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Which Classification of Proximal Humerus Fractures Leads to Postoperative Avascular Necrosis of the Humeral Head?
2017 ISAKOS ABSTRACTS
significant repetitive stress and is at risk for damage to the structures of the joint. However, this damage can remain asymptomatic even under the repetitive stress incurred throughout an athlete’s career. Our current study is the first that we know to evaluate the dominant shoulders of asymptomatic, elite volleyball players. We found that MRI findings in elite overhead athletes are highly likely to include abnormalities that could be considered surgical; however, these findings are often asymptomatic. It is important to recognize that there is a high rate of asymptomatic, yet abnormal MRI findings in this patient population. Therefore, we recommend that operative management on overhead athletes only be utilized following significant non-operative treatment as patient symptoms may not correlate with MRI findings.
Category: Shoulder - Other Paper #48: Which Classification of Proximal Humerus Fractures Leads to Postoperative Avascular Necrosis of the Humeral Head? TAKESHI KAWAKAMI, MD, PHD, JAPAN TERUHISA MIHATA, MD, PHD, JAPAN AKIHIKO HASEGAWA, MD, PHD, JAPAN Towaki Hospital, Takatsuki, Oaka, JAPAN SUMMARY The purpose of this study was to determine which classification of proximal humerus fractures leads to postoperative avascular necrosis of the humeral head. The 3-part and head-split fracture in Neer classification, C2-2, C3-2, C3-3 in AO classification, and Type1B, Type3, Type4 in Yamane classification had high rate of postoperative avascular necrosis of the humeral head. ABSTRACT DATA Background: The purpose of this study was to determine which classification of proximal humerus fractures leads to postoperative avascular necrosis of the humeral head. Methods: Between January 2008 and June 2015, 76 patients with proximal humeral fractures underwent open reduction and internal fixation. There were 24 males, 52 females. Mean age was 66.9 years old (21-93 years old) and average follow-up was 17.9 months (5-42 months). Fracture types in all patients were evaluated using Neer classification, AO classification, and Yamane classification. The number of postoperative avascular necrosis was recorded in each fracture type. Results: Seven patients (9.2%) had avascular necrosis of the humeral head after surgery. In Neer classification, 3 of 3-part fracture (11%), 1 of 4-part fracture (17%), 3 of 3-part dislocated fracture (60%), and head-split fracture (100%) had postoperative avascular necrosis. In AO classification, 1 of B2-2 (17%), 1 of C1-1 (33%), 2 of C2-2 (67%), 2 of C3-2 (67%) and 1 of C3-3 (100%) suffered postoperative avascular necrosis. In Yamane classification,
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4 of Type1B (80%), 2 of Type3 (100%) and 1 of Type4 (100%) resulted in AN. Discussion: The 3-part and head-split fracture in Neer classification, C2-2, C3-2, C3-3 in AO classification, and Type1B, Type3, Type4 in Yamane classification had high rate of postoperative avascular necrosis of the humeral head. Preoperative evaluation of fracture types using some classifications is useful to predict the risk of postoperative avascular necrosis. Category: Shoulder - Other Paper #49: Coracoclavicular Stabilization Using a Suture Button Device for Neer Type IIB Lateral Clavicle Fractures CHUL-HYUN CHO, MD, PHD, KOREA, REPUBLIC OF KI-CHEOR BAE, MD, KOREA, REPUBLIC OF DU HAN KIM, MD, KOREA, REPUBLIC OF Keimyung University Dongsan Medical Center, Daegu, REPUBLIC OF KOREA
SUMMARY Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures yielded satisfactory radiological and clinical outcomes. The major advantage of this technique is that implant removal is not required. ABSTRACT DATA Background: The treatment for Neer type IIB fractures remains especially controversial. It is not easy to achieve stable fixation in Neer type IIB fractures because the lateral fragment is too small. Although various fixation techniques have been proposed to manage this fracture type, high complication rates have been reported. The purpose of this study was to evaluate the radiological and clinical outcomes of coracoclavicular (CC) stabilization using a suture button device for Neer type IIB lateral clavicle fractures. Methods: Eighteen consecutive patients with Neer type IIB fracture were treated with CC stabilization using a TightRopeTM (Arthrex, Naples, FL, USA). The mean follow-up period was 46.6 months (range, 24-75 months). Radiological outcomes were assessed using serial plain radiographs. Clinical outcomes were assessed using the visual analogue scale (VAS) pain score, University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Intraoperative and postoperative complications were also evaluated. Results: Seventeen cases (94.4%) showed complete bony union. The mean final VAS pain score, UCLA score, ASES score, SSV were 1.1, 31.3, 88.5, and 88.6%, respectively. Four complications were observed: i) intraoperative coracoid process fracture, ii) nonunion, iii) delayed union, and iv) shoulder stiffness. A case with
significant repetitive stress and is at risk for damage to the structures of the joint. However, this damage can remain asymptomatic even under the repetitive stress incurred throughout an athlete’s career. Our current study is the first that we know to evaluate the dominant shoulders of asymptomatic, elite volleyball players. We found that MRI findings in elite overhead athletes are highly likely to include abnormalities that could be considered surgical; however, these findings are often asymptomatic. It is important to recognize that there is a high rate of asymptomatic, yet abnormal MRI findings in this patient population. Therefore, we recommend that operative management on overhead athletes only be utilized following significant non-operative treatment as patient symptoms may not correlate with MRI findings.
Category: Shoulder - Other Paper #48: Which Classification of Proximal Humerus Fractures Leads to Postoperative Avascular Necrosis of the Humeral Head? TAKESHI KAWAKAMI, MD, PHD, JAPAN TERUHISA MIHATA, MD, PHD, JAPAN AKIHIKO HASEGAWA, MD, PHD, JAPAN Towaki Hospital, Takatsuki, Oaka, JAPAN SUMMARY The purpose of this study was to determine which classification of proximal humerus fractures leads to postoperative avascular necrosis of the humeral head. The 3-part and head-split fracture in Neer classification, C2-2, C3-2, C3-3 in AO classification, and Type1B, Type3, Type4 in Yamane classification had high rate of postoperative avascular necrosis of the humeral head. ABSTRACT DATA Background: The purpose of this study was to determine which classification of proximal humerus fractures leads to postoperative avascular necrosis of the humeral head. Methods: Between January 2008 and June 2015, 76 patients with proximal humeral fractures underwent open reduction and internal fixation. There were 24 males, 52 females. Mean age was 66.9 years old (21-93 years old) and average follow-up was 17.9 months (5-42 months). Fracture types in all patients were evaluated using Neer classification, AO classification, and Yamane classification. The number of postoperative avascular necrosis was recorded in each fracture type. Results: Seven patients (9.2%) had avascular necrosis of the humeral head after surgery. In Neer classification, 3 of 3-part fracture (11%), 1 of 4-part fracture (17%), 3 of 3-part dislocated fracture (60%), and head-split fracture (100%) had postoperative avascular necrosis. In AO classification, 1 of B2-2 (17%), 1 of C1-1 (33%), 2 of C2-2 (67%), 2 of C3-2 (67%) and 1 of C3-3 (100%) suffered postoperative avascular necrosis. In Yamane classification,
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4 of Type1B (80%), 2 of Type3 (100%) and 1 of Type4 (100%) resulted in AN. Discussion: The 3-part and head-split fracture in Neer classification, C2-2, C3-2, C3-3 in AO classification, and Type1B, Type3, Type4 in Yamane classification had high rate of postoperative avascular necrosis of the humeral head. Preoperative evaluation of fracture types using some classifications is useful to predict the risk of postoperative avascular necrosis. Category: Shoulder - Other Paper #49: Coracoclavicular Stabilization Using a Suture Button Device for Neer Type IIB Lateral Clavicle Fractures CHUL-HYUN CHO, MD, PHD, KOREA, REPUBLIC OF KI-CHEOR BAE, MD, KOREA, REPUBLIC OF DU HAN KIM, MD, KOREA, REPUBLIC OF Keimyung University Dongsan Medical Center, Daegu, REPUBLIC OF KOREA
SUMMARY Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures yielded satisfactory radiological and clinical outcomes. The major advantage of this technique is that implant removal is not required. ABSTRACT DATA Background: The treatment for Neer type IIB fractures remains especially controversial. It is not easy to achieve stable fixation in Neer type IIB fractures because the lateral fragment is too small. Although various fixation techniques have been proposed to manage this fracture type, high complication rates have been reported. The purpose of this study was to evaluate the radiological and clinical outcomes of coracoclavicular (CC) stabilization using a suture button device for Neer type IIB lateral clavicle fractures. Methods: Eighteen consecutive patients with Neer type IIB fracture were treated with CC stabilization using a TightRopeTM (Arthrex, Naples, FL, USA). The mean follow-up period was 46.6 months (range, 24-75 months). Radiological outcomes were assessed using serial plain radiographs. Clinical outcomes were assessed using the visual analogue scale (VAS) pain score, University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV). Intraoperative and postoperative complications were also evaluated. Results: Seventeen cases (94.4%) showed complete bony union. The mean final VAS pain score, UCLA score, ASES score, SSV were 1.1, 31.3, 88.5, and 88.6%, respectively. Four complications were observed: i) intraoperative coracoid process fracture, ii) nonunion, iii) delayed union, and iv) shoulder stiffness. A case with