scholarly journals Proximal Humeral Fractures: A Review of Current Concepts

2013 ◽  
Vol 7 (1) ◽  
pp. 361-365 ◽  
Author(s):  
James C. Widnall ◽  
Sujay K. Dheerendra ◽  
Joby Jacob George Malal ◽  
Mohammed Waseem
Keyword(s):  
Elderly Population ◽  
Proximal Humerus ◽  
Treatment Options ◽  
The Elderly ◽  
Open Reduction Internal Fixation ◽  
Non Union ◽  
Majority Group ◽  
Medullary Nailing ◽  
Humerus Fractures ◽  
Arthroplasty Surgery

The majority of proximal humerus fractures are sustained via low energy falls in the elderly population. These patients can attain an acceptable level of function via non-operative treatment. There is yet to be a clear consensus on treatment options suitable for those that fall outside of this majority group. Open reduction internal fixation, intra medullary nailing and arthroplasty surgery have all been used to varying effects. Good results are achievable if complications such as mal-union, non-union and avascular necrosis can be avoided. This review aims to clarify the options available to the current day trauma surgeon.

scholarly journals Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures

2020 ◽  
Author(s):  
Lukas Dankl ◽  
Werner Schmoelz ◽  
Romed Hoermann ◽  
Simon Euler
Keyword(s):  
Humeral Head ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Test Group ◽  
The Elderly ◽  
Bending Test ◽  
Control Group ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Abstract Introduction Proximal humerus fractures are common injuries of the elderly. Different treatment options, depending on fracture complexity and stability, have been recommended in the literature. Particularly for varus displaced fractures with a lack of medial support, and patients suffering from osteoporosis, structural allografts can be used to enhance the stability of the construct. An individually shaped allograft has been suggested in the literature and investigated in a clinical setting. However, biomechanical properties have yet to be evaluated. Materials and methods Twenty-four fresh-frozen humeri and 12 femoral heads were obtained, and an unstable three-part fracture of the humeral head was simulated. Fracture fixation was achieved by using a locking plate in both groups. In the test group, a mushroom-shaped allograft was tailored out of a femoral head to individually fit the void inside the humeral head. Specimens were fitted with a 3D motion analysis system and cyclically loaded with a stepwise increasing load magnitude in a varus-valgus bending test until failure or up to a maximum of 10,000 load cycles. Results The mushroom group reached a significantly higher number of load cycles (8342; SD 1,902; CI 7133–9550) compared to the control group (3475; SD 1488; CI 2530–4420; p < 0.001). Additionally, the test group showed significantly higher stiffness values concerning all observational points (p < 0.001). Conclusion This mushroom-shaped allograft in combination with a locking plate significantly increased load to failure as well as stiffness of the construct when exposed to varus-valgus bending forces. Therefore, it might be a viable option for surgical treatment of unstable and varus displaced proximal humerus fractures to superiorly prevent loss of reduction and varus collapse.

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani
Keyword(s):  
Low Back Pain ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
Treatment Method ◽  
Open Reduction Internal Fixation ◽  
Low Back ◽  
Insufficiency Fractures ◽  
Invasive Treatment ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

scholarly journals Treatment of proximal humerus fractures in the elderly

2015 ◽  
Vol 86 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Antti P Launonen ◽  
Vesa Lepola ◽  
Tapio Flinkkilä ◽  
Minna Laitinen ◽  
Mika Paavola ◽  
...  
Keyword(s):  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Rhythm-control vs rate-control in the elderly: When to do it and which drug to prefer?

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Giovanni Luca Botto ◽  
Carlo Piemontese ◽  
Giovanni Russo
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patient ◽  
Rate Control ◽  
Ischemic Cardiomyopathy ◽  
Elderly Population ◽  
Antiarrhythmic Drugs ◽  
Treatment Options ◽  
The Elderly ◽  
Rhythm Control ◽  
Abnormal Rate

Atrial fibrillation (AF) is a relevant cardiovascular condition that is more prevalent in the elderly patients aged over 65 years. AF, with abnormal rate and rhythm can cause symptoms directly or indirectly by exacerbating other frequently coexisting cardiac conditions such as valvular heart disease, hypertension, ischemic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy. Evidence suggests that aging-related cardiovascular changes predispose to the elderly to AF. Current therapeutic options such as antiarrhythmic drugs have not been extensively evaluated in the elderly population. Emerging pharmacological and non-pharmacological treatment options for the management of AF, such as dronedarone or catheter ablation, are of particular interest in the elderly. The present paper reviews the pathophysiology, diagnosis, and the management of AF in the elderly patient.

TREATMENT OF PROXIMAL HUMERUS FRACTURES AND OUTCOME – A PROSPECTIVE STUDY

2021 ◽  
pp. 84-87
Author(s):  
S. Kishore Babu ◽  
S. Rajeswara Rao ◽  
Pamu.bala Avinash
Keyword(s):  
Closed Reduction ◽  
Evaluation Method ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Method Comparison ◽  
Fracture Pattern ◽  
Proximal Humerus Fractures ◽  
Chi Square ◽  
Study Results ◽  
Humerus Fractures

BACKGROUND: Proximal humerus fractures are commonest fractures account for about 4 – 5% of the fractures.Complicated fracture pattern in proximal humerus are increasing due to increase inincidence of high velocity trauma. Because of inconsistency in fracture classication, treatment and evaluation method,comparison of these fractures are impeded. This studydetermines and compare the results of different modalities of xations in proximal humerus fractures and outcome. MATERIALS AND METHODS: This study was done from August 2018 to February 2020 in king Georgehospital,Visakhapatnam. Total 32 patients with proximal humerus fractures were operatedwith different modalities depend on fracture pattern.The results were evaluated using the Neers Shoulder Scoring System. RESULTS:The results show that most Neer's two part fracture had excellent to satisfactory results (85%). Neer's three part fracture also had 73% excellent to satisfactory results. Neer's four part fracture which went into failure. This study results were compared with other studies by using chi square test. CONCLUSION: The management modality depended on the pattern of the fracture andthequality of the bone .The patient's goals with treatment options for these displaced fractures included closed reduction and percutaneous screws xation (13% cases), closed reduction and percutaneous k- wires xation (9% cases) ,open reduction and internal xation (78 % cases).

Trends in Surgical Management and Costs for Operative Treatment of Proximal Humerus Fractures in the Elderly

Orthopedics ◽  
2017 ◽  
Vol 40 (4) ◽  
pp. e641-e647 ◽  
Author(s):  
Eddie K. Hasty ◽  
Edward W. Jernigan ◽  
Adrianne Soo ◽  
Dax T. Varkey ◽  
Ganesh V. Kamath
Keyword(s):  
Surgical Management ◽  
Operative Treatment ◽  
Proximal Humerus ◽  
The Elderly ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals Primary Versus Salvage Reverse Total Shoulder Arthroplasty for Displaced Proximal Humerus Fractures in the Elderly: A Systematic Review and Meta-analysis

2020 ◽  
Vol 4 ◽  
pp. 247154922094973
Author(s):  
Patrick A Nelson ◽  
Changyow C Kwan ◽  
Vehniah K Tjong ◽  
Michael A Terry ◽  
Ujash Sheth
Keyword(s):  
Range Of Motion ◽  
Patient Reported Outcomes ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
The Elderly ◽  
Salvage Procedure ◽  
Proximal Humerus Fractures ◽  
Patient Reported ◽  
Humerus Fractures ◽  
Reverse Total Shoulder

Background There is currently no established consensus on best treatment for complex proximal humerus fractures (PHFs) in the elderly. Reverse total shoulder arthroplasty (RTSA) is a viable option in this population but many times is used as a salvage procedure. Methods A systematic review of studies comparing RTSA as a primary treatment for PHF versus as a salvage procedure following failed open reduction internal fixation (ORIF), humeral intramedullary nailing, hemiarthroplasty (HA) or non-operative treatment was conducted using PRISMA guidelines. Pooled outcomes and sub-group analyses assessing range of motion, patient reported outcomes and complications were examined using RevMan. Results Five articles were included in final analysis with 104 patients in the primary RTSA group and 147 in the salvage RTSA group compromising 251 total patients. Primary RTSA had a statistically significant advantage in range of motion (forward flexion and external rotation), patient reported outcomes, and complications compared to salvage RTSA. Conclusions Based on the best available evidence, primary RTSA may result in slightly better patient reported outcomes, range of motion and a lower rate of complication when compared to salvage RTSA. Further high-quality prospective studies are needed to confirm the findings of the current review.

Psychopharmacological Agents, Side Effects, and Black Box Warnings

2017 ◽  
Author(s):  
Manish A. Fozdar ◽  
Jacob C. Holzer
Keyword(s):  
Side Effects ◽  
Elderly Population ◽  
Treatment Options ◽  
Management Strategies ◽  
The Elderly ◽  
Mood Stabilizers ◽  
Pharmacological Management ◽  
Risk Management Strategies ◽  
Black Box Warnings ◽  
Sedative Hypnotics

From a medical-legal viewpoint, psychopharmacological management in the elderly population requires a multifaceted, comprehensive approach, involving a detailed clinical diagnostic assessment, an awareness of a patient’s current medical status, risk factors, and an understanding of the risks and benefits of various treatment options. Several risk management strategies can be employed as part of the treatment process, which are reviewed in this chapter. Special attention is needed in the pharmacological management of the elderly population with respect to efficacy and risk as well as polypharmacy. It is important that clinicians have a broad understanding of the different medication classes, including antidepressants, antipsychotics, mood stabilizers, cognitive-enhancing medications, benzodiazepines, sedative-hypnotics, and stimulants; specific agents; indications; kinetics; and side effects in both the clinical management of elderly patients and in medical-legal consultation.

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