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Objective:To evaluate anatomical locking plate combined with bone cement intramedullary support in the treatment of proximal humeral fractures in the elderly.Methods:From May 2016 to July 2018, 19 geriatric proximal humeral fractures were treated with anatomical locking plate combined with bone cement intramedullary support at Department of Orthopaedics, General Hospital of Shenyang Northern Theater. There were 8 females and 5 males, with an average age of 71 years (from 60 to 84 years). All the fractures were closed. According to the Neer classification, there were 4 two-part, 5 three-part and 4 four-part fractures. At 6, 12, 18 and 36 weeks and one year postoperatively, anteroposterior and lateral X-ray films of the scapula were taken. At the last follow-up, the Constant-Murley shoulder score and the Disabilities of the Arm, Shoulder and Hand (DASH) score for the upper limb dysfunction were recorded.Results:The 13 patients were followed up for 3 to 12 months (6 months on average). Bony union was achieved in all the 13 patients. Local necrosis and deformation of the humeral head and partial screw perforation were observed one year after operation in 2 cases, but other patients reported no such complications or loosening of internal fixation. At the last follow-up, their mean Constant-Murley score was 82.6 (from 71 to 95) and their mean ADSH score 19.2 (from 9.2 to 48.1).Conclusion:Anatomical locking plate combined with bone cement intramedullary support may lead to fine early efficacy for the treatment of proximal humeral fractures in the elderly, since it can facilitate fracture reduction, promote rigid fixation and prevent loss of reduction.
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Objective To compare the clinical efficacy of Philos plate and Multiloc intramedullary nail for 3-or 4-part proximal humeral fractures in the middle-aged and elderly patients.Methods A retrospective case control study was conducted to analyze the clinical data of 52 middle-aged and elderly patients with 3-or 4-part proximal humeral fractures admitted to Sichuan Orthopedic Hospital from January 2014 to January 2016.The patients were divided into Philos plate group (27 patients) and Multilloc intramedullary nail group (25 patients) according to different treatment methods.In the Philos plate group,there were 11 males and 16 females,aged (59.3 ± 4.5) years.Based on the Neer classification,there were 16 patients with 3-part fracture,11 patients with 4-part fracture including two patients with 4-part fracture dislocation.There were eight patients with varus fracture and 19 patients with valgus fracture.In the Multiloc intramedullary nail group,there were 10 males and 15 females,aged (62.2 ± 7.4) years.Based on the Neer classification,there were 18 patients with 3-part fracture,seven patients with 4-part fracture including one with 3-part fracture dislocation and one with 4-part fracture dislocation.There were 12 patients with varus fracture and 13 with valgus fracture.The operation time,intraoperative bleeding volume,fracture healing time,neck-shaft angle changes and complications of humeral head ischemic necrosis were compared between the two groups.At the last follow-up,the motion range of affected shoulder joint,American Shoulder and Elbow Surgeons (ASES) scale,Constant-Murley score and visual analogue score (VAS) were compared between the two groups.Results There was no significant difference in the operation time between the two groups (P ＞ 0.05).The intraoperative bleeding volumes were 170-350 ml [(260.1 ± 110.3) ml] in the Philos plate group and 70-250 ml [(172.2 ± 100.3)ml] in the Multiloc intramedullary nail group,with statistically significant difference (P ＜ 0.05).All incisions were healed by first intention,and no infection was found.The patients in the Philos plate group were followed up for 12-36 months [(17.2 ±6.5)months],and patients in the Multiloc intramedullary nail group for 12-36 months [(14.5 ± 4.7) months] (P ＞ 0.05).All fractures were healed,with the healing time for 2.5-4 months [(3.5 ± 0.5)months] in the Philos plate group and for 2-3.3 months [(3.0 ± 0.5) months] in the Multiloc intramedullary nail group.The neck-shaft angle was lost to some degree in both groups at the last follow-up compared with the first day after operation,but the differences were not statistically significant (P ＞ 0.05).The Philos plate group had a higher incidence rate of complication [22％ (6/27)] than the Multiloc intramedullary nail group [12％ (3/25)] (P ＜ 0.05).Three patients in the Philos plate group had partial ischemic necrosis of the humeral head,while none was found in the Multiloc intramedullary nail group.There were no significant differences in active shoulder joint ante-flexion and uplift,lateral intorsion and extorsion,ASES score,Constant-Murley score and VAS between the two groups (P ＞ 0.05).Conclusions For 3-or 4-part proximal humeral fractures in middle-aged and elderly patients,both Philos plate and Multiloc nail can obtain stable and reliable fixation and achieve satisfactory results of shoulder joint function.However,the Philos plate fixation has more intraoperative bleeding,longer fracture healing time,and higher incidence rate of humeral head ischemic necrosis than the intramedullary nail.
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<p><b>OBJECTIVE</b>To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation (ORIF) in treating senile NEER IIproximal humerus fractures.</p><p><b>METHODS</b>From March 2014 to March 2016, 46 elderly patients with Neer II proximal humerus fractures were retrospectively reviewed. Among them, 20 patients in MIPPO group included 9 males and 11 females with an average age of (70.4±4.4) years old; while 26 patients in ORIF group included 11 males and 15 females with an average age of (70.9±4.0) years old. The length of hospital stay, times of fluoroscopy, beginning time of function rehabilitation, healing time of fracture, Constant Murley score of the shoulder joint at 3, 6, 12 months after operation and complications were observed and compared.</p><p><b>RESULTS</b>All patients were followed up for 12 to 24 months with an average of 16.8±3.7. The healing time of fracture, beginning time of function rehabilitation in MIPPO group were(13.0±0.8) weeks, (3.0±0.9) days respectively and shorter than those in ORIF group which were (13.8±1.4) weeks and(6.8±1.3) days. The times of fluoroscopy in MIPPO group was 19.2±3.7 and more than that in ORIF group which was 12.1±3.4. At 3 and 6 months after operation, Constant Murley score in MIPPO group were 81.3±3.9, 86.6±5.4 and more than that in ORIF group which were 69.5±6.6, 80.5±6.7. There were no differences between two groups in the length of hospital stay, Constant Murley score at 12 months after operation and grading at the final follow-up. There was one fracture redisplacement in each group. And 1 case of axillary nerve injury in MIPPO group, 2 cases of delayed union in ORIF group. No incision infection, screw loosening or plate break was found.</p><p><b>CONCLUSIONS</b>MIPPO and ORIF are both effective in treating Neer II proximal humeral fractures. MIPPO technique has the advantages of faster recovery, earlier rehabilitative exercise and better shoulder function. The disadvantages are more exposure to radiationd and the possibility of axillary nerve injure.</p>
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<p><b>OBJECTIVE</b>To explore the clinical curative effect of anterolateral acromial approach in treating two-and three-part of proximal humeral fractures.</p><p><b>METHODS</b>Forty-two patients of proximal humeral fractures from January 2010 to June 2014 were analyzed retrospectively, including 23 males and 19 females with a mean age of 61.5 years old ranging from 40 to 76 years old. Among them, 22 cases were treated with anterolateral acromial approach and 20 cases were treated with deltopectoral approach. The operation time, intraoperative blood loss, postoperative hospitalization days, fracture healing time of two groups were compared. The shoulder pain after 1 week was assessed by the VAS score. The postoperative shoulder joint function was evaluated after 3 months and more than 6 months by Constant score.</p><p><b>RESULTS</b>The follow-up time was at final 14 months. There were significant differences in operation time(=0.003), intraoperative blood loss(=0.001), postoperative hospital day(=0.013), postoperative shoulder pain after 1 week(=0.026), postoperative Constant score after 3 months(=0.014) between the anterolateral acromial approach group and the deltopectoral approach group. There were no significant differences in clinical union time of bone(=0.462), postoperative constant score after more than 6 months(=0.204) between the anterolateral acromial approach group and the deltopectoral approach group. There were no breakage of the internal fixation and humeral head osteonecrosis.</p><p><b>CONCLUSIONS</b>It has some advantages with anterolateral acromial approach to treat Neer two-and three-part of proximal humeral fractures, such as short operation time, less intraoperative bleeding, lighter postoperative pain, quicker recovery of function.</p>
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Objective:To describe long-term results of locking plate used for the treatment of non-osteoporotic fresh three-and four-part proximal humeral fractures with at least 2 years follow-up.Methods:The functional outcomes and the complications of non-osteoporotic three-and four-part fresh proximal humeral fractures treated with locking plate were assessed retrospectively.The active range of motion,the Constant score,the University of California at Los Angeles (UCLA) shoulder score,the visual analogue score (VAS) were employed to evaluate the postoperative shoulder function,and the radiographic images were taken to evaluate the neck-shaft angle of the proximal humeral and postoperative implant-related complications.Results:From January 2007 to October 2014,107 consecutive fresh three-and four-part non-osteoporotic fresh proximal humeral fractures were treated with a locking plate in our department.Among them,67 patients completed at least 2 years follow-up.The average follow-up time was (43.9 ± 23.3) months (range:24-108 months).The mean Constant score was 87.1 ± 11.7 (range:51-100),the mean UCLA score was 30.5 ± 3.9 (range:18-35),the mean VAS score was 1 ±2 (range:0-7).The mean active forward flexion was 159.0° ± 19.3° (range:80°-180°),the mean external rotation was 36.8°± 19.5° (0°-80°) and the mean internal rotation was T11 level (T2-LS level).There were 11 patients who suffered from complications.Screw perforations were observed in 5 (7.5％) patients,avascular necrosis of the humeral head was observed in 9 (13.4％) patients and traumatic osteoarthritis was observed in 5 (7.5 ％) patients.Six patients showed two or more complications.There was no significant difference in outcomes when comparing the patients with three-part fractures (31 patients) with those with four-part fractures (36 patients).The rates of complications and avascular necrosis were significantly higher in the four-part fracture group than in the three-part fracture group.Conclusion:The locking plate is an effective method in treating three-and four-part non-osteoporotic fresh proximal humeral fractures.Strict surgical indication and precise surgical skill are the key points for successful treating non-osteoporotic fresh proximal humeral fractures.There is a higher rate of complications and avascular necrosis of the humeral head in the four-part fractures than in the three-part fractures.
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Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.MethodsFrom Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification.Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months.No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.
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Objective To summarize the clinical effect of open reduction and internal fixation for the proximal humeral fracture with locking proximal humerus plate (LPHP). Methods A total of 45 cases with complex humeral fractures were operated via deltoid-pectoral approach. According to the Neer classification, there were 33 cases with three-part fractures and 12 with four-part fractures. Neer nu- merical rating system was employed to evaluate postoperative function of the involved shoulder. Results Of all, 38 cases were followed up for a mean 14.7 months, which showed fracture union within 3 months in 35 cases and fracture union within 4 months in 3. According to the Neer numerical rating system, re- suh was excellent in 20 eases and satisfactory in 15, with total excellence rate of 92%. Conclusion LPHP is characterized by stable fixation, minor complication and high satisfaction, and hence is an effec- tive method for proximal humeral fractures.
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[Objective]To discuss the treatment effect of locking compression plate(LCP)for proximal humeral complicated fractures.[Method]A retrospective study was done on 21 cases of proximal humeral fractures treated with LCP from April 2005 to June 2006.There were 13 male and 8 female,with age of 26-71 year(mean 42.3 year).According to Neer classification,15 cases were three-part fractures including 5 cases with anterior dislocation and 6 cases with primary osteoporosis;6 cases were four-part fractures including 3 cases with anterior dislocation and 2 cases with posterior dislocation.Reduction and fixation were done by deltopectoral-gap approach,the operator put the locking plate on 10mm positerior to the intergroove of tuberosity,5mm away from the tip of humeral greater tuberosity.If there were bone defects in the fracture site after reduction,they were treated with allografts,locking screws and unlocking screws were drilled into proximal and distal part of the fracture.Shoulder exercise should be performed passively three days after operation.One week after operation,active shoulder exercise was done,which was gradually intensified two weeks after operation.[Result]Twenty-one cases were followed up for 10-14 months,average 12.5 months,all fractures were union in 12 month.According to Neer shoulder score,the result was excellent in 11 cases,good in 7 and fair in 3,with excellent and good rate of 85%.[Conclusion]The screw of LCP can lock the plate so that the plate can firmly fixate the proximal humeral comminution fractures and osteoporosis bone,so simultaneously reach fracture union and function exercise,but attentions should be paid to the suitable procedure of LCP to avoid a series of problem of locking plate.
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Objective To summarize the methods of operative treatment for complex proximal humeral fractures and its clinical results. Methods 40 cases with complex proximal humeral fractures underwent operation from December 1999 to February 2002. Of 40 cases, 29 were followed up with a mean of 25 months (11 to 40 months). Using Neer system, Constant-Murley rating system and questionnaire were adopted to classify the fractures and evaluated postoperative functions of the daily life and work. A deltoid-pectoral approach was used in all patients. The surgical neck fractures were fixed with the terminal threaded pin or modified Ender's nail. The tubercle fragments were sutured with non-absorbable Ethibond No.5 or "8" figure tension band wire. Results The average absolute Constant-Murley score was 81.7(54 to 96), the excellent and good rate was 65%(19/29), fair 24%(7/29), and poor 11%(3/29). The average forward elevation was 142.5?(60? to 180?). The average pain VAH score was 12(9 to 15). The humeral head avascular necrosis, detected by the follow-up X-ray film, was diagnosed if the humeral head was completely or partially absorbed or reduced. In three-part fractures, 71% cases were excellent or good results, no poor result, and 17% had humeral head necrosis; in four-part fractures, 58% cases were excellent or good results, 25% poor, and 67% were found with humeral head necrosis. The extent of the humeral head necrosis was one of main causes to the poor function for complex proximal humeral fractures. All of the fractures healed at 6 to 8 weeks postoperatively without delayed union and nonunion. Conclusion For complex proximal humeral fractures, a good clinical result can be obtained on condition of the anatomical reduction of the tubercle fragments, as well as the stable fixation of the surgical neck fracture with appropriate suture materials and proper post-operative rehabilitation. Satisfactory result is possible even while the humeral head avascular necrosis happened.