Search Results (137)

Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article

Background: There are no clear guidelines to support management decisions for patients with three-part fractures of the proximal humerus. The aim of the study is to identify the treatment used and to assess the functional and radiological outcomes at follow-up. Methods: A total of 126 patients were retrospectively included in the study and were divided into two groups based on the type of surgery: plate and nail group. We collected data on the patient’s sex, age, fracture type, surgery duration, fracture healing, initial and final neck–shaft angles, shoulder joint score, and complications. Results: A total of 69 patients received locking-plate internal fixation, while 77 patients underwent fixation with intramedullary nail. The two groups were comparable, with no significant differences observed in age, sex, or the number of patients. The average operation time for the locking-plate group (88.7 ± 10.5 min) was significantly longer compared to the intramedullary nail group (70.2 ± 8.3 min). The Constant–Murley score was 91.2 ± 6.7 (range 79–98) in the plate group and 90.5 ± 7.7 (range 80–98) in the nail group, with no statistically significant difference. Complications were observed in 16 patients (23.2%) of the locking-plate group and in 7 patients (9.1%) of the intramedullary nail group, with significant difference. Conclusions: Our assessment revealed no significant differences in fracture healing times, loss of reduction, or Constant–Murley scores between two groups. However, our results suggest that intramedullary nails have an advantage over locking plates in terms of reduced operation time and complications. Full article

Background: Displaced proximal humerus fractures (PHFs) in adults represent a common orthopedic challenge, especially in elderly patients with compromised bone quality. Intramedullary nails (IM) and locking plates (LP) are the most widely used fixation techniques, though the literature remains inconclusive regarding their comparative efficacy. Methods: This retrospective cohort study included 187 patients (mean age: 65.4 years) treated surgically for Neer ≥ 2-part proximal humerus fractures at a single tertiary referral center between 2018 and 2023. Patients underwent either IM nailing or LP fixation. Baseline characteristics included age, sex, smoking status, ASA score, trauma mechanism, and bone quality (assessed by the Deltoid Tuberosity Index). Functional outcomes (DASH and Constant–Murley scores), range of motion (ROM), radiographic healing, and complications were evaluated at 1, 3, 6, and 12 months postoperatively. Results were stratified by fracture type (two-, three-, and four-part fractures) and treatment group. Results: At 12 months, no statistically significant differences were found between groups in terms of DASH (p = 0.484) or Constant–Murley scores (p = 0.057). ROM recovery was comparable across all time points. Stratified analysis showed similar outcomes across fracture types. Age, smoking, and bone quality did not significantly influence clinical results. The overall complication rate was 11.8%, with no significant difference between groups. Avascular necrosis and hardware-related issues occurred predominantly in four-part fractures. Conclusions: Both intramedullary nailing and locking plate fixation provided comparable short-term outcomes for displaced PHFs. Functional recovery appeared more dependent on fracture complexity than on the choice of implant. Surgical technique should therefore be selected based on fracture morphology, patient characteristics, and surgeon experience. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

Osteoporosis is characterized by an imbalance between bone formation and resorption, leading to decreased bone mass and an increased fracture risk, mainly associated with aging. Current treatments include anti-resorptive and anabolic drugs. However, these often have side effects, leading many patients to seek natural biological alternatives. We have demonstrated previously that hops extract, rich in compounds with estrogenic activity classified as phytoestrogens, exerts osteogenic effects by promoting the osteoblastic differentiation of bone marrow stem cells (BMSCs) while inhibiting osteoclast activity in vitro. In our study, young male Sprague Dawley rats were randomized into two groups: one received hops extract (LPL, 1% w/v in drinking water) for two months, and the other drank water alone (C). The rats were euthanized, and their femurs were dissected and processed for static histomorphometry and bone biomechanics. Additionally, BMSCs were isolated from the humeri to evaluate their osteogenic potential. Our result demonstrated that LPL treatment enhanced the osteogenic potential of humeral BMSCs in ex vivo assays, upregulating osteogenic genes and downregulating pro-resorptive markers. These findings correlated with improved femoral bone microarchitecture and biomechanical parameters. In conclusion, a two-month treatment with LPL enhanced the osteogenic capacity of BMSCs, improving bone microarchitecture and biomechanical properties. These results suggest its potential as a natural alternative for promoting bone health. Full article

Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex pathology of this structure nerve may result in clinical consequences. We present a unique set of brachial plexus abnormalities involving the C4–C6 nerve roots, superior and middle trunks, additional communicating branches, and delayed median nerve union. Case Presentation: During the routine dissection of a 70-year-old female cadaver, several unique variations in the brachial plexus anatomy were identified. The C4 root contributed to C5 before the superior trunk formed, resulting in a superior trunk composed of C4–C6. The C5 root was located anterior to the anterior scalene muscle, whereas C6 maintained its usual posterior position. Additionally, an anterior communicating branch from the middle trunk to the posterior cord was observed. A communicating branch between the lateral and medial cords split into two terminal branches: one merged with the ulnar nerve, and the other joined the medial contribution of the median nerve. The median nerve contributions from the lateral and medial cords merged approximately two inches above the elbow. Conclusions: This rare combination of brachial plexus anomalies has not been previously described in the literature and is of significant clinical relevance. The additional anterior communicating branch from the middle trunk may suggest potential flexor muscle innervation by the posterior cord, which typically innervates extensor muscles. Additionally, the delayed convergence of the median nerve may provide a protective mechanism in cases of midshaft humeral fracture. Awareness of these peripheral nerve abnormalities is important for diagnostic imaging, surgery, or peripheral nerve blocks. Knowledge of such variations is critical for clinicians managing upper limb pathologies. Full article

Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di Roma “Tor Vergata”, following the principles of the Declaration of Helsinki. It included postmenopausal women aged over 60, with the case group receiving Romosozumab after fracture fixation, and the control group consisting of women on Romosozumab therapy without fracture fixation. Exclusion criteria included psychiatric conditions, contraindications to Romosozumab, high-energy trauma, or other bone metabolism disorders. Data on fractures, surgeries, FRAX (Fracture Risk Assessment Tool) scores, BMD (Bone Mineral Densit) values, and follow-up details were collected. Side effects, including nasopharyngitis and severe events like hypocalcemia, stroke, and myocardial infarction, were recorded. Adherence was assessed via pharmacy records and patient interviews during routine clinical follow-up visits. Statistical analysis was performed using descriptive statistics, t-tests, and chi-square tests. Results: The study included 25 patients, with 12 in the surgical group and 13 in the conservative treatment group. The surgical group had a mean age of 67.3 years and a follow-up of 374 days, while the conservative group had a mean age of 76.4 years and a follow-up of 287 days. The surgical group underwent various fracture treatments, including femoral, humeral, and distal radius fractures, while the conservative group was treated with immobilization. There were no significant differences in FRAX scores or BMD values between the two groups. Vitamin D levels increased significantly in both groups after supplementation, but parathyroid hormone levels showed no difference. No new fractures occurred, and surgical patients had no delayed union or nonunion, though two had superficial wound infections. Conclusions: Both groups adhered well to Romosozumab therapy, with no severe side effects; minor side effects included myalgia in the surgical group and shoulder arthralgia in the conservative group. Romosozumab is well-tolerated and adherent in osteoporotic patients after osteosynthesis surgery, with adverse events similar to non-fractured individuals. While the study design is appropriate, multicenter trials would improve the sample size and allow for subgroup analysis based on fracture type and demographics. Full article

Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of complicated supracondylar humeral fractures (Gartland types II and III). Gartland type II and III fractures are most frequently treated with closed reduction and percutaneous Kirchner-wire pinning or open reduction with K-wire pinning, depending on the degree of displacement and the orthopedic surgeon’s preference. Most studies recommend avoiding open reduction because of prolonged hospitalization and higher rates of complications. Orthopedic surgeons have different opinions regarding the Kirschner pin placement technique. Studies suggest that only lateral pinning is safe and effective, but medial and lateral pinning is proven to give more stability; there is always a risk of iatrogenic ulnar nerve damage during surgery. Modern treatment of supracondylar humeral fracture in children should focus on minimally invasive techniques and avoid open reduction, when possible, to ensure the best outcome for the patients. This scoping review’s purpose is to gather the available information on the topic in one place and to underline the lack of clear protocols. Full article

Background: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. Methods: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Results: Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (p = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, p = 0.03). However, intraoperative blood loss (p = 0.36), Mayo Elbow Performance Score (p = 0.71), range of motion (p = 0.36), and complication rates (p = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (p = 0.17), and four cases required implant removal due to discomfort (p = 0.18) in the anterolateral group. Conclusions: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection. Full article

Phosphatidylinositol glycan class T (PIGT) is part of the glycosylphosphatidylinositol transamidase (GPI-TA) complex, crucial for various cell functions. Biallelic pathogenic variants in PIGT are associated with Multiple Congenital Anomalies-Hypotonia Seizures Syndrome 3 (MCAHS3), a rare neonatal hypotonia syndrome characterized by dysmorphic features and seizures. Diagnosing neonatal hypotonia, which has diverse congenital and acquired causes, is challenging, particularly in syndromic monogenic cases. Next-generation sequencing is essential for accurate diagnosis. This study reports a term newborn with hypotonia, dysmorphic features, seizures, and severe skeletal issues, including a humeral fracture at birth, consistent with MCAHS3. Trio whole exome sequencing (WES) analysis revealed a novel homozygous missense variant in PIGT, expanding the clinical spectrum of MCAHS3 and marking the first such case in the Thai population. The identified c.257A>G (p.His86Arg) variant manifests a severe MCAHS3 phenotype, as evidenced by reduced CD59 expression in western blot analysis, indicating impaired GPI-AP synthesis. Computational predictions suggest this mutation causes protein instability, potentially affecting GPI anchor attachment. While alkaline phosphatase (ALP), a GPI-AP crucial for skeletal mineralization, was elevated in this case, suggesting a late-stage GPI synthesis defect. The His86Arg mutation in PIGT may disrupt GPI-TA function, hindering proper protein attachment and leading to cleaved protein secretion. Further functional studies are needed to elucidate the impact of this mutation on PIGT function and MCAHS3 phenotypes. Full article

Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1–46 months) with a mean follow-up of 37 months (range: 0.5–516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension–flexion arc was 2.1° to 127.8° (range: −10–140°). The mean Bauman’s angle was 72.4° (range: 66–79°), the mean shaft–condylar angle was 43.8° (range: 25–59°), the mean humeral length was 21.9 cm (range: 15.5–25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus–19° valgus). According to Flynn’s criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate. Full article

Background and Clinical Significance: Neurological complications in extension-type-III supracondylar humeral fractures (SCHFs) in children represent 11% of cases. An extension-type-III SCHF with posterolateral displacement of the distal fragment is commonly associated with damage to the median nerve and the anterior interosseous nerve (AIN). Neurological complications are often unnoticed, and their immediate postoperative diagnosis is difficult, particularly in young children. Neurapraxia, the most common complication, usually undergoes spontaneous nerve recovery. Case Presentation: We report a case of a 7-year-old patient with postoperative median nerve palsy after an SCHF (Gartland type III) who was referred to our unit from another hospital due to a lack of spontaneous recovery. In addition, motor and sensory functions were absent. As ultrasound (US) indicated nerve kinking at the fracture site, an exploration was performed. The nerve was trapped within the fracture and the callus. It was surgically extracted, and intraoperative examination with US indicated that resecting the kinked nerve, freeing the two stumps, and attempting a primary end-to-end suture represented the best course of action. We present this case with a 5-year follow-up surgery, which showed a good clinical outcome. Conclusions: This case is noteworthy because of its diagnostic and therapeutic pathways, and it is complemented by surgical and ultrasound images that can assist other surgeons in similar circumstances. Full article

This study compares the compression force of cortical screws used in lag fashion with partially threaded cannulated screws and fully threaded headless cannulated screws as fixation methods for humeral condylar fractures in dogs. Cadavers of eleven dogs weighing an average of 10.99 ± 2.51 kg (6.1–14.4 kg) were used. The humeri were subjected to simulated fracture by performing an osteotomy at the trochlea of humerus and classified into three groups: Group 1 applied a 3.0 mm cortical screw applied in a lag fashion, Group 2 applied a 3.0 mm partially threaded cannulated screw, and Group 3 applied a 3.5 mm fully threaded headless cannulated screw. The samples were then placed in a material testing machine, and a compression force was applied vertically to the lateral condyle until failure. There were statistically significant differences in failure load between the groups (p = 0.009). The maximum failure load in Group 3 was significantly higher than in Group 2 (p = 0.014), while there were no statistically significant differences between Group 1 and Group 2) or between Group 1 and Group 3. Partially threaded cannulated screws and fully threaded headless cannulated screws can be alternatives to traditional stabilization methods, offering simpler procedures and additional advantages. Full article

This retrospective study compares the clinical outcomes of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) and intramedullary nailing (IMN) in treating isolated surgical neck fractures of the humerus. A total of 42 patients were included, with 18 treated using MIROS and 24 with IMN. The primary outcomes assessed were the complication rates, functional recovery (DASH score), pain levels (VAS), and radiological healing. The MIROS group exhibited a higher complication rate (22.2% vs. 8.8%), with K-wire migration and superficial infections being the most frequent. Patients treated with MIROS reported lower postoperative pain (VAS 45 ± 25.7) compared to the IMN group (VAS 58.1 ± 12.5). Both groups demonstrated radiological healing within three months, but one MIROS patient required reoperation due to hardware failure. No significant differences were observed in the DASH scores between the groups. Our findings suggest that IMN is a preferable treatment option for younger patients with good bone quality, while MIROS may still be beneficial for elderly patients with significant comorbidities, albeit with a higher risk of complications. Future prospective studies are recommended to confirm these findings. Full article

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications. Full article