This document discusses the classification and anatomy of proximal humeral fractures. It provides details on:
1) Neer's classification system which categorizes fractures based on displacement of fragments into 1, 2, 3, or 4-part fractures or fracture-dislocations.
2) Important anatomical factors like the relationship between the articular head and tuberosities which impact fracture patterns.
3) Pre-operative planning involves accurate imaging like radiographs and CT scans to identify fracture characteristics to guide treatment.
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
Management of Posterior Glenohumeral Instability with Large Humeral Head DefectPeter Millett MD
Traumatic posterior instability may occasionally cause a large osteochondral lesion when the anterior humeral head is compressed against the posterior glenoid rim. This is termed a reverse Hill–Sachs lesion. Such osteochondral defects may be very large in the case of chronic locked dislocations. Even in acute posterior disclocations, closed reduction may be difficult when the humeral head is locked posteriorly over the glenoid. In such cases closed or open reduction under general anesthesia with muscle relaxation may be necessary. In cases where the anterior humeral head defect is large, reconstruction may be necessary to maintain stability. Management must be tailored to the individual patient and depends on several factors, which include the size of the defect, the duration of the dislocation, the quality of the bone, the status of the articular cartilage, and the patient’s overall health. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
arthroscopy of the knee joint is a relatively common orthopedic procedure to treat a host of sports injuries and other knee diseases. Commonly a 4 mm size scope is used via two standard arthroscopy portals. Arthroscopic examination of the knee confirms MRI findings. Synovial fluid and biopsy can be taken to confirm diagnosis.
Management of Posterior Glenohumeral Instability with Large Humeral Head DefectPeter Millett MD
Traumatic posterior instability may occasionally cause a large osteochondral lesion when the anterior humeral head is compressed against the posterior glenoid rim. This is termed a reverse Hill–Sachs lesion. Such osteochondral defects may be very large in the case of chronic locked dislocations. Even in acute posterior disclocations, closed reduction may be difficult when the humeral head is locked posteriorly over the glenoid. In such cases closed or open reduction under general anesthesia with muscle relaxation may be necessary. In cases where the anterior humeral head defect is large, reconstruction may be necessary to maintain stability. Management must be tailored to the individual patient and depends on several factors, which include the size of the defect, the duration of the dislocation, the quality of the bone, the status of the articular cartilage, and the patient’s overall health. For more shoulder surgery and instability studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Shoulder pain is the third most common musculoskeletal symptom encountered in medical practice after back and neck pain, accounting for almost 3 million patient visits each year in the United States. A wide range of potential pathoanatomic entities can give rise to shoulder pain, from simple sprains to massive rotator cuff tears. The majority of these conditions are amenable to conservative treatment. Rotator cuff dysfunction is a particularly important entity because it occurs frequently and may necessitate surgical treatment. This report will provide a critical overview of current diagnostic and treatment techniques for rotator cuff disease. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, shoulder surgeon, Greater Denver http://drmillett.com/shoulder-studies
A fractured neck of femur (NOF) is a serious injury, especially in older people. It is likely to be life changing and for some people life threatening.
Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Elderly osteoporotic women are at greatest risk.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Proximal Humeral Fxs
Majority occur in the elderly ,
minimally displaced and stable.
osteoporotic and metaphyseal
fractures, with compromised
bone quality -optimal surgical
and functional outcomes are
limited.
F- affected three times more
common
Low energy trauma in elderly
and high energy trauma in
younger age group
3. proximal humeral fractures account for 5%of all
skeletal fractures and 80 % of them are minimally
displaced or undisplaced which can be treated non
surgically with good results , they generally occur in
elderly patients , as a result of trivial and low energy
trauma , risk factors in the elderly include poor bone
quality, impaired vision, and balance , medical co-
morbidities
4. irrespective of age , operative or non operative
, management, the premise of treatment is to achieve
a stable ,pain free range of movement of the
limb, thereby avoiding the late sequelae like
, refractory shoulder
stiffness, osteonecrosis, malunion, nonunion, and
heterotopic ossification
5. In order to achieve this objective , it is imperative , to
pay utmost attention to the anatomical distortion and
disturbance of, shoulder joint ,that is inherent to
proximal humeral fractures
At this juncture it is pertinent to look at the
anatomical profile of the proximal humerus, which has
a direct bearing on the diagnosis, work up, treatment
protocols and rehabilitation.
6.
7. Proximal humerus comprises of
four major segments
The Articular head,
The greater tuberosity,
lesser tuberosity, and
the shaft. the muscle insertions
on these segments and the
magnitude and direction of the
forces causing injury, determine
the pattern of fracture lines
,displacement and angulation
8. Critical Anatomic Factors
The critical anatomic relationships of the articular
segment to the shaft and the tuberosities, and include
retroversion,
inclination angle, and
translation of the head relative to the shaft, and the
relationship of the head to the greater tuberosity
Rotator cuff
9. The articular head lies above the greater tuberosity, 3-
20 mm. Avg – 8mm
The ascending branch of the anterior circumflex
humeral artery provides most of the blood flow to the
articular segment. If the medial calcar of the humerus
is spared by the fracture, the vessel is spared
10. Anatomic
Parameters
Shoulder is a very unstable joint , Joint capsule ,though
strong is lax
Stabilising factors – the labrum deepens the glenoid
cavity, scapular muscles hold the head in close
opposition , coraco acromial arch , fusion of the tendons
of the scapular muscles to the capsule and the muscles
attaching the humerus to the pectoral girdle
Head of the humerus is larger than the glenoid cavity
deepened by the labrum
The head is inclined 130 degrees to the shaft with 3mm
offset posteriorly and from the centre of the shaft
Retroversion of the head varies from 18 to 40degrees
Normal humeral retroversion places the humeral head
posterior to the humeral shaft
The bone quality of greater tuberosity is marginal and is
often comminuted
The bone quality of lesser tuberosity often better than
GT , particularly laterally near the bicipital groove
Radius,of curvature of the average adult humeral head is
between 22 and 25 mm and is proportional to the
thickness of the humeral head
11. Clinical Features
A complete history and physical examination
must be obtained about the mechanism of
injury and velocity of fracture and other
associated injuries - viz rib ,cervical, and
scapular fxs
Patients are tender over the injured
shoulder, with swelling and
ecchymosis, echymoses appears 24 to 48 hrs
and may to arm ,forearm, ,chest
wall, , indicates t extensive soft tissue injury
The patient will hold the arm in
internal,rotation
Palpation over the shoulder and any attempted
movement of the extremity will elicit pain in
the shoulder
Complete Neuro vascular asssessment is made
12. Pre op planning
Preoperative planning
Imaging—accurate
identification, of the size, location
and displacement of the fragments
is essential for Fracture
classification and formulation of
Rx Plan
Initial Radiographs , must be
Neer’s Trauma series
True AP
Scapular Lateral
Axillary
True AP View -- Identifies major
Fracture lines ,, Tuberosity ,and
humeral head displacement
Axillary view reveals the articular
surface , in relation to glenoid
, evaluates the degree of Tuberosity
displacement, surface defects, and
dislocations
13. Pre op Planning
CT Scan
Delineates, Comminution, amount
of Tuberosity
displacement, humeral head
indentation Fractures, evaluates the
Head splitting Fractures and
assesses Glenoid Fxs , posterior
dislocations
MRI Is rarely indicated in a trauma
setting , and is done to evaluate any
pre existing Shoulder problem , as a
corollary in Pathologic Fxs, and in
non unions
Angiography,
To assess vascular injury, specially in
two Part neck Fracture, because of
the tethering of the circum flex
anastomosis – is often associated
with severe medial shaft
displacement through Surgical
neck
14. Classification of
Proximal humeral
Fxs
First systems dating back to 17th Century, classed them as Simple
closed versus Open
Modern Times - 1896, -- Kocher Focused on the location of the
fracture and divided Proximal humerus Fractures into Supra
Tubercular, Peritubercular,infratubercular, and Sub Tubercular
Codman Classified according to the Fracture pattern, he
described fractures along the lines of epiphyseal scars and
observed that fractures occur in several combinations of four
parts
Watson Jones System , based on the Mechanism of injury
described PHF as Impacted adduction and Impacted abduction, a
contusion crack fracture, and a fracture of minimal displacement
Dehne Classification
DeAnquin and DeAnquin similar to the one used by Neer.
AO /ASIF Classification – emphasises on the vascular supply of
the articular portion of the proximal humerus with 27 possible
subgroups based on Extra articular/articular
involvement, Focality, Dislocation and degree of comminution.
The vascular supply to the fragment is considered adequate , if
either of the tuberosity remains attached to the head
15. Neer’s(1970)
classification
It is a Refinement of Codman’s System, incorporates ,the
concept of displacement and vascular isolation of the
articular segment and relates the anatomy and
biomechanical forces resulting in the displacement of
fragments to diagnosis and treatment
Fractures are classified by evaluating the displacement of
the Parts (head, shaft, greater tuberosity, lesser
tuberosity) from each other
To meet the Criteria of a part, the fragment must be
rotated 45 degrees or 1cm from another fragment
Classifies as one part, Two part, three Part and Four part
Fractures
Neer also categorized Fracture –Dislocation , which are
displaced proximal fractures – 2,3,or4 Part associated
with either anterior or posterior dislocation of the
articular segment
Neer also described articular surface fractures of two
types, --1) Impression Fractures, of the articular surface
(seen in Chronic Dislocations 2 ) Head Splitting
Fractures is usually associated with other displaced fxs of
proximal humerus
16. Neer’s(1970) classification
It is a Refinement of Codman’s System, incorporates
,the concept of displacement and vascular isolation of
the articular segment and relates the anatomy and
biomechanical forces resulting in the displacement of
fragments to diagnosis and treatment
Fractures are classified by evaluating the displacement
of the Parts (head, shaft, greater tuberosity, lesser
tuberosity) from each other
To meet the Criteria of a part, the fragment must be
rotated 45 degrees or 1cm from another fragment
Classifies as one part, Two part, three Part and Four
part Fractures
Neer also categorized Fracture –Dislocation , which
are displaced proximal fractures – 2,3,or4 Part
associated with either anterior or posterior dislocation
of the articular segment
Neer also described articular surface fractures of two
types, --1) Impression Fractures, of the articular
surface (seen in Chronic Dislocations 2 ) Head
Splitting Fractures is usually associated with other
displaced fxs of proximal humerus
17. Indications
Surgical options- Inthe absence Specific Surgical indications for PHFXs is
poorly defined , any single surgical technique
of medical contraindications, all is not appropriate for all patients Treatment
must be tailored to each specific situation
displaced fractures must be Significantly (>1cm )Displaced Greater Fxs
operated .results of surgery is Requires Repair, to avoid Rotator cuff
deficiency. and sub acromial impingement of
variable, the cuff . 0.5 cm displacement may lead to
pain or disability after fracture healing.
Prognostic factors include --- Displaced lesser Tuberosity – where
Fracture Pattern , Bone significant amount of articular head is
attached to the fragment , or Fxs that limit
quality, Quality of surgical internal rotation .
Reduction, stability of Fixation Two part anatomic neck Fxs. In Young pts ,--
ORIF
, Age of the patient, Patient Two part Surgical neck FXs
motivation, and reliability Two Part tuberosity Fx Dislocation
, Surgeon experience and post Fx - Dislocation , involving the Surgical neck
op Rehabilitation.
18. Varied Surgical options are
available and is to be
individualized to the fracture
pattern and class. , these include –
Closed reduction and
Percutaneous , pinning
Open reduction and Percutaneous
pinning
Good Bone Quality--Extra
medullary Fixation with – Tension
Band wiring , Blade Plate ,,Locking
compression periarticular plates
Poor Bone Quality – Intra
medullary Fixation with – Enders
nail
Hemiarthroplasty
Total shoulder replacement
Reverse shoulder arthroplasty
19. Percutaneous Pinning
Percutaneous pinning – first Contra indications -- Severe
advocated by Bohler - Termed comminution and osteopenia are
Biological Fixation absolute contraindications
Less soft tissue dissection , and Inability to reduce Fracture
disruption, Fragments
vascularity of the humeral head is Fracture Dislocation
preserved Non Compliant patients
incidence of osteonecrosis is
minimal
PHFXs – without comminution, in
patients with good quality bone who
are willing to comply with serial
Radiographs and shoulder
immobilization for4 to 6 weeks
The ideal Indication is Two Part
Surgical neck Fractures and can also
be done in 3 Part and 4 part
fractures
20.
21. Contra indications -- Severe The orientation and pin
comminution and osteopenia placement must be parallel and
are absolute contraindications avoid
Inability to reduce Fracture 1)the Axillary nerve , which
Fragments courses 5cms distal to the lateral
Fracture Dislocation edge of the Acromion from
Non Compliant patients
posterior to anterior.
2)The Radial Nerve , Passing
around the spiral groove
3) Anteriorly ,- the long head
of Biceps must be avoided
4) Medially , the Anterior
circumflex humeral vessels
, along the medial cortex
22.
23.
24.
25.
26. Locking Humeral Plate
Concept Indications for use
The development of the locking plate has In the treatment of acute unstable 2, 3
changed the management of many and 4 part fractures and fracture
fractures.
dislocations.
They have a number of advantages
including improved fixation in osteoporotic Non-union of fractures especially at
bone, and the facilitation of reconstruction the neck of the humerus (combined
of comminuted irreducible fractures with bone grafting).
The concepts behind its use are to provide: Pathological fractures .
Stable fixation of the unstable proximal
humerus fracture until bony union.
Early mobilisation of the shoulder and early
Contraindications
active rehabilitation program. Extensively comminuted humeral
Good functional outcomes and a good head fractures which cannot be
restoration of the activities of daily living adequately reconstructed.
[5]. Fractures in immature patients.
Local infection after previous surgery
[5].
27. Arthroplasty in PHFxs
4-part fractures,
fracture dislocations,
head-splitting fractures,
impaction fractures,
humeral head fractures with
involvement of more than
50% of the articular
surface, and
3-part fractures in elderly
patients with osteoporotic
bone. However, heterogeneity
of fracture patterns exists
within these groups
28. Reverse Shoulder Prostheses
for acute complex fractures of the proximal
humerus in elderly population with poor bone quality
and
severe rotator deficiency, when an efficient and
reliable
re-fixation of the tubercles is diffcult or impossible
31. Complications
Humeral head necrosis
Delayed union/non-union
Screw cut out with intra-articular displacement
Implant failure
Varus displacement (>10˚)
Infection
Heterotopic bone formation
32. Complications
Shoulder stiffness, osteonecrosis, malunion or nonunion.
technical errors, such as inadequate reduction, incorrectly positioned
implants, screw penetration into the joint, loss of fixation, tuberosity
disruption, and nerve injury.
The use of plates with angular stability, such as blade plates or plates
with locking screws, and/or augmentation of the fracture with
polymethylmethacrylate (PMMA) or calcium phosphate cement
lessens this risk.
Osteonecrosis of the humeral head following fracture may be partial or
complete; the significance of this complication on outcome remains
controversial. Open reduction and internal fixation with plates
requires a more invasive approach and may be associated with an
increased risk of osteonecrosis. However, rigid fixation may promote
better and more rapid revascularization by creeping substitution of the
humeral head and may therefore lessen the risk of articular collapse