ABSTRACT
BACKGROUND: Proximal humeral fractures are one of the most common types of upper limb fractures In adults. With the aging of the population, the Incidence of proximal humeral fractures has been increasing in recent years, and its treatment is still controversial. OBJECTIVE: To compare the clinical efficacy of locking plate and intramedullary nail in the treatment of proximal humeral fractures using meta-analysis. METHODS: We retrieved PubMed, the Cochrane Library, Embase, CNKI, Wanfang, and VIP database to collect studies on intramedullary nail and locking plate in the treatment of proximal humeral fractures. In accordance with the inclusion and exclusion criteria, studies were included. Data were extracted from the included studies. Continuous variables (Constant score, operation time, blood loss) and binary classification variables (total complications, postoperative infection, screw cutout and internal fixation failure, humerus head necrosis, secondary surgery, and acromial impact) were analyzed, and considered as evaluation indexes for the meta-analysis. Statistical software Stata12.0 was used to analyze the data. RESULTS AND CONCLUSION: (1) A total of 8 articles and 891 patients were included, and 9 data were analyzed. (2) The amount of blood loss (SMD=-1.82, 95%C/: -2.77—0.87, P 0.05). (3) These results confirmed that intramedullary nailing is superior to locking plate in operation time and intraoperative blood loss in the treatment of proximal humeral fractures. The results were similar in total complication rate, common complication rate and postoperative recovery of shoulder joint function between the two groups.
ABSTRACT
Introduction: The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoidprocess of scapula which prevent the superior humeral head displacement. It plays a key role in the pathoetiology of sub-acromial impingement syndrome when there are no significant bony abnormalities.Material and Methods: In the present study we have studied 120 formalin preserved upper limbs (right: 60; left:60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament. The CALwas identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the numberof bands present and shape of the ligament. Photographs were taken.Results: Different morphological subtypes of coraco-acromial ligament were observed and classified accordingto Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %), typeIII (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%.Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledgeof morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical andintraoperative decision while dealing with sub-acromial impingement syndrome.