Simple bone cysts (SBCs) are the most common osteolytic lesions in children, often leading to pathological fractures of non-weight-bearing bones. These benign tumors primarily arise in the proximal humerus, femur, or calcaneus. The cystic cavity is filled with serous or serosanguineous fluid and lined by a thin fibrovascular connective tissue membrane. The etiological factors include disturbances in bone growth, local venous obstruction, synovial origin disorders, and genetic predispositions. SBCs are most frequently observed in individuals from birth to 20 years of age. The report presented a case of a 12-year-old male patient who was admitted to the hospital with a history of a mass on his left upper arm. The mass had an acute onset and gradually progressed to its current size over three to four weeks, after which it became nonprogressive. The patient had been healthy until the age of four, after which he experienced frequent fractures of the left arm following trivial trauma. Multiple traumas led to the gradual formation of a diffuse mass over the upper part of the humerus. Radiological imaging modalities, such as X-ray and magnetic resonance imaging, are crucial in diagnosing bone cysts and evaluating their clinical conditions. Treatment can involve the injection of bone marrow or steroids into the cyst to facilitate the healing process.

Chondrosarcoma is the third most common primary malignant bone tumor. The proximal humerus is the most common site. Since it is resistant to chemotherapy and radiotherapy, the mainstay of treatment is surgery. Due to the extensive involvement of long bones, it requires reconstruction with either a prosthetic implant or bone graft. We present a case of a 43-year-old female who presented with chondrosarcoma involving 15 cm of humerus. The patient was managed with the resection of 15 cm of humerus and reconstruction with the same resected bone after autoclaving. It was secured with long fixation resulting in arthrodesis of the glenohumeral joint. The patient was followed for one year and there was evidence of callus formation by ultrasound and computed tomography (CT) scan.

UNASSIGNED: The role of biceps tenodesis (BT) during open reduction internal fixation (ORIF) of proximal humerus fractures (PHFs) remains unclear. A subset of patients undergoing ORIF have persistent pain with unclear etiology. The purpose of our study was to compare outcomes of ORIF of PHFs with and without concomitant BT. We hypothesize patients undergoing BT at the time of ORIF will have improved patient-reported outcome scores with fewer secondary procedures related to treatment of the biceps.
UNASSIGNED: In this retrospective cohort study, all patients undergoing ORIF for a PHF at a single level one trauma center from January 2019 to June 2022 were reviewed. Patients under the age of 18 were excluded. Primary outcomes were patient-reported outcomes measurement information system physical function, depression, and pain interference scores at 5 time points up to final follow-up. Secondary outcomes included total operative time, complications, subsequent procedures, steroid injections, and range of motion. Chi-square tests were performed for categorical values and paired t-tests for continuous variables.
UNASSIGNED: 71 patients met inclusion criteria: 41 undergoing ORIF without BT and 30 undergoing ORIF with BT. Average follow-up was 11 months. There were no statistically significant differences in patient demographics between groups. There were no differences in patient-reported outcomes measurement information system scores at any time point postoperatively. At final follow-up patients in the ORIF with BT group had higher forward flexion than those who did not undergo BT (142 vs. 123 degrees, respectively, P < .02). There were no differences in surgical time, revision rates, postsurgical complications, or postoperative injections between groups.
UNASSIGNED: BT performed during ORIF of PHFs did not result in significantly different functional or patient-reported outcomes between groups, except for greater forward flexion at final follow-up. Although BT was done more commonly in severe PHFs, patients in both groups had similar rates of subsequent biceps-related procedures and revision surgery.

BACKGROUND: The majority of all proximal humeral fractures (PHFs) are treated non-surgically. Due to the risk of early secondary fracture displacement patients with non-surgically treated PHFs routinely undergo serial clinical and radiological evaluations. However, the value of these routine follow-up visits is unclear. This study aimed to examine the rate of early conversion to surgery in non-surgically treated PHFs. Moreover, the associations between patient and fracture characteristics and the risk of conversion to surgery were explored in order to assess the need for routine follow-ups.
METHODS: Data on all patients aged ≥18 years with a non-surgically treated PHF registered between 2013 and 2021 were extracted from the Swedish Fracture Register. Early change of treatment from non-surgical to surgical is an optional treatment modality in the SFR. The rate of early conversion to surgery within 60 days from injury was analyzed in relation to age and sex of the patient, energy level at injury and fracture morphology according to the AO/OTA classification.
RESULTS: A total of 31,761 primarily non-surgically treated PHFs (mean age 70 years: 76 % female) were included in the study. The overall rate of early conversion to surgery was 3.7 %. Younger age and increasing fracture severity were associated with a higher conversion rate to surgery. Patients ≥80 years and those with the three most common fracture types (A1, A2, and B1) had <2 % early conversion to surgery. In contrast, patients with C-type fractures, unstable/displaced fractures (A3, B2, and C2), or fracture dislocations (A1.3, B3, and C3) had a substantially higher risk (5.0-20 %) of early conversion.
CONCLUSIONS: The overall risk of early conversion to surgery in non-surgically treated PHFs is low and can be further predicted based on patient age and fracture morphology. These results could have implications regarding which patients are in need of routine follow-ups.
METHODS: Level II; Retrospective design; Prognosis study.

OBJECTIVE: Managing proximal humerus pathologic fractures requires strategic planning to ensure optimal patient outcomes. Traditionally, fixation of the humerus using long devices has been considered the standard of care, but emerging evidence has challenged this approach. This study aimed to compare long plates (LPs) and intermediate-length plates (IPs) in this clinical context.
METHODS: Forty-four patients with proximal humerus metastatic bone disease were retrospectively studied from 2013 to 2019, with 11 (25%) receiving long plates (LPs) and 33 (75%) intermediate-length plates (IPs). Outcomes included tumor progression, reoperation rates, postoperative anemia, blood loss, operation time, and hospitalization duration. Tumor progression was classified into three categories, with Type III progression (new metastatic lesions in the distal humerus) theoretically benefiting most from whole bone stabilization.
RESULTS: Tumor progression occurred in three patients (7%), all of them was in IPs. No revision surgery was needed to address these tumor progressions, including one type III progression which occurred 34 months postoperatively after IP surgery. IP were associated with a reduced operation time compared with LP (median, 1.5 h [IQR, 1.2-1.9] vs. 2.4 [IQR, 1.7-2.5]; p = 0.004). No differences were found for the other perioperative outcomes.
CONCLUSIONS: Our findings reveal a low incidence of tumor progression and low reoperation rates in both groups. The shortened operative time associated with IP use suggests its particular suitability for patients with limited life expectancy. Further research is needed to elucidate the ideal prosthesis length that best balances the risks and benefits when addressing proximal humerus metastatic disease.

Giant cell tumors (GCTs) of the bone are uncommon neoplasms that predominantly affect the metaphysis of long bones, with proximal humerus involvement being less frequent. We present the case of a 58-year-old male who presented with a two-month history of progressive right shoulder pain and difficulty in raising his arm. Clinical examination revealed a palpable swelling on the lateral aspect of the right arm. Radiological investigations, including X-ray and magnetic resonance imaging (MRI), confirmed the presence of a primary osseous neoplasm involving the proximal humerus, suggestive of a GCT. The patient underwent surgical excision of the tumor with bone grafting and bone cementing of the proximal humerus. Post-operative care included prescribed medications and physiotherapy. This case highlights the successful management of GCTs of the proximal humerus through a multidisciplinary approach, emphasizing the importance of meticulous surgical technique, appropriate reconstruction, and comprehensive post-operative care for optimal patient outcomes.

Tuberculosis can present in various atypical forms. The clinical manifestations could involve sites like bones. Tuberculosis of the scapula, humerus, and posterolateral thoracic wall is extremely rare, and diagnosis is challenging due to similarities with conditions like tumors. A young boy presented with swelling of the right shoulder joint for three months. The diagnosis was challenging due to similarities with Ewing\'s sarcoma on the initial radiometric workup. A clinical assessment and diagnostic workup with biopsy, a cartridge-based nucleic acid amplification test, and an advanced radiometric investigation resulted in a final diagnosis. He was started on antituberculous drugs for 12 months.

OBJECTIVE: To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service.
METHODS: From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16 years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores.
RESULTS: Mean age was 11.2 years (8-15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0-1.7), and Constant score was 9 (3-24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar.
CONCLUSIONS: Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent.

UNASSIGNED: Humeral fractures (HF) are common orthopedic pathologies. Reviewing the content and quality of influential literature over time is important to advance scientific research regarding a specific topic. This study aims to explore and appraise the fifty most cited HF studies that had been published in orthopedic literature.
UNASSIGNED: The Web of Science database was used to conduct a systematic search for articles pertaining to HF. Articles were sorted out in descending order of citations and were included based on their relevance to HF. Data and metrics of the included studies were recorded. The methodological quality of the studies was assessed using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies criteria. Statistical analysis was conducted to explore any significant relationships between the date of publication and other relevant variables.
UNASSIGNED: Included articles (N = 50) were published between 1959 and 2015, with a total of 14,864 accumulated citations. Europe and North America contributed to all but one of the included studies. The Journal of Bone and Joint Surgery contributed to the highest number of included articles with 27 articles (54%). The proximal humerus was the most commonly explored HF location in our study (72%). The average MCMS and Methodological Index for Non-randomized Studies scores were reported to be 64.6 and 10.4, respectively, and the majority of articles (52%) were considered level four case series. Year of publication was found to have a positive correlation with increasing level of evidence(r = -0.301, P = .044), citation density (r = 0.734, P < .001), and MCMS score (r = 0.41, P = .01).
UNASSIGNED: The level of evidence, MCMS scores, and citation density of influential HF literature has been increasing with time, reflecting the increasing effort and work being put in that field. While the findings seem encouraging, additional high-quality research is needed to help achieve better treatment strategies and outcomes.

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