Surgical Treatment in Maresca Type A2 Bifocal Humeral Fractures
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Published:
Aug 17, 2023
Keywords:
Bifocal fractures, humerus fractures, surgical treatment
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Abstract
Bifocal humeral fractures are infrequent injuries, and fractures involving the proximal and diaphyseal humerus are even rarer. We present four patients with bifocal humeral fractures of the Maresca type A2 classification. We detail the surgical plan, technical pearls, and functional outcomes.
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How to Cite
Viollaz, G. M., Tedeschi, A., Calo, L., Muratore, Álvaro J., Durán, R., Teruya, G., & Gómez, D. (2023). Surgical Treatment in Maresca Type A2 Bifocal Humeral Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 409-418. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1580
Section
Clinical Research
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References
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3. Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur Vol 2016;41(4):365-6.
https://doi.org/10.1177/1753193416641590
4. Meinberg E, Agel J, Roberts C, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium 2018.
J Orthop Trauma 2018;32(1):S1-S170. https://doi.org/10.1097/bot.0000000000001063
5. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal
humerus. J Orthop Trauma 2008; 22(2):132-7. https://doi.org/10.1097/BOT.0b013e3181589f8c
6. Eastaugh-Waring SJ, Joslin CC, Hardy JRW, Cunningham JL. Quantification of fracture healing from radiographs
using the maximum callus index. Clin Orthop Relat Res 2009;(467):1986-91. https://doi.org/10.1007/s11999-009-0775-0
7. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res1987;(214):160-4. PMID: 3791738
8. Boileau P, Alami G, Rumian A, Schwartz DG, Trojani C, Seidl AJ. The doubled-suture nice knot. Orthopedics
2017;40(2):e382-e386. https://doi.org/10.3928/01477447-20161202-05
9. Mauch J, Renner N, Rikli D. Intramedullary nailing of humeral shaft fractures— Initial experiences with an
unreamed humerus nail. Swiss Surg 2000;6(6):299-303. https://doi.org/10.1024/1023-9332.6.6.299
10. Matsunaga FT, Tamaoki MJ, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally invasive osteosynthesis
with a bridge plate versus a functional brace for humeral shaft fractures: a randomized controlled trial. J Bone Joint Surg Am 2017;99(7):583-92. https://doi.org/10.2106/JBJS.16.00628
11. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic
compression plate for the management of diaphyseal fractures of the humerus: a randomised controlled study. Int Orthop 2007;31(3):391-5. https://doi.org/10.1007/s00264-006-0200-1
12. Liu GD, Zhang QG, Ou S, Zhou LS, Fei J, Chen HW, et al. Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures. Int J Surg 2013;11(9):864-8. https://doi.org/10.1016/j.ijsu.2013.08.002
13. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation:
intramedullary nails versus plates. J Orthop Trauma 2000;14(3):162-6. https://doi.org/10.1097/00005131-200003000-00002
14. McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of
the humerus by dynamic compression plate or intramedullary nail: a prospective randomized trial. J Bone Joint Surg Br 2000;82(3):336-9. https://doi.org/10.1302/0301-620x.82b3.9675
15. Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of
humeral shaft fractures a metaanalysis. Acta Orthop 2006;77(2):279-84. https://doi.org/10.1080/17453670610046037
16. O’Donnell T, McKenna JV, Kenny P, Keogh P, O’Flanagan SJ. Concomitant injuries to the ipsilateral shoulder in
patients with a fracture of the diaphysis of the humerus. J Bone Joint Surg Br 2008;90(1):5-61. https://doi.org/10.1302/0301-620x.90b1.19215
17. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are
results reproducible. Int Orthop 2010;34(8):1297-305. https://doi.org/10.1007/s00264-009-0893-z
18. Levy B, Herrera D, Templeman D, Cole P. Segmental proximal humerus fractures: A case report of submuscular plating. J Trauma 2008;65(6):1554-7. https://doi.org/10.1097/01.ta.0000215382.66954.54
19. Touloupakis G, Di Giorgi L, Bibiano L, Elena Biancardi E, Ghirardelli S, Dell’Orfano M, et al. Exploring the
difficulties to improve minimally invasive application with long PHILOS plate in multifocal metadiaphyseal fractures of the proximal humerus: analysis of intraoperative procedure and clinical outcomes. Acta Biomed
2018;89(4):532-40. https://doi.org/10.23750/abm.v89i4.6212
20. Garnavos C, Lasanianos N. Intramedullary nailing of combined/extended fractures of the humeral head and shaft. J Orthop Trauma 2010;24(4):199-206. https://doi.org/10.1097/BOT.0b013e3181b2b74d
2. Broadbent MR, Quaba O, Hadjucka C, McQueen MM. The epidemiology of multifocal upper limb fractures. Scand J Surg 2003; 92(3):220-3. https://doi.org/10.1177/145749690309200310
3. Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur Vol 2016;41(4):365-6.
https://doi.org/10.1177/1753193416641590
4. Meinberg E, Agel J, Roberts C, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium 2018.
J Orthop Trauma 2018;32(1):S1-S170. https://doi.org/10.1097/bot.0000000000001063
5. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal
humerus. J Orthop Trauma 2008; 22(2):132-7. https://doi.org/10.1097/BOT.0b013e3181589f8c
6. Eastaugh-Waring SJ, Joslin CC, Hardy JRW, Cunningham JL. Quantification of fracture healing from radiographs
using the maximum callus index. Clin Orthop Relat Res 2009;(467):1986-91. https://doi.org/10.1007/s11999-009-0775-0
7. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res1987;(214):160-4. PMID: 3791738
8. Boileau P, Alami G, Rumian A, Schwartz DG, Trojani C, Seidl AJ. The doubled-suture nice knot. Orthopedics
2017;40(2):e382-e386. https://doi.org/10.3928/01477447-20161202-05
9. Mauch J, Renner N, Rikli D. Intramedullary nailing of humeral shaft fractures— Initial experiences with an
unreamed humerus nail. Swiss Surg 2000;6(6):299-303. https://doi.org/10.1024/1023-9332.6.6.299
10. Matsunaga FT, Tamaoki MJ, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally invasive osteosynthesis
with a bridge plate versus a functional brace for humeral shaft fractures: a randomized controlled trial. J Bone Joint Surg Am 2017;99(7):583-92. https://doi.org/10.2106/JBJS.16.00628
11. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic
compression plate for the management of diaphyseal fractures of the humerus: a randomised controlled study. Int Orthop 2007;31(3):391-5. https://doi.org/10.1007/s00264-006-0200-1
12. Liu GD, Zhang QG, Ou S, Zhou LS, Fei J, Chen HW, et al. Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures. Int J Surg 2013;11(9):864-8. https://doi.org/10.1016/j.ijsu.2013.08.002
13. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation:
intramedullary nails versus plates. J Orthop Trauma 2000;14(3):162-6. https://doi.org/10.1097/00005131-200003000-00002
14. McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of
the humerus by dynamic compression plate or intramedullary nail: a prospective randomized trial. J Bone Joint Surg Br 2000;82(3):336-9. https://doi.org/10.1302/0301-620x.82b3.9675
15. Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of
humeral shaft fractures a metaanalysis. Acta Orthop 2006;77(2):279-84. https://doi.org/10.1080/17453670610046037
16. O’Donnell T, McKenna JV, Kenny P, Keogh P, O’Flanagan SJ. Concomitant injuries to the ipsilateral shoulder in
patients with a fracture of the diaphysis of the humerus. J Bone Joint Surg Br 2008;90(1):5-61. https://doi.org/10.1302/0301-620x.90b1.19215
17. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are
results reproducible. Int Orthop 2010;34(8):1297-305. https://doi.org/10.1007/s00264-009-0893-z
18. Levy B, Herrera D, Templeman D, Cole P. Segmental proximal humerus fractures: A case report of submuscular plating. J Trauma 2008;65(6):1554-7. https://doi.org/10.1097/01.ta.0000215382.66954.54
19. Touloupakis G, Di Giorgi L, Bibiano L, Elena Biancardi E, Ghirardelli S, Dell’Orfano M, et al. Exploring the
difficulties to improve minimally invasive application with long PHILOS plate in multifocal metadiaphyseal fractures of the proximal humerus: analysis of intraoperative procedure and clinical outcomes. Acta Biomed
2018;89(4):532-40. https://doi.org/10.23750/abm.v89i4.6212
20. Garnavos C, Lasanianos N. Intramedullary nailing of combined/extended fractures of the humeral head and shaft. J Orthop Trauma 2010;24(4):199-206. https://doi.org/10.1097/BOT.0b013e3181b2b74d