Aims

Conservative treatment of moderately displaced proximal humeral head fractures yields good clinical results, but secondary fragment displacement may occur. Identification of those fractures at risk of displacement may influence initial decision-making.

Aims

Heterotopic ossification (HO) is a potentially devastating complication of the surgical treatment of a proximal humeral fracture. The literature on the rate and risk factors for the development of HO under these circumstances is lacking. The aim of this study was to determine the incidence and risk factors for the development of HO in these patients.

Aims. In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. Patients and Methods. Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. Results. In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients’ age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. Conclusion. Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307–1312

Objectives

Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck.

Introduction: Optimal management of proximal humeral fractures is still to be defined. The objective of this study is to present the functional and quality of life results of proximal humeral fractures conservatively treated in elderly population. Material and Methods: Prospective study including 74 fractures in patients over 60 and less than 85 years-old. 4 patients lost at final follow-up. Fractures were assessed by X-ray and C.T. exam. There were 14 one-part fractures, 15 two-part greater tuberosity (GT), 17 two-part surgical neck, 10 three-part GT, 6 four-part, 6 two-part GT fracture dislocation, 1 four-part fracture dislocation and 1 impression fracture. Constant Score, EuroQol 5-D and X-Ray study at two-year follow-up. U Mann-Whitney for non parametric and t-student for parametric. Results: Constant Score: non-displaced fractures mean of 73,58 while displaced fractures 59,41 (p0,003). Significant differences between them in all Constant items except for External rotation (p0,17). Total Constant Score diminished as fracture pattern increased complexity: 2-part GT 72,78, 2-part surgical neck 65,88, 2-part GT fracture dislocation 71, 3-part GT 54,64 and 4-part 33,66. Despite these differences there were no significant differences as far as pain was concerned among all displaced fractures. Quality of life perception: no significant differences in VAS between displaced and non-displaced fractures (p 0,75). 4 avascular necrosis at final follow-up, 2 in the 4-part group, 1 in 3-part GT and 1 in 4-part fracture dislocation. Conclusion: Conservative treatment of proximal humeral fractures give reasonable good functional results in 1-part, 2-part GT, 2-part surgical neck and 2-part GT fracture dislocation in specially selected elderly population. 3-part GT and 4-part fractures achieve a limited functional result with conservative treatment. No differences have been observed between non-displaced and displaced fractures conservatively treated as far as quality of life perception is concerned in such elderly population

Most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated non-operatively. The management of the smaller number of more complex displaced fractures is more controversial and new fixation techniques have greatly increased the range of fractures that may benefit from surgery.

This article explores current concepts in the classification and clinical aspects of these injuries, reviewing the indications, innovations and outcomes for the most common methods of treatment.

Purpose: The purpose of our study was to compare serum titanium levels in patients with the three-piece modular AcuMatch® and one-piece nonmodular Versys® titanium femoral components. Methods: Blood samples were obtained at multiple time points for four years after the surgery in patients with the Versys® one-piece (47 patients) or AcuMatch® three-piece (70 patients) femoral stems. Control levels were measured in 20 patients without titanium implants. Titanium (Ti) levels were measured using high resolution inductively coupled-plasma mass spectroscopy by a technician blinded to the patient groups. Results: Medium Ti was significantly lower in the control group (.21 & #61549;g/L), when compared to patients with one- and three-part stems at all follow-up periods (p < .02). At 1 and 2 years post-operatively, medium Ti levels in the three-part group (3.1 and 3.4 & #61549;g/L) were significantly higher than levels in the one-part group (1.7 and 1.6 & #61549;g/L) (p < .004). At 3 and 4 years, medium titanium levels were not significantly different in the one-part group (2.5 and 2.7 & #61549;g/L) when compared to the three-part group (3.5 and 3.1 & #61549;g/L) (p > .05). Conclusions: The intraoperative flexibility provided by modular femoral stems may be offset by increased wear at modular junctions. Ti levels were significantly higher in patients with a highly modular three-part femoral stems at 1 and 2 years but no significant difference was found at 3 and 4 years postoperatively. Continued monitoring of these patients is warranted to determine if metal levels can be used to evaluate stem performance