Preview

Russian Sklifosovsky Journal "Emergency Medical Care"

Advanced search

DIAGNOSIS AND TREATMENT OF PROXIMAL HUMERUS FRACTURES

https://doi.org/10.23934/2223-9022-2018-7-2-144-151

Abstract

Proximal humeral fractures typically occur in elderly patients and lead to significant functional disorders. There are many different nonsurgical and surgical treatment options for these injuries, including immobilization and early physical therapy, percutaneous K-wires fixation, plate osteosynthesis, intramedullary nailing and shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon skill level, patient’s age and health status. Today, there is no single algorithm for treating such injuries, there are no large randomized studies which allow it to be created. The aim of this article is to generalize various methods of treatment and diagnosis of fractures of the proximal humerus.

About the Authors

A. M. Fain
N.V Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation

Department of Emergency Traumatology and Musculoskeletal System,

Bolshaya Sukharevskaya Square, 3, Moscow 129090



A. Y. Vaza
N.V Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation

Department of Emergency Traumatology and Musculoskeletal System,

Bolshaya Sukharevskaya Square, 3, Moscow 129090



V. V. Slastinin
N.V Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation

Department of Emergency Traumatology and Musculoskeletal System,

Bolshaya Sukharevskaya Square, 3, Moscow 129090



R. S. Titov
N.V Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department
Russian Federation
Researcher, Department of Emergency Traumatology and Musculoskeletal System,

Bolshaya Sukharevskaya Square, 3, Moscow 129090



References

1. Palvanen M., Kannus P., Niemi S., Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006; 442: 87–92. PMID: 16394745.

2. Song J.Q., Deng X.F., Wang Y.M., et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015; 49(4): 345–353. DOI: 10.3944/AOTT.2015.14.0451.

3. Court-Brown C.M., Garg A., McQueen M.M. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001; 72(4): 365–371. DOI: 10.1080/000164701753542023.

4. Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989; 108(5): 285–287. PMID: 2789504.

5. Lomtatidze E.SH., Lomtatidze V.E., Potseluyko S.V., et al. Analysis of Functional Outcomes in Inner Osteosynthesis for Proximal Humerus Fractures. Vestnik travmatologii i ortopedii imeni NN Priorova. 2003; (3): 62–66. (In Russian).

6. Kazayev S.YA., Sitnik A.A. Management of proximal humeral fractures. Meditsinskiy zhurnal. 2005; 13(3): 63–66. (In Russian).

7. Klyuchevskiy V.V., SHkrebko A.N., Borisova N.V Treatment of the load after surgery on the shoulder joint. Meditsina i sport. 2006; (1): 19–20. (In Russian).

8. Eldzarov P.E., Zelyanin A.S., Filippov V.V. Surgical treatment of consequences of femoral fractures. Khirurgiya. 2010; (9): 47–52. (In Russian).

9. Minayev A.N., Gorodnichenko A.I., Uskov O.N. The transosseous osteosynthesis by proximal metaepiphyseal fractures of humerus in elderly patients. Khirurgiya. 2010; (1): 50–53. (In Russian).

10. Bondarenko P.V., Zagorodnii N.V., Gil’fanov S.I., et al. Surgical Treatment of Proximal Humeral Fractures with Short Straight Intramedullary Nail. Vestnik travmatologii i ortopedii imeni NN Priorova. 2015; (4): 17–20. (In Russian).

11. Burkhart K.J., Dietz S.O., Bastian L., et al. The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int. 2013; 110 (35–36): 591– 597. DOI: 10.3238/arztebl.2013.0591.

12. Zuckermann J.D., Checroun A.J. Fractures of the proximal humerus. In: Ianotti J.P., Williams G.R., eds. Disorders of the shoulder: Diagnosis and management. Philadelphia, PA: Lippincott Williams & Wilkins; 1999: 639–685.

13. Bryukhanov A.V. Magnetic resonance imaging in the diagnosis of ruptures of the rotator cuff. Radiologiya — praktika. 2011; (5): 64–70. (In Russian).

14. Kondyrev N.M., Kopenkin S.S., Skoroglyadov A.V. Early diagnosis of the rotator cuff damage. Vestnik RUDN Ceriya Meditsina. 2016; (1): 68–76. (In Russian).

15. Tingart M.J., Apreleva M., von Stechow D., et al. The cortical thickness of the proximal humerus diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br. 2003; 85(4): 611–617. PMID: 12793573. (In Russian).

16. Gurkin B.E., Kalintsev A.S., Ivanov D.V. Basis for choice of treatment of patients with fracture of the proximal humeral. Kubanskiy nauchnyy meditsinskiy vestnik. 2015; (2): 49–56. (In Russian).

17. Slobodskoy A.B., Badak I.S., Voronin I.V., et al. Morphological changes in the head of the humerus in acute injury of the proximal humerus in elderly patients. In: Ilizarov readings: materials of the scientific and practical conference with international participation. Kurgan, 2011: 260–261. (In Russian).

18. Lee C.K., Hansen H.R. Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures. J Trauma. 1981; 21(9): 788–791. PMID: 7277543.

19. Leysho R.L. Closed treatment of fractures of the proximal humerus. Orthop Scand. 1984; 55(1): 48–51. PMID: 6702428.

20. Hertel R., Hempfing A., Stiehler M., Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004; 13(4): 427–433. doi: 10.1016/S1058274604000795.

21. Handoll H.H., Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015; (11): CD000434. DOI: 10.1002/14651858.CD000434.pub4.

22. Robinson B.C., Athwal G.S., Sanchez-Sotelo J., Rispoli D.M. Classification and imaging of proximal humerus fractures. Orthop Clin North Am. 2008; 39(4): 393–403. DOI: 10.1016/j.ocl.2008.05.002.

23. Skoroglyadov A.V., Magdiyev D.A., Remizov A.N., et al. Possibility of Ultrasound Diagnosis for Visualization of Peripheral Nerves of and Forearm. Vestnik travmatologii i ortopedii imeni NN Priorova. 2008; (2): 64–69. (In Russian).

24. Mora Guix J.M., Pedrós J.S., Serrano A.C. Updated Classification System for Proximal Humeral Fractures. Clin Med Res. 2009; 7(1–2): 32–44. DOI: 10.3121/cmr.2009.779.

25. Bell J.E., Leung B.C., Spratt K.F., et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am. 2011; 93(2): 121–131. DOI: 10.2106/ JBJS.I.01505.

26. Dreving E.F. Therapeutic physical training in traumatology. Moscow– Leningrad: Medgiz Publ., 1990. (In Russain).

27. Gorinevskaya V.V. Fundamentals of traumatology. Moscow: Meditsina Publ., 1953. Vol. 2. 1036 p. (In Russain).

28. Lill H., Voigt C. Proximal humeral fracture. Z Orthop Unfall. 2010; 148(3): 353–360. PMID: 20578323.

29. Hauschild O., Konrad G., Audige L., et al. Operative versus nonoperative treatment for two-part surgical neck fractures of the proximal humerus. Arch Orthop Trauma Surg. 2013; 133(10): 1385–1393. DOI: 10.1007/s00402-013-1798-2.

30. Bucholz R.W., Heckman J.D., Court-Brown C.M., Tornetta P., eds. Rockwood and Green’s fractures in adults. 7th ed. Wolters Kluwer health / Lippincott Williams & Wilkins, 2010.

31. Rommens P.M., Heyvaert G. Conservative treatment of subcapital humerus fractures. A comparative study of the classical Desault bandage and the new Gilchrist bandage. Unfallchirurgie. 1993; 19(2): 114–118. PMID: 8493730.

32. Boons H.W., Goosen J.H., van Grinsven S., et al. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthopaed Related Res. 2012; 470(12): 3483–3491. DOI: 10.1007/s11999-012-2531-0.

33. Song J.Q., Deng X.F., Wang Y.M., et al. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthop Traumatol Turc. 2015; 49(4): 345–353. DOI: 10.3944/AOTT.2015.14.0451.

34. Wronka K.S., Ved A., Mohanty K. When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm. Eur J Orthop Surg Traumatol. 2017; 27(3): 335–340. DOI: 10.1007/ s00590-016-1899-z.

35. Siebenbürger G., Van Delden D., Helfen T., et al. Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures. Injury. 2015; 46 (Suppl 4): S58–S62. DOI: 10.1016/S0020- 1383(15)30019-X.

36. Boudard G., Pomares G., Milin L., et al. Locking plate fixation versus antegrade nailing of 3- and 4-part proximal humerus fractures in patients without osteoporosis. Comparative retrospective study of 63 cases. Orthop Traumatol Surg Res. 2014; 100(8): 917–924. DOI: 10.1016/ j.otsr.2014.09.021.

37. Lekic N., Montero N.M., Takemoto R.C., et al. Treatment of two-part proximal humerus fractures: intramedullary nail compared to locked plating. HSS J. 2012; 8(2): 86–91. DOI: 10.1007/s11420-012-9274-z.

38. Tamimi I., Montesa G., Collado F., et al. Displaced proximal humeral fractures: when is surgery necessary? Injury. 2015; 46(10): 1921–1929. DOI: 10.1016/j.injury.2015.05.049.

39. Magovern B., Ramsey M.L. Percutaneous fixation of proximal humerus fractures. Orthop Clin North Am. 2008; 39(4): 405–416. DOI: 10.1016/ j.ocl.2008.05.005.

40. Innocenti M., Carulli C., Civinini R., et al. Displaced fragility fractures of proximal humerus in elderly patients affected by severe comorbidities: percutaneous fixation and conservative treatment. Aging Clin Exp Res. 2013; 25(4): 447–452. DOI: 10.1007/s40520-013-0063-4.

41. Dilisio M.F., Nowinski R.J., Hatzidakis A.M., Fehringer E.V. Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg. 2016; 25(5): e130-8. DOI: 10.1016/ j.jse.2015.11.016.

42. Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma. 1998; 44(5): 859–864. PMID: 9603089.

43. Cox M.A., Dolan M., Synnott K., McElwain J.P. Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail. J Orthopaed Trauma. 2000; 14(5): 349–353. PMID: 10926243.

44. Sudkamp N., Bayer J., Hepp P., et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009; 91(6): 1320–1328. DOI: 10.2106/JBJS. H.00006.

45. Schulte L.M., Matteini L.E., Neviaser R.J. Proximal periarticular locking plates in proximal humeral fractures: functional outcomes. J Shoulder Elbow Surg. 2011; 20(8): 1234–1240. DOI: 10.1016/j.jse.2010.12.015.

46. Duralde X.A., Leddy L.R. The results of ORIF of displaced unstable proximal humeral fractures using a locking plate. J Shoulder Elbow Surg. 2010; 19(4): 480–488. DOI: 10.1016/j.jse.2009.08.008.

47. Pritchett J.W. Inferior subluxation of the humeral head after trauma or surgery. J Shoulder Elbow Surg. 1997; 6(4): 356–359. PMID: 9285875.

48. Besch L., Daniels-Wredenhagen M., Mueller M., et al. Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a longterm analysis of 34 cases. J Trauma. 2009; 66(1): 211–214. DOI: 10.1097/TA.0b013e31815d9649.

49. Kralinger F., Schwaiger R., Wambacher M., et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br. 2004; 86(2): 217–219. PMID: 15046436.

50. Nho S.J., Brophy R.H., Barker J.U., et al. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am. 2007; 89 (Suppl 3): 44–58. DOI: 10.2106/JBJS.G.00648.


Review

For citations:


Fain A.M., Vaza A.Y., Slastinin V.V., Titov R.S. DIAGNOSIS AND TREATMENT OF PROXIMAL HUMERUS FRACTURES. Russian Sklifosovsky Journal "Emergency Medical Care". 2018;7(2):144-151. https://doi.org/10.23934/2223-9022-2018-7-2-144-151

Views: 2263


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2223-9022 (Print)
ISSN 2541-8017 (Online)