Comparison of Reverse Shoulder Arthroplasty and Hemiarthroplasty for Proximal Humeral Fractures: What about Functional Outcome? Reverse versus Hemiarthroplasty in Shoulder Fractures

Purpose: Shoulder replacement becomes more indicated in complex fractures of the humeral head. Indications depend on some factors especially age and fracture’s pattern. The aim of our study is to compare the functional results of both reverse shoulder arthroplasty (RSA) and hemi-arthroplasty (HA) in complex proximal humerus fractures. Materials and Methods: Fifty-two shoulder arthroplasties (20 reverse shoulder arthroplasties, 38 hemiarthroplasties), were reviewed retrospectively, between January 2010, and December, 2015. Preoperative, operative, and postoperative evaluations were achieved based on medical observations. At last follow-up, functional outcomes were established according Constant-Murley Score and American Shoulder and Elbow Surgeons (ASES) score. Complications rates were well-defined and compared between the study groups. Results: The mean of follow-up was 41.5 months. Comparing the study groups, reverse shoulder arthrosplasties were significantly older (mean age: 76.3 versus 66). These fractures occur more in women (70% versus 57%). At last follow-up, functional outcomes were better in reverse shoulder arthroplasty group (Constant-Murley Score 76 versus 59;ASES score 56 versus 41). The mean anterior elevation and external rotation were better in reverse shoulder arthroplasty respectively (110°versus 88°;28° versus 19°). Revision was more required in hemiarthroplasty group than reverse shoulder arthroplasty group. Conclusion: Reverse shoulder arthroplasty seems to improve functional outcome at intermediate and long-term of follow-up of proximal complex humeral fractures on comparison to hemiarthroplasty.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report

BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty(RTSA)are a well-known complication that may negatively impact the effects of long-term outcomes.However,to the best of our knowledge,there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.CASE SUMMARY A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration.Based on plain radiographs and magnetic resonance images,the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair.This patient was treated with staged bilateral RTSA at a two-month interval.At 5 and 3 mo after right and left side surgery,the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event.A computed tomography scan revealed nondisplaced acromial base fractures of both shoulders.Considering bilateral involvement,fracture location,and patient’s demand,open reduction and internal fixation(ORIF)using plate for bilateral acromial base fractures were performed.At 2 years after ORIF,the fracture was completely healed,and the patient was satisfied with shoulder status.CONCLUSION This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a precontoured plate designed for distal clavicle fractures.Although acromial fracture after RTSA can be treated conservatively,simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Fractures around the shoulder in the skeletally immature:A scoping review

Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable potential for remodeling,which is why most of these fractures in children can be treated conservatively.However,the key is to understand when a child benefits from surgical management.Clear indications for surgery of these fractures are lacking.This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children.The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures,tenting of the skin with necrosis,associated neurovascular injury,or a floating shoulder.There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic.In the rare case of a symptomatic malunion of the clavicle in children,corrective osteosynthesis is a viable treatment option.For proximal humerus fractures in children,treatment is dictated by the patient's age(and thus remodeling potential)and the amount of fracture displacement.Under ten years of age,even severely displaced fractures can be treated conservatively.From the age of 13 and onwards,surgery has better outcomes for severely displaced(Neer types III and IV)fractures.Between 10 and 13 years of age,the indications for surgical treatment are less clear,with varying cut-off values of angulation(30-60 degrees)or displacement(1/3–2/3 shaft width)in the current literature.

Plate vs reverse shoulder arthroplasty for proximal humeral fractures:The psychological health influence the choice of device?

BACKGROUND Proximal humeral fractures represent the third most common observed osteoporotic fracture;the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial.Among the treatments described in literature,open reduction and internal fixation(O.R.I.F)and reverse shoulder arthroplasty(RSA)are gaining an increasing popularity.AIM To investigate the correct treatment for three and four-part proximal humeral fractures according to psychological aspects.METHODS It was conducted a prospective study with a series of 63 patients treated with O.R.I.F.(group A)and with RSA(group B)for three and four-part proximal humeral fractures according to Neer classification system.A conservative treatment group,as control,was finally introduced.One independent observer performed clinical and a psychological evaluation at one(T0),six(T1)and twelve months(T2)postoperatively.The Constant’s score and The Disabilities of the Arm,Shoulder and Hand(DASH score)were used for clinical evaluation,while General Anxiety Disorder-7(GAD-7)and Caregiver Strain Scale(CSS)were used for psychological evaluation.RESULTS At one month follow up in group A the mean values were DASH score 50.8,Constant score 36.1,GAD-7 score 5.4,CSS 5.0.For the group B,the average values at T0 were:DASH score 54.6,Constant score 32.0;GAD-7 score 6.4,CSS 6.2.At six months in group A the average values were DASH score 42.1,Constant score 47.3,GAD-7 score 4.3,CSS 3.9.For the group B,the average values at T1 were:DASH score 39.1,Constant score 43.2,GAD-7 score 5.7,CSS 5.5.At twelve months in the group A,the mean values were DASH score 32.8,Constant score 60.0,GAD-7 score 3.2,CSS 3.1.For the group B shown these mean values:DASH score 33.6,Constant score 52.9,GAD-7 score 4.3,CSS 4.5.We demonstrated a better clinical and psychological outcome at T2 in the group treated with osteosynthesis compared to the group treated with arthroplasty(Constant P=0.049,GAD-7 P=0.012 and CSS P=0.005).A better clinical and psychological outcome emerged in control group at T2 comparing with surgical group(DASH score P=0.014,Constant score P<0.001,GAD-7 P=0.002 and CSS P=0.001).CONCLUSION Both open osteosynthesis and reverse shoulder arthroplasty are valid treatments for proximal humeral fractures.According to the best osteosynthesis results the authors suggested to perform a psychological analysis for each patient in order to choose the appropriate treatment.

Management of proximal humerus fractures in adults

The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures.Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each indi-vidual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes.

Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability:A rare case report

BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.

Bilateral Anterior Shoulder Fracture-Dislocation: About a Case

Bilateral anterior dislocations of the shoulder are rare lesions. They are even rarer when combined with a bilateral fracture of major tubercles. We report the case of a 28-year-old patient admitted to trauma emergencies after trauma by falling from the top of a stool. Clinical and radiographic findings revealed bilateral anterior shoulder dislocation associated with bilateral fracture of major tubercles. The patient was treated orthopedically by a reduction of dislocations under General Anesthesia, immobilization of the shoulders for 6 weeks followed by reeducation. The functional result after 12 months was satisfactory with a UCLA score of 30 points.

Mechanisms of shoulder trauma: Current concepts

Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions.Therefore,when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns.Here,we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation,dislocation with fracture of the humeral head,and the proximal humerus fracture.We have focused on common injury mechanisms and the correlation with radiological diagnostics.Radiological and laboratory findings of distinct types of injury were also discussed.

Ipsilateral Rockwood type V acromioclavicular joint dislocation and midshaft clavicle fracture:A case report

BACKGROUND Clavicle fractures are among the most common fractures seen in the emergency department.While acromioclavicular(AC)joint injuries are much less common.However,ipsilateral combinations of these injuries are quite rare with only a few cases reported in the literature.CASE SUMMARY A 29-year-old man who sustained a combination of ipsilateral AC joint dislocation and midshaft clavicle fracture.He underwent open reduction and plate fixation of the clavicle fracture,as well as semi-rigid surgical implants used to restore both the AC ligaments and the coracoclavicular joint.one year follow-up revealed that the patient had a complete range of motion and excellent shoulder scores.This case presents a rare presentation of such combination of injuries,contributing valuable insights to the literature on such rare injuries.CONCLUSION Combined midshaft clavicle fractures and AC joint dislocations are considered quite rare.Timely diagnosis of such injuries leads to great functional outcomes.AC joint dislocation should be suspected with midshaft clavicle fractures and should be investigated radiologically and clinically in an appropriate manner.Still,there is no consensus on the optimal management of such injuries.

肌内效贴配合理筋治疗肩部骨折术后上肢肿胀临床观察

目的探讨肌内效贴配合中医理筋手法缓解肩部骨折术后上肢肿胀的效果。方法将南昌市洪都中医院于2020年6月—2022年12月收治的78例肩部骨折术后上肢肿胀患者纳入研究,利用随机数字表法将其分为试验组(肌内效贴贴扎配合中医理筋手法治疗)、对照组1(肌内效贴贴扎治疗)与对照组2(绝对卧床无任何治疗),各组均为26例。2周后,评估三组情况,包括临床疗效、视觉模拟量表(VAS)评分以及症状缓解效果。结果治疗后,试验组总有效率100.00%(26/26)高于对照组1的84.62%(22/26)和对照组2的61.54%(16/26)(P<0.05);试验组VAS评分较对照组1、对照组2低(P<0.05);试验组症状缓解效果为优的占比61.54%(16/26),高于对照组1的30.77%(8/26)和对照组2的7.69%(2/26)(P<0.05)。结论肌内效贴配合中医理筋手法能够有效改善肩部骨折术后上肢肿胀,减轻患者疼痛,促进相关症状的缓解,应用价值确切。

Reverse polarity shoulder replacement: Current concepts and review of literature

Shoulder replacement in cuff tear arthropathy(CTA)is an unsolved challenge.CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty cannot reliably provide stability,range of movement,function or satisfactory long term outcome.In the past two decades since the introduction of the reverse shoulder replacement,the prosthesis has evolved and has shown promising results.It is a partially constraint joint by virtue of its design features.The reversal of the concavity and convexity of the joint to the proximal humerus and the glenoid,respectively,also shifts and improves its center of rotation onto the osseous surface of the glenoid with less exposure to shear stress.It is a successful pain relieving procedure,offering good outcome in patients with irreparable massive rotator cuff tear with or without osteoarthritis.Consequently,this has led to wider use and expansion of its indication to include more complex elective and trauma cases.Whereas originally used in the more elderly patients,there is increasingly more demand in the younger patients.It is important to have good quality long term data to support these increasing indications.Therefore,we review the literature on the concepts of reverseshoulder replacement and the contemporary evidence.

Parameters Calibration of the GISSMO Failure Model for SUS301L-MT

With the development of the rail transit industry,more attention has been paid to the passive safety of rail vehicles.Structural damage is one of the main failure behaviors in a rail vehicle collision,but it has been paid little attention to in past research.In this paper,the quasi-static fracture experiments of SUS301L-MT under different stress states were carried out.The mechanical fracture properties of this material were studied,and the corresponding finite element simulation accuracy was improved to guide the design of vehicle crashworthiness.Through the tests,the fracture behavior of materials with wide stress triaxiality was obtained,and each specimen’s fracture locations and fracture strains were determined.Parameters of a generalized incremental stress state dependent damage model(GISSMO)of the material were calibrated,and the model’s accuracy was verified with test results from a 45°shear specimen.The GISSMO failure model accurately reflected the fracture characteristics of the material.The mesh dependency of this model was modified and discussed.The results show that the simulation agrees well with experimental data for the force-displacement curve after correction,but the strain distribution needs to be further studied and improved.

Injury to the axillary artery and brachial plexus caused by a closed floating shoulder injury: A case report

BACKGROUND A floating shoulder may be associated with catastrophic neurovascular injury and requires a multidisciplinary approach for its management. To maximize the like-lihood of good patient outcomes, this unique injury pattern should be recognized in patients as early as possible. This can be difficult to achieve, however, as there are currently few reports of floating shoulder in the literature, meaning that associated neurovascular injuries may be overlooked.CASE SUMMARY We present here a rare case of floating shoulder with axillary artery injury in a 34 -year-old woman. The patient complained of pain and numbness of her left upper limb after losing control of her motorcycle on a highway and falling from the vehicle 2 h ago. No blood pressure reading could be obtained from her left upper limb and no blood oxygen readings could be obtained from any of her left fingers. Computed tomography angiography and duplex ultrasonography revealed interruption of blood flow through the axillary artery, with distal flow being maintained through collateral arteries. The clinical diagnosis including fracture of the left proximal humerus, the left clavicle, and the left scapula, left axillary artery rupture, and left brachial plexus injury. We successfully performed open reduction and internal fixation of the fracture and vascular repair. The patient showed satisfactory recovery that was observed during 4 -mo follow-up.CONCLUSION Emergency surgery can be an effective therapeutic option for the closed floating shoulder with catastrophic axillary artery injury.

Functional Outcome Following Reverse Total Shoulder Replacement in the Setting of Trauma with Minimum 1 Year Follow-Up

Aims: To evaluate the short term functional outcomes following a reverse total shoulder replacement for complex neck of humerus fractures. Methods: A single centre retrospective case series evaluating all patients who underwent reverse shoulder arthroplasty following a complex neck of humerus fracture. Functional shoulder movements were assessed by two orthopaedic trainees at 1 year follow-up and compared to the opposite shoulder. Subjective assessment was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Oxford Shoulder Score (OSS). Documentation of any complications was also noted. Findings: The reverse total shoulder replacement showed favourable outcomes both subjectively and objectively. Subjectively patients in this study scored a mean of 27.5 +/- 24.4 (range 0 - 57.8) in the DASH and 37.9 +/- 9.2 (range 26 - 48) in the OSS. There was a high negative linear correlation between the 2 scoring systems (r = -0.95, p Conclusion: A reverse total shoulder replacement shows favourable subjective and objective outcomes for complex neck of humerus fractures in the trauma setting.

Isolated Two Non-Displaced Coracoid Fracture Treated with Conservative Means: Report of Two Cases

Coracoid fractures are usually seen with other shoulder injuries. Isolated fractures of this prominence are rare conditions. Herein we present two isolated coracoid fractures after a motorcycle accident and a fall onto the shoulder respectively. Conservative treatment with sling and passive-active shoulder exercises is accepted approach in these fractures. We also prefer conservative treatment at our cases and both of them have good results.

肱骨近端骨折合并肩袖损伤发病率及术后影响肩关节功能的多因素分析

目的评估肱骨近端骨折伴肩袖损伤的发生率,探讨影响肩关节功能恢复的因素。方法回顾性分析2018年1月至2022年8月在承德医学院附属医院关节外科接受手术治疗的168例肱骨近端骨折患者的临床资料。记录术后1年随访时的肩关节NEER评分。对影响NEER评分的指标进行单因素及Logistic多因素分析。结果肱骨近端骨折合并肩袖损伤患者发病率为25.60%(43/168)。单因素分析显示,年龄、术后开始功能锻炼时间、骨折分型、复位质量、骨质疏松、肩袖损伤、抗骨质疏松药物应用等指标与术后NEER评分优良率相关(P<0.05);Logistic回归分析显示,年龄、术后开始功能锻炼时间、骨质疏松、复位质量、肩袖损伤、抗骨质疏松药物应用是肱骨近端骨折术后影响肩关节功能的主要因素(P<0.05);以上述因素建立ROC曲线,曲线下面积为0.926。结论肱骨近端骨折合并肩袖损伤发病率较高,术后肩关节功能的恢复与年龄、术后开始功能锻炼时间、骨质疏松、复位质量、肩袖损伤、抗骨质疏松药物应用相关,需要我们在术前、术中及术后及时发现并积极应对相关因素,使患者获得满意的肩关节功能。

手术治疗高龄肩关节多发骨折合并肩锁关节脱位1例

患者,男,80岁,车祸伤致左肩部疼痛活动受限半小时,于我院急诊行CT检查,显示左肩峰骨折、肩锁关节脱位、喙突基底部骨折、肩骨性Bankart损伤。入院排除其他手术禁忌证后,于2022年8月12日在全身麻醉下行左肩峰骨折钢板内固定+肩锁关节脱位钢板内固定+喙突基底部骨折空心钉内固定+肩骨性Bankart损伤带线锚钉内固定术。

不同内固定系统在老年肱骨外科颈骨折中的应用对比

目的对比分析桥接组合式内固定系统(OBS)与肱骨近端内锁定系统(PHILOS)治疗老年肱骨外科颈骨折(HSNF)的临床效果。方法回顾性分析我院收治的80例老年HSNF患者的临床资料,根据手术方法不同将患者分为2组,其中30例采用OBS治疗的患者纳入OBS组,50例采用PHILOS治疗的患者纳入PHILOS组。比较2组患者手术情况、术后康复情况、血清骨代谢指标[骨钙素(OCN)、Ⅰ型前胶原氨基端前肽(PINP)、碱性磷酸酶(ALP)]水平、骨痂评分、肩关节功能评分[Constant-Murley量表(CMS)评分、Neer评分]、并发症发生率。结果OBS组患者手术时间长于PHILOS组,骨折愈合时间短于PHILOS组(P<0.05);OBS组患者术后1个月、3个月血清OCN、PINP、ALP水平高于PHILOS组(P<0.05);OBS组患者术后1个月、2个月、3个月骨痂评分高于PHILOS组(P<0.05);OBS组患者术后1个月、3个月CMS、Neer评分高于PHILOS组(P<0.05);2组患者术后切口恢复良好,均为Ⅰ级愈合,无伤口感染、骨不连等并发症发生。结论与PHILOS比较,应用OBS治疗老年HSNF患者的近期临床效果更佳,且能促进骨折愈合。

微创经皮钢板内固定技术在锁骨中段粉碎性骨折锁定钢板固定术中应用

目的 探讨微创经皮钢板内固定(MIPPO)技术在锁骨中段粉碎性骨折锁定钢板固定术中的应用价值。方法 回顾性选取2020年6月—2022年6月130例锁骨中段粉碎性骨折的临床资料,根据手术方法分为观察组和对照组,每组65例。对照组行传统切开复位内固定,观察组行MIPPO技术联合锁定钢板治疗。比较2组围术期指标、并发症、手术优良率及手术前后疼痛应激介质、肩关节功能指标。结果 观察组切口长度、骨折愈合时间短于对照组,术中出血量少于对照组,术后1 d疼痛视觉模拟评分法评分低于对照组(P<0.01)。术后1 d,观察组血清P物质、前列腺素E_(2)低于对照组,β内啡肽高于对照组(P<0.05);术后3、6个月,观察组Constant-Murley肩关节功能评分及肩关节前屈、后伸、外旋活动度高于对照组(P<0.05)。观察组并发症总发生率低于对照组,术后6个月手术优良率高于对照组(P<0.05)。结论 MIPPO技术联合锁定钢板治疗锁骨中段粉碎性骨折能显著提高手术优良率,减少术中出血量,促进肩关节功能恢复,抑制疼痛因子释放,缓解术后早期疼痛,还能降低并发症风险。