band wiring in the greater tuberosity fragment were carried out. Postoperative radiographs showed the anatomical reduction in three and non-anatomical in three.
CONCLUSION
Non-anatomical reduction, insufficient medial bony buttress, inadequate screw length to the head and the neglect for the greater tuberosity fragment were the contributing factors to the failure of LCP. Knowledge of these factors will enable the surgeon to avoid failure of the LCP. Augmentation fixation and bone graft procedures with careful preoperative planning are necessary for successful fixation of LCP.

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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
Journal of the Korean Fracture Society.2013; 26(4): 292. CrossRef
A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus
Sung-Weon Jung
Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years
Ki Won Lee, Young Joon Choi, Hyung Sun Ahn, Chung Hwan Kim, Jae Kwang Hwang, Jeong Ho Kang, Han Ho Choo, Jun Seok Park, Tae Kyung Kim
Clinics in Shoulder and Elbow.2012; 15(1): 25. CrossRef
Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture
Jin-Oh Park, Jin-Young Park, Sung-Tae Lee, Hong-Keun Park
Journal of the Korean Fracture Society.2007; 20(1): 45. CrossRef

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Intrathoracic Migration of K-wire after Fixation of Proximal Huemrus Fracture: Case Report: Tae Jin Song, Joon Yeop Song, Sung Kon Kim, Jung Ho Park, Joon Ho Wang, Jong Woong Park; J Korean Fract Soc 2005;18(4):462-465. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.462

Abstract PDF

We report an unusual case of Kirschner wire migration from the proximal humerus into the thoracic cavity and diaphragm which induced pneumothorax and hemoperitoneum. An 81-year-old woman admitted to the emergency room due to sudden onset of dyspnea. X-rays showed pneumothorax and old proximal humerus fracture fixed with rush pins and K-wires. One of K-wires was seen on the diaphragm level at posterior gutter of chest wall. Through the abdomen, K-wire was removed from the diaphragm and a chest tube was inserted. The potential for K-wires to migrate must be recognized, and frequent postoperative radiographic studies have to be performed for the early detection of loosening and migration. It appears that if K-wires are used for fixation of proximal humerus, the lateral ends must be bent to prevent medial migration, and when the desired therapeutic goals have been achieved, these pins have to be susbsequently removed as soon as possible.

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Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture
Byung-Ill Lee, Yong-Beom Kim, Hyung-Suk Choi, Chang-Hyun Kim, Jung-Woo Ji
Journal of the Korean Orthopaedic Association.2013; 48(3): 231. CrossRef
Early Intrathoracic Migration of K-wire Used for Fixation of Proximal Humerus Fracture
Sang Jin Cheon, Ji Min Lee
Journal of the Korean Orthopaedic Association.2011; 46(2): 167. CrossRef

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Inferior Subluxation of Humeral of Head after Surgery for Fracture of Proximal Humerus: Jun Gyu Moon, Hyok Woo Nam, Jong Oh Kim, Jong Kyoung Ha, Seok Bae Ryu; J Korean Fract Soc 2005;18(1):43-47. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.43

Abstract PDF

PURPOSE
To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed.
MATERIALS AND METHODS
A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation.
RESULTS
13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients).
CONCLUSION
Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.

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Transient postoperative inferior subluxation of the shoulder after surgical stabilization of recurrent anterior dislocation in a patient with myasthenia gravis: a case report
Samuel Baek, Geum-Ho Lee, Myung Ho Shin, Tae Min Kim, Kyung-Soo Oh, Seok Won Chung
Clinics in Shoulder and Elbow.2023; 26(3): 302. CrossRef

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Closed Reduction and External Fixation of Displaced Fractures of the Proximal Humerus: Seung Ju Jeon, Ho Seung Jeon, Kye Nam Cho, Jae Ho Choi, Joon Yong Lee; J Korean Fract Soc 2004;17(1):43-48. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.43

Abstract PDF: PURPOSE
This is a retrospective study to analyze the functional results of closed reduction and external fixation of unstable fractures of the proximal humerus.
MATERIALS AND METHODS
Ten unstable proximal humerus fractures were managed with closed reduction and external fixation in which other operative methods are not proper due to comminution, osteoporosis or poor general condition of patients. 4 cases of 2-part and 6 cases of 3-part fracture were included. Radiologically union of fracture, malunion and the evdence of avascular necrosis of humeral head were assessed and the functional results were analyzed with Neer scoring system.
RESULTS
Radiologically all fractures were healed but in 2 cases malunion was resulted because of reduction loss in proximal fragment. Pin site infection was developed in 7 cases and oral antibiotics were needed. The functional results were excellent in 4, satisfactory in 3 and unsatisfactory in 3 cases. 2 cases with malunion and one case with lack of postoperative cooperation resulted in functionally unsatisfactory.
CONCLUSION
External fixation is an alternative method in the treatment of unstable proximal humerus fractures in which open reduction or percutaneous pinning are not proper due to comminution, osteoporosis or poor general condition of patient.

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Proximal Humeral Fracture with Epiphyseal Plate Injury: Sung Kwan Hwang, Jin Rok Oh, Jung Ho Rah, Ki Ho Kim; J Korean Soc Fract 1997;10(4):793-800. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.793

Abstract PDF: Proximal humerus fracture with epiphyseal plate injury does not cause the growth disturbances and deformity of humerus in comparison with other fracture of epjphyseal plate. The explanation about this phenomenon is that the fracture occurs microscopically in maturing Bone near provisional calcifying zone, another explanation is that the epiphyseal plate in proximal humerus greatly contribute the longitudinal growth of humerus and has trimendous remodelling potential. In this study, we experienced the 25 cases of proximal humeral epiphyseal injury from January, 1991 to June, 1997 We analyzed the growth disturbance and deformity of the proximal humeral epiphyseal plate in regard to age, fracture type, treatment method of the 15 cases with 3 years follow-up among the 25 cases. This fracture is most common in the age of 13 to 16, 11 cases among total 15 cases(75 percent). Most common fracture type is type II by Salter-Harris classification, 14 cases among total 15 cases, 3 cases is type IV by Neer-Horowitz classification, where, manual reduction was impossible because of interposition with biceps tendon between fracture fragments. There was no impairment of motion, growth distrubance and deformity in all cases. We concluded there is no direct correlation with patient age, the degree of fracture, displacement, treatment method in view of gorwth disurbance and deformity.

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Treatment of the Proximal Humeral Fracture by Bent Semitubular Plate: Choong Gil Lee, Jin Woo Kwon, Jae Hyum Park, Sung Ho Shin, Wan Eub Kim; J Korean Soc Fract 1997;10(3):634-639. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.634

Abstract PDF: There is no consensus on the best way to treat complicated fractures of the proximal humerus. Open reduction and internal fixation with plate is one of the most popular method, but it has several disadvantages. Thus we used bent semitubular plates to fix the proximal humeral fractures, which were reported by Szabo and Sehr. Moda etc. This method provided relatively firm fixation and then early ROM exercise was possible even in case of osteoporotic or severely comminuted fractures. We treated 9 cases of proximal humerus fractures which were with bent semitubular plates from January 1992 to June 1996 and followed up more than 6 months. The following results were obtained. 1. The bent semitubular piate fixation was useful method even in treatment of comminuted or osteoporotic proximal humerus fractures. 2. The mean duration of radiologic bone union was postoperative 10 weeks. 3, Complications developed in 2 cases ; one case was plate failure and the other was humeral head penetration by blade portion. 4, According to Neer criteria 5 cases were excellent, 2 cases satisfactory, 1 case unsatisfactory and 1 case failure.

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Operative Treatment of Proximal Humeral Fracture using Inlay Graft of Fibular Allograft Combined with Plating: Duck Yun Cho, Eun Sung Koh, Myong Hyoung Lee; J Korean Soc Fract 1995;8(1):84-92. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.84

Abstract PDF

Fracture of the proximal humerus occurs more frequently in older individuals who may have advancing osteoporosis, causing the bone to weaken, even with minimal force. And, most proximal humeral fractures respond satisfactory to conservative treatment. But, operative treatment is reconmended in the case that poor results are anticipated by the severe displacement and comminution. In older patient with proximal humerus fracture, there was some problem such as osteoporosis, absorption of cancellous bone, cystic formation, and weakness of the mechanical support, and it has difficulties in rigid fixation and early ROM. Four cases of displaced fracture of the proximal humerus in older patients over 50-year-old Treated by using plate & inlay fibular allograft from Apr. 1991 to Dec. 1993 were analized clinically and radiologically. The following results were obtained. 1. The results of these patients were rated by the Neers functional criteria. Of four cases, three cases had excellent results, one case had satisfactory. 2. There was no allograft related complications, such as infection & graft rejection. So, in treatment of proximal humerus fracture at old individuals, open reduction and internal fixation with plating and inlay graft using fibular allograft was very useful method, and it resulted in rigid fixation, early ROM. and good functional result.

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Allogeneic Inlay Cortical Strut Grafts for Large Cysts or Post-curettage Cavitary Bony Defects
Yang-Guk Chung, Yong-Koo Kang, Chol-Jin Kim, An-Hi Lee, Jeong-Mi Park, Won-Jong Bahk, Hyun-Ho Yoo
The Journal of the Korean Bone and Joint Tumor Society.2011; 17(2): 73. CrossRef

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