Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2016
Review Meta AnalysisMinimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials.
The purpose of this study was to perform a meta-analysis comparing the clinical outcomes and complications between anterior humeral minimally invasive plate osteosynthesis (MIPO) and the 2 standard techniques, either open reduction and plating or humeral nailing. ⋯ Current evidence indicates the MIPO approach has better clinical outcomes with a lower rate of complications compared with alternative surgical techniques. However, the results of this meta-analysis are limited by problems inherent in the primary studies, including poor reporting of randomization protocols, as well as possible attrition bias and reporting bias, of the primary studies. Future publications may therefore change the trend of the pooled estimate in either direction.
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J Shoulder Elbow Surg · Oct 2016
Comparative StudyReverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis.
Surgical treatment of proximal humeral fractures in the elderly pose challenges in decision making. Reverse total shoulder arthroplasty (RTSA) has been established as a reliable option for salvage of failed hemiarthroplasty, although few studies have analyzed RTSA after failed open reduction with internal fixation (ORIF). This study evaluated the outcomes of patients with failed osteosynthesis who undergo salvage RTSA compared with patients undergoing primary RTSA for proximal humeral fractures. ⋯ Although RTSA after failed ORIF has a higher rate of complications compared with acute RTSA, the revision and reoperation rate as well as clinical outcomes and shoulder function remained comparable. When a surgeon approaches these complex fractures in patients with poor underlying bone stock, this study supports acute arthroplasty or ORIF with the knowledge that salvage RTSA still has the potential to achieve good outcomes if osteosynthesis fails.
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J Shoulder Elbow Surg · Oct 2016
Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.
Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. ⋯ The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome.