Shoulder
Stein J. Janssen; Prakash Jayakumar; Dirk P. Ter Meulen; Derek F.P. Van Deurzen; David Ring
Abstract
Background: The aim of this study was to assess differences in fracture morphology and displacement betweenisolated greater tuberosity (GT) fractures (i.e. fractures of the greater tuberosity without other fractures of the proximalhumerus) with and without shoulder dislocation utilizing quantitative ...
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Background: The aim of this study was to assess differences in fracture morphology and displacement betweenisolated greater tuberosity (GT) fractures (i.e. fractures of the greater tuberosity without other fractures of the proximalhumerus) with and without shoulder dislocation utilizing quantitative 3-dimensional CT imaging.Methods: Thirty-four CT-scans of isolated greater tuberosity fractures were measured with 3-dimensional modeling.Twenty patients (59%) had concomitant dislocation of the shoulder that was reduced prior to CT-scanning. Wemeasured: degree and direction of GT displacement, size of the main fracture fragment, the number of fracturefragments, and overlap of the GT fracture fragment over the intact proximal humerus.Results: We found: (1) more overlap –over the intact humerus– in patients without concomitant shoulder dislocationas compared to those with shoulder dislocation (P=0.03), (2) there was a trend towards greater magnitude ofdisplacement between those without (mean 19mm) and those with (mean 11mm) a concomitant shoulder dislocation(P=0.07), and (3) fractures were comparable in direction of displacement (P=0.50) and size of the fracture fragment(P=0.53).Conclusion: We found substantial variation in degree and direction of displacement of GT fracture fragments. Variationin degree of overlap and displacement is partially explained by concomitant shoulder dislocation.Level of evidence: IV
Shoulder
Morteza Nakhaei Amroodi; Vahid Behshad; Paniz Motaghi
Abstract
Background: Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article ...
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Background: Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures. Methods: We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder. Results: Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1, Mean ASES: 28.6 to 88.9) (P value<0.0001). Conclusion: ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.