Fixation of Proximal Third Humeral Shaft Fractures in Older Patients.

Background: Humeral shaft fractures occur frequently in older patients. The more proximal end of the shaft is prone to non-union when compared with more distal fractures. We provide an overview of several key features of this significant patient group. Method: Our institutional fracture database was searched for all cases of proximal third humeral shaft fractures in patients over 60 years of age. Retrospective evaluation of patient demographics, management, length of stay and incidence of non-union was performed. Results: 75 patients (61 female) were analysed. 33 patients were 'frail' (Clinical Frailty Scores of >4). Non-union occurred in 19 of 45 non-surgically treated fractures and in 1 of 37 cases treated surgically. Mean length of stay was 5.9 days (non-operative) and 6.6 days (operative). Proximal extension into the humeral head is common. Conclusion: Non-surgical management of proximal third humeral shaft fractures is associated with an increased risk of non-union. We detail an operative technique and case example supporting early fixation of displaced proximal third humeral shaft fractures in older patients that can be utilized for both primary and delayed fixation. In view of the significant association of non-union a well-constructed prospective cohort study with outcome assessment would be of value to further characterize this emerging injury population.Level of Evidence: Level IV, retrospective case series.

Seven-year survival analysis of the Global® CAP® (Conservative Anatomic Prosthesis) shoulder resurfacing.

BACKGROUND: Shoulder resurfacings represent approximately one-third of shoulder arthroplasties and have the highest revision rates of any shoulder arthroplasty. We present a survival analysis of the Global CAP hemi-resurfacing implanted by multiple surgeons with up to 10 years of follow-up. METHODS: A life-table survival analysis of the Global CAP hemi-resurfacing was undertaken in a single site with multiple surgeons. Two survival analyses were performed; first, where failure was defined as component exchange and, second, where failure was defined as re-operation for any reason. Postoperative functional outcome was quantified using the Quick Disability Arm Hand and Shoulder Score (Quick DASH) and Oxford Shoulder Score (OSS). RESULTS: Eighty-seven Global CAPs were implanted in 75 patients. At a mean (SD) follow-up of 5.4 years (2.5 years) (range 0.9 years to 10 years), five patients had revision surgery and three patients underwent a reoperation for any reason. Survival at year 7 with component exchange as the endpoint was 80% (95% confidence interval = 93 to 65) and survival with re-operation for any reason as the end point was 62% (95% confidence interval = 82 to 50). The mean OSS and Quick DASH were 35 and 27.6, respectively. CONCLUSIONS: The Global CAP has similar survivorship in the short to medium term and produces similar clinical outcomes compared to other shoulder resurfacings.

A novel method of open reduction and internal fixation of a displaced manubrial fracture using distal clavicle locking plates.

A 52-year-old man sustained a sternal fracture after a blunt traumatic chest injury. He was in severe pain in the intensive care unit, which resulted in difficulty breathing and increased analgesic requirement, and a decision was made to stabilize his manubrial fracture. Orthopaedic and thoracic surgeons jointly performed open reduction and internal fixation of the displaced manubrial fracture using 2 distal clavicle locking plates. This resulted in improvement in patient's pain and helped with his subsequent recovery and discharge from the hospital. This case report describes a new, safe and effective method of treating this uncommon injury.

Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data.

BACKGROUND: The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR). AIM: This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England. METHOD: Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score. RESULTS AND CONCLUSION: Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p<0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p=0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p=0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.