TY - JOUR
T1 - Three- and 4-part proximal humeral fracture fixation with an intramedullary cage
T2 - 1-year clinical and radiographic outcomes
AU - Hudgens, Joshua
AU - Jang, Jessica
AU - Aziz, Keith
AU - Best, Matthew J.
AU - Srikumaran, Uma
N1 - Publisher Copyright:
© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2019/6
Y1 - 2019/6
N2 - Background: Reverse total shoulder arthroplasty is a treatment option for 3- and 4-part proximal humeral fractures in elderly patients. However, arthroplasty has drawbacks in younger patients because of their greater activity level and more likely need for revision surgery. In such patients, an intramedullary cage may allow for reconstruction of the proximal humerus. Methods: We reviewed the outcomes of patients with proximal humeral fractures treated with expandable intramedullary cages from 2016 to 2017. We included patients with closed 3- or 4-part fractures (Neer classification), no osteoarthritis of the glenohumeral joint, and minimum 12-month follow-up. We assessed range of motion, pain, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value. Results: Eleven patients (mean follow-up, 54 weeks [range, 49-61 weeks]) were included. Two patients had 3-part fractures, and nine had 4-part fractures. At final follow-up, the mean visual analog scale score for pain was 1.4 (range, 0-6), the mean Subjective Shoulder Value was 69 (range, 20-90), and the mean American Shoulder and Elbow Surgeons score was 80 (range, 27-98). Mean forward flexion was 123° (range, 45°-160°), mean abduction was 82° (range, 30°-90°), and mean external rotation in 90° of abduction was 71° (range, 30°-90°). At final radiographic evaluation, all fractures were healed. No wound-related or neurologic complications were noted. Avascular necrosis developed in 1 patient; conversion to shoulder arthroplasty was performed. Conclusion: Treatment of 3- and 4-part proximal humeral fractures with an expandable intramedullary cage produced good clinical outcomes and a 100% union rate.
AB - Background: Reverse total shoulder arthroplasty is a treatment option for 3- and 4-part proximal humeral fractures in elderly patients. However, arthroplasty has drawbacks in younger patients because of their greater activity level and more likely need for revision surgery. In such patients, an intramedullary cage may allow for reconstruction of the proximal humerus. Methods: We reviewed the outcomes of patients with proximal humeral fractures treated with expandable intramedullary cages from 2016 to 2017. We included patients with closed 3- or 4-part fractures (Neer classification), no osteoarthritis of the glenohumeral joint, and minimum 12-month follow-up. We assessed range of motion, pain, the American Shoulder and Elbow Surgeons score, and the Subjective Shoulder Value. Results: Eleven patients (mean follow-up, 54 weeks [range, 49-61 weeks]) were included. Two patients had 3-part fractures, and nine had 4-part fractures. At final follow-up, the mean visual analog scale score for pain was 1.4 (range, 0-6), the mean Subjective Shoulder Value was 69 (range, 20-90), and the mean American Shoulder and Elbow Surgeons score was 80 (range, 27-98). Mean forward flexion was 123° (range, 45°-160°), mean abduction was 82° (range, 30°-90°), and mean external rotation in 90° of abduction was 71° (range, 30°-90°). At final radiographic evaluation, all fractures were healed. No wound-related or neurologic complications were noted. Avascular necrosis developed in 1 patient; conversion to shoulder arthroplasty was performed. Conclusion: Treatment of 3- and 4-part proximal humeral fractures with an expandable intramedullary cage produced good clinical outcomes and a 100% union rate.
KW - Case Series
KW - Clinical outcomes
KW - Level IV
KW - Treatment Study
KW - fracture fixation
KW - intramedullary cage
KW - pain
KW - proximal humeral fracture
KW - range of motion
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U2 - 10.1016/j.jse.2019.05.002
DO - 10.1016/j.jse.2019.05.002
M3 - Article
C2 - 31196507
AN - SCOPUS:85066956619
SN - 1058-2746
VL - 28
SP - S131-S137
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 6
ER -