The effect of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing / 中华创伤骨科杂志

Objective:To investigate the effect of the use of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing.Methods:A retrospective study was conducted to analyze the data of 36 patients with Near type Ⅲ fracture of the proximal humerus who had received Multiloc intramedullary nailing at Department of Upper Limbs, Sichuan Orthopedic Hospital from January 2016 to December 2021. There were 6 males and 30 females with an age of (63.9±5.3) years. They were divided into 2 groups according to whether medial calcar screws had been used or not. There were 17 cases in the group without medial calcar screws and 19 cases in the group with medial calcar screws. The 2 groups were compared in terms of flexion and lifting, external rotation, internal rotation and back touch, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score for shoulder function (Constant score), neck shaft angle, and incidence of complications at the last follow-up.Results:There were no statistically significant significances in the preoperative general data between the 2 groups, indicating comparability between the groups ( P>0.05). The 36 patients were followed up for 13.5(12.0,19.8) months after surgery. The flexion and lifting, external rotation, internal rotation and back touch, VAS, ASES score, Constant score, neck shaft angle at the last follow-up in the group without medial calcar screws were, respectively, 134.1°±8.4°, 32.1°±5.3°, 14.0 (13.0, 15.5) , 0.0 (0.0, 1.0), 78.2±5.2, 78.0±5.8, and 137.6°±8.1°, insignificantly different from those in the group with medial calcar screws [134.7°±6.1°, 35.0(30.0, 35.0)°, 14.0(13.0, 15.0), 1.0 (0.0, 1.0), 78.2±5.4, 76.7±4.5, and 136.9°±6.4°] ( P>0.05). Postoperative complications occurred in 6 patients in each group, showing no statistically significant difference between the 2 groups ( P=1.000). Conclusion:The use of medial calcar screws has no significant impact on the postoperative shoulder function and incidence of complications in the treatment of Neer type Ⅲ fractures of the proximal humerus with Multiloc intramedullary nailing.

Risk factors for failure in closed reduction of flexed supracondylar humerus fractures in children / 中华创伤骨科杂志

Objective:To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children.Methods:The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins type Ⅲ from January 2013 to December 2021 at Department of Orthopaedics, Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital. They were divided into a reduction failure group (35 cases) and a reduction success group (136 cases). Factors such as fracture height, age, body mass index, ulnar-radial offset direction, obvious axial rotation of the distal fracture fragment, combined ulnar nerve injury, and time from injury to operation were listed as risk factors. The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results:The average age of 171 children was (7.8±2.6) years. There were 151 cases of radial deviation and 20 cases of ulnar deviation, 120 high type fractures and 51 low type fractures, and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment. The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age, obvious rotation of the distal fracture fragment, and ulnar nerve injury ( P<0.05), but no significant differences in fracture height, body mass index, ulnar-radial offset direction, or time from injury to operation ( P>0.05). Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment ( OR=3.287, 95% CI: 1.136 to 9.513, P=0.028) and combined ulnar nerve injury ( OR=6.439, 95% CI: 2.262 to 18.327, P=0.001) were risk factors for failure in closed reduction. Conclusion:As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children, they should arouse more attention in the treatment of such fractures.

Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#Unsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores.@*METHODS@#We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed.@*RESULTS@#Of 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 - 79 years) and mean follow-up was 58.7 months (range 18 - 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000).@*CONCLUSION@#Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.

An unusual case of symmetric quadruple limb fractures / 中华创伤杂志(英文版)

A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries. On radiological evaluation, the patient had symmetrical quadruple limb involvement with bilateral humerus shaft, bilateral olecranon, bilateral femur shaft, and bilateral patella fractures. The patient was actively managed using damage control orthopaedics, and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment. Symmetrical quadruple limb fractures are very rare, which could be associated with higher mortality. A meticulous clinical evaluation, periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.

Effects of preoperative nutritional status on postoperative functional prognosis in elderly patients with proximal humerus fracture / 中华创伤骨科杂志

Objective:To investigate the effects of preoperative nutritional status on postoperative functional prognosis in elderly patients with proximal humerus fracture.Methods:From January 2020 to December 2020, 103 elderly patients (≥65 years old) were treated for proximal humerus fractures by open reduction and internal fixation at Department of Traumatology, Honghui Hospital Affiliated to Xi'an Jiaotong University. Upon admission, according to the Geriatric Nutrition Risk Index (GNRI), they were assigned into a normal nutrition group (55 cases, with GNRI≥92) and a malnutrition group (48 cases, with GNRI<92). The baseline data, preoperative hemoglobin level, time from injury to operation, intraoperative blood transfusion, postoperative complications, 1-year mortality, and Neer shoulder functional scores at 3 months, 6 months and the last follow-up were compared between the 2 groups.Results:The 2 groups were comparable because there were no significant differences in gender, injury side, Neer fracture classification, injury cause, or American Society of Anesthesiologists (ASA) grading ( P>0.05). The age of the malnutrition group was significant older than that of the normal nutrition group ( P<0.05). All patients were followed up for 9 to 16 months (mean, 13.6 months) after surgery. In the normal nutrition group and the malnutrition group, respectively, the preoperative hemoglobin level was (10.24±0.68) g/dL and (8.94±0.89) g/dL, the time from injury to operation (3.9±1.3) d and (5.8±1.2) d, the rate of intraoperative blood transfusion 14.5%(8/55) and 60.4%(29/48), the rate of postoperative complications 20.0%(11/55) and 39.6%(19/48), the 1-year mortality 1.8%(1/55)、4.2%(2/48), and the Neer shoulder function score (46.7±8.8) points and (43.2±5.6) points at 3 months after operation, (67.6±6.2) points and (76.3±5.5) points at 6 months after operation, and (80.4±5.0) points and (76.3±5.5) points at the last follow-up. Comparisons of all the above items showed significant differences between the 2 groups (all P<0.05). Conclusions:Preoperative malnutrition in elderly patients with proximal humerus fracture has adverse effects on preoperative waiting time, intraoperative blood transfusion, complications and postoperative shoulder function. Therefore, perioperatively, attention should be paid to the nutritional status of elderly patients to reduce their stress responses to fracture, surgery and anesthesia, and to improve their postoperative function and quality of life.

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.@*METHODS@#Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.@*RESULTS@#Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).@*CONCLUSION@#BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

Effect of the fracture line direction in the sagittal profile on the Gartland type Ⅲ supracondylar humerus fractures in children / 中华实用儿科临床杂志

Objective:To compare the effects of the fracture line direction in the sagittal profile on the Gartland type Ⅲ supracondylar humerus fractures in children.Methods:A total of 153 cases of Gartland type Ⅲ supracondylar humerus fractures treated in the Department of Pediatric Orthopedics, Qilu Hospital of Shandong University (Qingdao) from January 2017 to April 2019 were retrospectively analyzed.They were categorized into the traditional oblique type (the fracture line went downward in the front and upward in the back), transverse type (the fracture line went horizontally) and reverse oblique type (the fracture line went upward in the front and downward in the back). Gender, age, injury side, cause of injury, ecchymosis before elbow, preoperative neurological symptoms, operation time, incision ratio, and Flynn scores of the elbow joint at the last follow-up were compared among the 3 groups.Results:Patients were followed up for (8.65±2.47) months (6-15 months). There were 60, 64 and 29 patients in the traditional oblique type, transverse type and reserve oblique type groups, respectively.There were no differences in the gender, injury side, and injury causes among the 3 groups (all P>0.05). The age of the traditional oblique type, transverse type and reverse oblique type group were (4.76±2.51) years, (4.71±2.09) years and (6.32±1.98) years, respectively, which was significant different among the 3 groups ( F=5.826, P<0.05). There were 10, 7 and 11 cases of preoperative elbow ecchymosis occurred in children of the traditional oblique type, transverse type and reverse oblique type groups, respectively, which was significant different ( χ2=9.902, P<0.05). No significant differences were found in preoperative neurological symptoms of the 3 groups ( P>0.05). The operative time for the traditional oblique type, transverse type and reverse oblique type group were (43.28±24.25) min, (40.95±27.41) min and (58.66±34.08) min, which was significant different ( F=4.337, P<0.05). The traditional oblique type and transverse type groups had 1 failure case of closed reduction, respectively, and the incision was performed during the operation.There were 4 cases in the reverse oblique type group who underwent the open reduction.The reduction rate was significantly different among 3 groups ( χ2=6.883, P<0.05). There was no significant difference in the excellent to good rate of traditional oblique type (96.67%, 58/60 cases), transverse type(95.31%, 61/64 cases)and reserve oblique type (93.10%, 27/29 cases) among 3 groups ( P>0.05). Conclusions:The reverse oblique Gartland type Ⅲ supracondylar humerus fractures are relatively rare in clinical practice, which involves more severe soft tissue damages and more obvious antecubital ecchymosis.The conventional reduction methods seem to be ineffectual for the reverse oblique supracondylar humerus fractures.

A novel cement-reinforced screw combined with locking plate fixation versus humeral head arthroplasty in the treatment of osteoporotic fractures of the proximal humerus / 中国组织工程研究

BACKGROUND: To solve the complications such as screw cut-out, loosening, and insufficient holding force that may occur during internal fixation of osteoporotic fractures, a new cement-reinforced screw combined with PHILOS plate is currently used to treat osteoporotic fracture of the proximal humerus. However, there are few reports on the clinical efficacy of this technique in the treatment of osteoporotic fractures of the proximal humerus in China. OBJECTIVE: To compare the clinical efficacy of a novel cement-reinforced screw combined with locking plate fixation and artificial humeral head replacement in the treatment of osteoporotic fractures of the proximal humerus. METHODS: Twenty-two patients with osteoporotic fractures of the proximal humerus admitted to at Guizhou Provincial People’s Hospital from February 2017 to March 2019 were enrolled, including 8 males and 14 females, aged 68-88 years. Ten patients underwent open reduction using new cement-reinforced screws combined with locking plate internal fixation (internal fixation group), and 12 patients underwent humeral head arthroplasty (humeral head arthroplasty group). The operation time, intraoperative blood loss, and intraoperative and postoperative complications were compared. The Visual Analogue Scale and Constant scores of the shoulder joint were detected at 6 months after surgery. All patients received a postoperative anti-osteoporosis treatment. The study was approved by the Ethics Committee of Guizhou Provincial People’s Hospital, approval No. 2017(02). RESULTS AND CONCLUSION: (1) Twenty-two patients were followed up for 6-15 months, an average of (9.0±1.6) months. (2) No toxicity reaction of bone cement or embolism occurred in both groups. One case of postoperative shoulder stiffness occurred in the internal fixation group. There were no complications in both groups, such as incision infection, heterotopic ossification, delayed healing, and screw cut-out. (3) The operation time and intraoperative blood loss in the internal fixation group were significantly less than those in the humeral head arthroplasty group (P 0.05). (5) In summary, the novel cement-reinforced screw technique combined with locking plate internal fixation has similar clinical efficacy with humeral head arthroplasty. Therefore, this new technique is an alternative internal fixation method for some patients scheduled for shoulder joint arthroplasty.

Treatment progress on proximal humerus fracture with proximal humerus cage / 中国骨伤

Proximal humerus fracture is one of the common shoulder fractures. With the increase in incidence, the proportion of surgical intervention is increasing. This paper explores the traditional and new treatment methods for proximal humerus fracture. Locking plate technology is the most commonly used method in the clinic, but its complication rate of intra-articular screw penetration and reoperation is too high.Fibular strut allografts can provide adequate support, but it is a significant trauma surgery and has a high incidence of potential disruption to necessary vascular.Arthroplasty is one of the treatments for complex proximal humerus fractures, but it has a long learning curve and high cost.In recent years, the proximal humerus cage's intervention model has emerged, which has the inherent advantagesof a three dimensional structure, which can provide adequate load bearing support for the humeral head and provide flexible screw placement Angle. The cage offers a new technical option to reduce postoperative complications and improve patients' rehabilitation safety. A comprehensive grasp of the treatments of proximal humerus fracture and rational choice of intervention measures will benefit patients.

Clasificación de Neer. Variabilidad interobservador / Interobserver Variability Of Neer Classification

Introducción Hacer objetiva la variabilidad interobservador al evaluar una fractura de húmero proximal utilizando la clasificación de Neer y establecer su utilidad diagnóstica y terapéutica. Materiales y Métodos Formulario digital con 20 casos elegidos al azar de fracturas de húmero proximal, de un mismo hospital entre 2010 y 2014. Cada caso incluyó: edad, sexo, lateralidad y dos proyecciones radiográficas. Evaluado de forma anónima por Traumatólogos, con y sin práctica habitual en cirugía del hombro, de hospitales nacionales e internacionales, indicando estadío de Neer y opción terapéutica adecuada. Se estableció la variabilidad interobservador entre grupos y comparando a todos por igual, calculando el índice de Kappa de Fleiss e interpretándolo según los criterios de Landis y Koch. Resultados 40 respuestas de Traumatólogos, 15 con práctica habitual de cirugía de hombro y 25 no. El índice Kappa de Fleiss medio fue 0,173 en el grupo de Traumatólogos con práctica habitual en cirugía de hombro. Siendo 0,176 en el grupo sin práctica habitual. Al evaluarlos conjuntamente, 0,184. Existe gran variabilidad interobservador en la indicación terapéutica y dentro de la indicación quirúrgica. Discusión El grado de acuerdo obtenido, según los criterios de Landis y Koch, ha sido pobre en todos los grupos en lo que a estadío se refiere y débil en lo referente al tratamiento, no influyendo la experiencia del Traumatólogo. Sería necesaria una clasificación más reproducible ya que la clasificación de Neer presenta la suficiente variabilidad interobservador como para aceptarla como único medio en la toma de decisiones.

Background To study inter-observer variability by evaluating a fracture of the proximal humerus using Neer's classification and to establish its diagnostic and therapeutic utility. Methods A computerised form was used with 20 randomly selected cases of fractures of the proximal humerus, from the same hospital between 2010 and 2014. Each case included: age, gender, laterality, and two radiographic projections. They were anonymously evaluated by Traumatologists, for whom shoulder surgery was routine practice or not, from national and international hospitals. They indicated Neer stage and an appropriate therapeutic option. Interobserver variability was established between groups, and comparing all of them equally, calculating Fleap's Kappa index and interpreting it according to the Landis and Koch criteria. Results A total of 40 responses were obtained from the Traumatologists, 15 of them were shoulder surgery was usual practice and 25 where it was not. The mean Fleap Kappa index was 0.173 in the Traumatologists group were shoulder surgery was usual practice, being 0.176 in the group were it was not usual practice. The overall index was 0.184. There is wide interobserver variability in the therapeutic indication, as well as within the surgical indication. Discussion The level of agreement obtained, according to the criteria of Landis and Koch, was poor in all groups in terms of stage, and weak in terms of treatment. The experience of the Traumatologist had no influence. A more reproducible classification may be necessary since Neer's classification has sufficient interobserver variability to accept it as the sole means of decision making.

Estudio comparativo entre clavo endomedular y tratamiento conservador en fracturas de húmero proximal de 2 y 3 fragmentos / Comparative study between intramedullary nailing and conservative treatment in proximal humerus fractures of 2 and 3 fragments

Introducción Hacer objetivas las diferencias relativas a funcionalidad y calidad de vida entre pacientes con fracturas de húmero proximal de 2 y 3 fragmentos tratados de forma conservadora y mediante enclavado endomedular. Materiales y Métodos Estudio descriptivo-retrospectivo realizado en un mismo centro hospitalario entre junio de 2010 y mayo de 2014. Se incluyeron pacientes con fractura de húmero proximal de 2 y 3 fragmentos, excluyendo los menores de 60 años. Se evaluó la movilidad, test de Constant y ASES. El análisis estadístico se realizó con el programa SPSS. Resultados 71 pacientes seleccionados; 43 presentaban fractura de 2 fragmentos y 28 de 3. Mediante enclavado endomedular fueron tratados 15, con una media de edad de 76,7 años, y 38 recibieron tratamiento conservador, con una edad media de 79,8 años; en ambos grupos el número de mujeres fue mayor. Las puntuaciones de los cuestionarios Constant y ASES fueron superiores en el grupo que recibió tratamiento conservador, al igual que su grado de satisfacción y mejor movilidad y funcionalidad. Discusión En las fracturas de 2 y 3 fragmentos el tratamiento conservador es utilizado en gran parte de los casos. La edad no es un factor influyente a la hora de decantarse por una u otra opción terapéutica. La mayoría de los pacientes están satisfechos con el tratamiento recibido. En los test de Constant y ASES obtienen mejor resultado los pacientes tratados de forma conservadora. La abducción y la flexión son ligeramente superiores en pacientes que recibieron tratamiento conservador.

Background To study the differences related to functionality and quality of life between patients with proximal humerus fractures of 2 and 3 fragments treated conservatively and by using intramedullary nailing. Material and Methods Descriptive-retrospective study was conducted in the same hospital between June 2010 and May 2014. Patients with proximal humerus fractures of 2 and 3 fragments were included. Patients under 60 years were excluded. Mobility was evaluated, using the Constant and ASES (American Shoulder and Elbow Surgeons) test. Statistical analysis was performed using the SPSS program. Results Of the 71 selected patients, 43 had a 2 fragments fracture, and 28 had a 3 fragment fracture Intramedullary nailing was used to treat 15 cases (with a mean age of 76.7 years), and 38 (mean age 79.8 years) received conservative treatment. The number of women was higher in both groups. The scores of the Constant and ASES questionnaires were higher in the group that received conservative treatment. They also had a higher level of satisfaction and better mobility and functionality. Discussion In fractures of 2 and 3 fragments conservative treatment is used in a large majority of the cases. Age is not an influential factor when opting for one or another therapeutic option. Most patients are satisfied with the treatment received. Patients treated conservatively obtain better results in the Constant and ASES tests. Abduction and flexion are slightly higher in patients that received conservative treatment.

Surgical exposures of the distal humeral fractures: An anatomical study of the anterior, posterior, medial and lateral approaches / 中华创伤杂志(英文版)

PURPOSE@#Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches.@*METHODS@#Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively.@*RESULTS@#The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively.@*CONCLUSION@#The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.

Proximal humerus internal locking system combined with allogeneic femoral head bone graft for osteoporotic proximal humeral fractures in the elderly / 中华创伤骨科杂志

Objective To evaluate the efficacy of proximal humerus internal locking system (PHILOS) combined with allogeneic femoral head bone graft for the treatment of osteoporotic proximal humerus fractures in the elderly patients.Methods A total of 36 osteoporotic proximal humerus fractures were analyzed retrospectively which had been treated at Department of Orthopaedics,Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from April 2015 to April 2017.They involved 14 men and 22 women,aged from 60 to 78 years(average,67 years).By the Neer classification,20 cases were two-part fractures,11 three-part fractures and 5 four-part fractures.They were all treated by PHILOS plating combined with allogeneic femoral head bone grafting.The outcomes were assessed using Neer evaluation system for shoulder function.Results All the 36 cases were followed up for 3 to 18 months (average,12 months).All the incisions healed postoperatively by the first intention,with no postoperative infection,nonunion,humeral head varus,screw cut-out,humeral head necrosis,or loosening of implants.Clinical healing of the fractures was achieved after 8 to 24 weeks (average,12 weeks).According to the Neer evaluation,shoulder function was excellent in 18,good in 15 and poor in 3 cases.Conclusion In the treatment of osteoporotic proximal humerus fractures in the elderly,combination of PHILOS plating and allogeneic femoral head bone grafting can effectively prevent such postoperative complications as humeral head varus,screw cut-out and loosening of implants.

Comparison of the Clinical Efficacy of Minimally Invasive Locking Plate and Traditional Open Reduction with Internal Fixation in the Treatment of Proximal Humerus Fractures / 现代生物医学进展

Objective:To discuss the clinical efficacy of minimally invasive locking plate and the traditional open reduction with internal fixation in the treatment of proximal humerus fractures.Methods:89 cases of patients with proximal humeral fractures were selected and divided into two groups according to different surgical methods.The observation group (45 cases) was given minimally invasive locking plate,while the control group (44 cases) was treated with the traditional open reduction and internal fixation.The operation time,hospitalization time,fracture healing time,intraoperative blood loss,Neer score and Constant-Murley score at 1 month after postoperatiion were compared between two groups.Results:The operation time,hospitalization,fracture healing time of observation group were significantly shorter than those of the control group,and the bleeding amount of observation group was less than that of the control group (P＜0.05).At 1 months after operation,the Constant-Murley scores of observation group were significantly better than those of the control group (P＜0.05).The For Neer scores,excellent rate of observation group (91.1％) were significantly higher than those of the control group (68.1％,P＜0.05).Conclusion:Compared with the traditional open reduction with internal fixation,minimally invasive locking plate was better,safer,faster and more effectively for promoting the recovery of shoulder function of patient with proximal humerus fractures.

Clinical study of two approaches for the treatment of proximal humerus fractures / 中国综合临床

Objective To evaluate the effect of locking plate in the treatment of proximal humerus fractures and to compare the results of two approaches used for fixation.Methods Surgical treatment of 47 cases of proximal humerus fractures in the elderly in Affiliated Hospital of Yan′an University from September 2014 to September 2015.All fractures were randomly divided into two groups and treated with Phlios plate.Deltoid splitting and deltopectoral approaches were used for fixation respectively 23 cases and 24 cases.Postoperative shoulder function was evaluated according to Neer Score.Results The operation time,length of incision,intraoperative bleeding,fracture healing time,length of hospitalization in thoracic deltoid muscle group were more than deltoid splitting pathway group((90.1±6.3) min vs.(73.0±9.5) min,(10.0±3.5) cm vs.(6.3±2.6) cm,(100.0±30.1) ml vs.(90.6±36.4) ml,(3.2±0.8) months vs.(3.0±0.7) months,(10.3±1.9) d vs.(10.1±1.9) d),the difference of operation time(t=2.133,P=0.042) and length of incision(t=2.236,P=0.036) was statistically significant between the two groups,while the difference of the intraoperative bleeding(t=1.867,P=0.063),fracture healing time(t=1.064,P=0.242) and length of hospitalization(t=0.667,P=0.256) were not statistically significant.Followed up for 6.0-12.0 months,the average was (9.0±2.0) months,all patients achieved the bony healing.During the followed up,5 complication(10.6%) were encountered,including 2 cases of varus malunion,1 case of acromial impingement(115°-124°),1 case of screw cut-out and 1 case of humerus head osteonecrosis.The patients with tow-or three parts fractrues in tow groups,Neer-Score scores were statistically significant ((76.8±2.8) points vs.(76.1±2.6) points,(78.9±2.3) points vs.(77.8±2.4) points,t=2.76,2.58,P0.05).The excellent-good rate in triangle muscle splitting approach group was 91.3%(21/23),of thoracic deltoid muscle group was 58.3%(14/24),there were significant different existed in two groups(P=0.023).Conclusion Locking plate for the treatment of proximal humerus fractures has a good effect.Deltoid splitting approach in the prognosis of function recovery has more advantages.

Effect of integrated nursing intervention on postoperative recovery of supracondylar humerus fractures with ulnar deviation in children / 中国实用护理杂志

Objective To observe the effect of comprehensive nursing of traditional Chinese medicine and Western Medicine on children′s supracondylar humerus fracture of ulnar deviation on postoperative recovery. Methods From November 2015 to February 2016, 52 inpatients were divided into 2 groups by random digits table method after the external fixation removal surgery with 26 cases each. The observation group was intervened by integrated nursing and was given TCM rehabilitation guidance, while the control group was intervened by regular nursing and was given regular rehabilitation guidance. After 4 weeks, the therapeutic effect was evaluated according to Chinese Medicine Orthopedic Syndrome Diagnosis and their elbow joint function was evaluated by Flynn score. In 8 weeks of follow up, all the patients were valued by their quality of life. Results In the process of intervention, with 1 case fell off in the observation group, 3 cases fell off in the control group, so finally the observation group with 25 cases, the control group with 23 cases. Fifteen cases were cured, 7 cases were improved, 3 cases were not cured at 4 weeks after surgery in the observation group, 8, 6, 9 cases in the control group, and the difference was statistically significant (Z=-2.120, P=0.034). At 4 weeks after surgery, 10, 6, 6, 3 cases were excellent, good, medium and poor evaluated by Flynn score in the observation group, 5, 4, 5, 9 cases in the control group, and the difference was statistically significant (Z=-2.051, P=0.040). Incidence of postoperative complications was 8.0% (2/25) in the observation group, 30.4% (7/23) in the control group, and the difference was statistically significant (χ2=2.622, P=0.047). Physical, psychological, social and environmental fields of quality of life were 77.84 ± 12.15, 81.13 ± 15.72, 79.95 ± 20.68, 79.44 ± 11.57 in the observation group, 63.31 ± 15.86, 63.07 ± 12.63, 65.65 ± 18.51, 61.32 ± 17.24 in the control group, and the difference was statistically significant (t=2.516- 4.363, P<0.05). Conclusions Integrated nursing intervention with TCM rehabilitation guidance is a method which can effectively help in improving the elbow movement function and the life quality of children with supracondylar humerus fractures of ulnar deviation.

Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.

A case control study of perpendicular or parallel double plate for the treatment of young and middle-aged patients with type C fractures of distal humerus / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults.</p><p><b>METHODS</b>From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared.</p><p><b>RESULTS</b>All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups.</p><p><b>CONCLUSIONS</b>There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.</p>

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.