ABSTRACT
Objective:To investigate the efficacy of the posterior axillary approach in the treatment of some scapular fractures.Methods:Retrospectively analyzed were the data of 41 patients with scapular fracture who had been treated through the posterior axillary approach at Department of Traumatology, The Second Hospital of Jilin University from April 2018 to July 2021. There were 32 males and 9 females, aged from 24 to 83 years (average, 52.4 years). Of them, 7 were complicated with multiple injuries, 16 with other fractures, and 4 with brachial plexus injury. Recorded were length of surgical incision, intraoperative blood loss, operation time, and range of shoulder motion, Disability of Arm Shoulder and Hand (DASH) score, Constant shoulder score and postoperative complications at the last follow-up.Results:In this cohort, length of incision ranged from 7 to 12 cm (average, 9.3 cm), intraoperative blood loss from 80 to 150 mL (average, 110.5 mL), exposure time of the posterior axillary approach from 5 to 10 min (average, 7.9 min), and fracture operation time from 85 to 140 min (average, 110.8 min). The 41 patients were followed up for 6 to 36 months (mean, 14.3 months) after surgery. At the last follow-up, the average ranges of shoulder motion were 177° (from 150° to 180°) in flexion, 175° (from 140° to 180°) in abduction and 47° (from 30° to 50°) in extension, the average DASH score was 36.4 points (from 34 to 46 points), and the average Constant score 96.0 points (from 84 to 100 points). There were no complications like loss of fracture reduction, loosening or breakage of plate or screw during follow-up. Incision healing was delayed in 2 patients and mild heterotopic ossification occurred in 2 patients.Conclusion:As a new surgical approach for some scapular fractures, the posterior axillary approach allows internal fixation of the fractures of the scapular glenoid, neck and body under direct vision, leading to good-looking postoperative wound and reliable curative effects.
ABSTRACT
Objective:To compare a novel kind of anatomical locking plate versus proximal humeral internal locking system (PHILOS) in the treatment of proximal humerus fractures.Methods:A retrospective study was performed in the 35 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third Hospital of Peking University from January 2020 to June 2021. They were 13 males and 22 females, aged from 24 to 83 years (average, 56.7 years). Of them, 14 were fixated by the novel anatomical locking plate and 21 by PHILOS. The 2 groups were compared in terms of gender, age, fracture type, operation time, intraoperative blood loss, hospital stay, University of California (UCLA) shoulder scores and Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction at one month after operation and at the last follow-up, and postoperative complications.Results:There was no significant difference in the preoperative general data between the novel plate group and the PHILOS group, showing comparability between them ( P>0.05). All the patients were followed up for 6 to 21 months (mean, 11.3 months). In the novel anatomical plate group, the operation time was (83.9±29.2) min, the intraoperative blood loss was (36.4±27.1) mL, the hospital stay was (2.3±1.1) d, the UCLA score and DASH score at one month after operation were (20.1±4.7) points and (55.5±19.1) points, the UCLA score and DASH score at the last follow-up were (28.5±4.6) points and (25.1±24.4) points, respectively; 2 patients developed complications after operation. In the PHILOS group, the operation time was (85.0±38.8) min, the intraoperative blood loss was (62.9±46.8) mL, the hospital stay was (2.4±0.9) d, the UCLA score and DASH score at one month after operation were (21.0±3.8) points and (49.6±23.7) points, and the UCLA score and DASH score at the last follow-up were (28.0±5.1) points and (19.1±17.3) points, respectively; 3 patients developed complications after operation. There was no significant difference in all the above items between the 2 groups (all P>0.05). Conclusion:In the treatment of proximal humerus fractures, the novel anatomical locking plate is a feasible internal fixator because it is comparable to PHILOS in fine efficacy, good fracture healing, and satisfactory functional recovery of the shoulder joint.