shoulder fractures

..Despite the fact that an understanding of the character of the fractures and implants has improved over the last few years, there are still types of fractures which need primary prosthetic replacement...

..Further research comparing primary treatment methods in a properly designed and controlled fashion is required, ideally using randomized controlled trials...

..Stable osteosynthesis is important, but the outcome of operatively treated proximal humerus fractures is dependent on soft tissue management as well...

..This may be achieved either with purposeful inferomedial humeral head screws or endosteal fibula allograft augmentation...

..Fixed-angle locked plates that maintain angular stability under load have been proposed as an alternative to hemiarthroplasty for the treatment of some osteoporotic fracture types...

..Aim of the study was to evaluate implant associated problems of angle-stable implants in comparison to other established osteosynthetic methods...

..Accurate placement of the tuberosities and healing at the bone-bone interface of the rotator cuff seem to be the most important factors influencing the outcome in prosthetic care of fractures...

..To report our experience from the use of the Philos plate for the treatment of three- and four-part proximal humeral fractures and to investigate factors influencing the final outcome...

..The purpose of this study was to carry out a systematic review of the literature on the efficacy and early to medium term functional results of locking plates for stabilization of proximal humeral fractures...

..Longer follow-up series are difficult to find. However, especially regarding the risk of avascular humeral head necrosis longer follow-up series are high of clinical relevance...

..The purpose of this study was to report early failure of the locking compression plate (LCP) in the treatment of osteoporotic proximal humerus fracture and characterize the mode of failure...

..Secondary aims include effects on functional outcome, pain, complications, quality of life, and cost-effectiveness...

..The goal of this study is to evaluate the incidence of complications and the functional outcome after open reduction and internal fixation with the proximal humeral locking plate (Philos)...

..Because of this underlying difficulty, optimum patient care might require the development of new imaging modalities and not necessarily new classification systems...

..Our study has shown that the PHILOS plate is a reliable implant. A direct correlation was observed between Oxford shoulder and DASH scores...

..Prospective study to assess the complications, outcomes, and cost effectiveness of nonoperative management compared to various surgical treatment options is warranted...

..Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee)...

..The aim of this study was to evaluate early results of proximal humerus fractures treated with the PHILOS locking plate...

..Results of the reverse prosthesis depend on the diagnosis and on the remaining cuff muscles, specifically the teres minor. Surgeons should be vigilant with regard to low-grade infection in revision surgery...

..Early mobilization of the shoulder and early active rehabilitation program to ensure a good functional outcome and a good restoration of the activities of daily living...

..In this prospective study, we evaluated the results of patients treated with the PHILOS (Proximal Humeral Internal Locking System) locking plate, a new technique recently developed by the AO/ASIF...

..We evaluated the outcome after internal fixation of unstable or displaced proximal humerus fractures with a new fixed-angle implant...

..To evaluate and compare proximal humeral fractures treated either by plate osteosynthesis with angular-stable screws or by intramedullary nailing, and to define the indications optimal for use of either technique...

..Thus, in order to limit complications, when the patient is elderly, complex fracture of the proximal epiphysis of humerus should be treated conservatively...

..The currently celebrated angle-stabilising plates did not lead to a significant improvement in functional outcome, compared with other established osteosynthesis procedures...

..LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence...

..Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability...

..A blinded physiotherapist will carry out the assessments. Other secondary outcomes are Oxford Shoulder Score, and general health status (Short Form-36)...

..Each patient failed early in the postoperative period and was revised to fixation with compression plating techniques, with uneventful union...

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..Therefore the aim of this study was to analyze the functional short-term outcome following removal of locking plate fixation of the proximal humerus...

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..Level of Evidence: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence...

..The Non-Contact Bridging (NCB) Plate for the proximal humerus (PH) is a new head locking system for treating fractures of the proximal humerus which allows minimally invasive surgery (MIS)...

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..Level of Evidence: Diagnostic study, level II (systematic review of level II studies). See the Guidelines for Authors for a complete description of levels of evidence...

..These results emphasise the importance of a careful initial decision to select the most appropriate treatment modality in complex fractures of the proximal humerus...

..It provides a stable fixation in young patients with good-quality bone sufficient to permit early mobilisation. Failure of the screws to maintain fixation in the elderly remains a problem...

..One of the new treatment options for proximal humeral fractures is the minimally invasive intramedullary nail. In this study, we reviewed the early clinical results after 1 year...

..The purpose of the present study was to evaluate the effects of etiology on the results of reverse total shoulder arthroplasty...

..This study prospectively assessed whether the presence of a rotator cuff tear in association with a proximal humeral fracture influences functional prognosis...

..However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly...

..It is hoped that advanced locking medullary screws or plates will reduce the risk of secondary dislocation of screws or fracture segments when the bone of the humeral head is osteoporotic...

..CLINICAL RELEVANCE: The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor...

..In this prospective study, complications observed after angularly stable proximal humerus plate fixation (locking proximal humerus plate) were analysed by deriving specific therapies...

..In this multicentre study, data on 102 shoulder hemiarthroplasties for the treatment of fractures were analysed retrospectively with regard to tuberosity healing and functional outcome...

..A discussion of nonsurgical and surgical treatment options and techniques needed to achieve anatomic reduction and stable fixation is important...

..OBJECTIVE: To determine the effect of alternate devices in the management of four part proximal humerus fractures in patients on the risks of reoperation, need for implant removal at 1 year, and pain...

..The aim of this study was to investigate if the differentiated use of anatomic and reversed prostheses in dependence of the preoperative anatomic situation is able to optimise the results...

..The aim of this study was to review the functional and radiographic results and complications of a new operative technique in a series of twenty-five patients...

..The goal was to optimize implant stiffness for fracture stabilization even in weak bone stock...

..8% and that of proximal migration of the humeral head 6.8%. The mean Constant score was 56.63 (11 to 98). At the final follow-up, no pain or only mild pain was experienced by most patients, but marked limitation of function persisted...

..Thus, in our study population, the current classification systems were inaccurate for realizing the fracture anatomy, particularly humeral head status. They would be accurate if the articular surface orientation was taken into account...

..We conclude that osteosynthesis with preservation of the humeral head is worth considering when adequate reduction and stable conditions for revascularization can be obtained...

..Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection...

..1, A2.2, A3.2 and A1.2 sub-groups comprise over half of all proximal humeral fractures, while the AO type C fractures occur in only 6%. We suggest that the literature does not adequately reflect the spectrum of proximal humeral fractures...

..Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence...

..In this study, we assessed the radiographic and clinical results of a single surgeon's experience treating proximal humeral fractures with a locked proximal humeral plate...

..This prospective case series was designed to evaluate the perioperative and early postoperative complications associated with fixed-angle implants and to record outcome after bone healing...

..Because 40% of the 4-part fractures with fracture dislocation yielded a satisfactory or better result, the plate fixator with angular stability may be an alternative to prosthetic replacement in selected cases...

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..The technique can be recommended for complex combined meta- and diaphyseal fractures of the upper two-thirds of the humerus...

..Secondary interventions for the sequelae of fractures of the proximal humerus are complex and involve high rates of complications and revisions...

..In particular, the development of locking implants has strongly influenced modern surgical techniques. The aim of this manuscript was to describe the special features of the proximal humerus fracture and its treatment...

..The availability of angular-stable plate/screw systems led to a euphoric use of these implants for the treatment of displaced proximal humerus fractures. The high implant costs seem to be justified by a potentially improved outcome...

..We recommend this technique in patients where the tuberosity fragments are large enough to allow fixation with screws, washers and a toothed plate...

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..Our findings, if we consider the low necrosis percentage, show the good adaptability and the preservation of the soft tissues as guaranteed by the synthesis equipment and by the surgery performed...

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Open periarticular shoulder fractures present a tremendous challenge for orthopedic surgeons...

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..The purpose of the present study was a direct comparison of fixed-angle plate fixation (FAPF) and shoulder hemiarthroplasty (SHA) for complex fractures of the proximal humerus in the elderly...

..In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients...

..Physical examination reveals that the patient is neurologically intact and has good pulses. Management of this case is described in the following opinions...

..Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis...

..Regarding all these topics, primary hemiarthroplasty in old patients and specific fracture situations is still to be recommended...

..The good functional results indicate that the Polarus nail is a satisfactory mechanical device that can be used in the treatment of displaced proximal humeral fractures in both the young and the elderly with osteopenic bone...

..As demonstrated by these good short-term results, this technique seems to be a suitable procedure for displaced humeral head fractures...

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..Such fixation should be performed utilising a limited open approach, with dissection to bone under direct vision, with the subsequent use of a drill-sleeve for soft-tissue protection...

..The aim of this study was to assess the effectiveness of the external rotation method in the reduction of acute anterior shoulder dislocations with and without fractures of the greater tuberosity and to evaluate the causes of failure...

..Functional after treatment however depends on the applied stabilisation principle and should be carefully monitored and adapted according to the bone healing process, monitored by regular postoperative x-ray controls...

..Prosthetic design features specific forfracture care have led to a reduction in complications. Techniques will continue to improve as prosthetic design features specific for fractures evolve...

..Satisfactory results are dependent on proper surgical technique, compliance of the patient with rehabilitation and the absence of postoperative complications...

..We therefore investigated clinical and radiological long-term results after humeral head preserving procedures...

..Greater tuberosity pins should be placed with the arm in external rotation, should be aimed for a point 20 mm from the inferior aspect of the humeral head, and should not overpenetrate the cortex...

..Although function is not completely restored, pain relief and high levels of subjective satisfaction can be achieved...

..All shoulders with tuberosity nonunion or resorption had an unsatisfactory result...

..CONCLUSION: The initial biomechanical properties of internal fixation as measured with use of a proximal humeral osteotomy model and three methods of fixation were significantly improved by the addition of calcium phosphate cement...

..Using orthogonal frontal and lateral radiographs, we found unrecognized pin penetration in 8 of 30 patients during fixation of unstable neck fractures of the humerus...

..This case report describes arthroscopic repair for the treatment of an anterior glenoid rim fracture associated with traumatic anterior shoulder dislocation...

..g., pin movement) will be reduced with further development. Whether there are also advantages for the patient remain to be seen...