Finite Element Analysis on Different Internal Fixations for Treating Proximal Humeral Fractures in Children / 医用生物力学

Objective To compare biomechanical characteristics of external fixator, Kirschner’s wire, elastic stable intramedullary nailing (ESIN) for fixing proximal humeral fractures in children by finite element method.Methods The CT scanning data from the healthy humerus of an 8-year-old patient with proximal humeralfractures were collected, and the image data were imported in Mimics 21. 0 to establish the rough humeralmodel, which was imported in Geomagic 2013 to construct the three-dimensional (3D) model of cancellous and cortical bones of the humerus. After the model was assembled with 3 fixators ( external fixator, Kirschner’swire, ESIN), it was imported in ANSYS 2019 to simulate the upper limb under quiet, abduction, adduction, flexion, extension, external rotation, internal rotation working conditions. The maximum displacement of the distal humerus, the maximum stress of the fixture, and the maximum displacement of the distal fracture surface were analyzed. Results The minimum values of the maximum displacement of the distal humerus in models fixed by external fixator, Kirschner’s wire, ESIN appeared under extension (2. 406 mm), external rotation (0. 203 mm), external rotation (0. 185 mm) working conditions, respectively. Conclusions External fixator is the most unstable fixation of proximal humeral fractures in children, and the biomechanical performance of ESIN is better than that of external fixator and Kirschner’s wire fixation

Treatment of the aged patients with unstable proximal humeral fracture with a locking plate and an intramedullary titanium mesh / 中华创伤骨科杂志

Objective:To evaluate the radiological and clinical outcomes of the aged patients with unstable proximal humeral fracture (UPHF) treated with a locking plate and an intramedullary titanium mesh.Methods:A retrospective study was conducted to analyze the 43 aged patients with UPHF who had been admitted to Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University from January 2017 to July 2019. There were 13 males and 30 females with an age of (71.3±10.3) years (from 60 to 83 years). All patients were treated with a locking plate and an intramedullary titanium mesh to support. The postoperative imaging measurements included changes in humeral head height (HHH) and neck-shaft angle (NSA) (the difference between 3 years after surgery and the second day after surgery, taken as an absolute value); the postoperative clinical measurements included visual analogue scale (VAS), range of shoulder motion, Constant-Murley shoulder functional score (Constant score), American Shoulder and Elbow Surgeons (ASES) score, and incidence of complications.Results:All patients were followed up for (39.2±2.3) months after surgery. The change in HHH at 3 years after surgery was (1.5±1.1) mm, and the change in NSA at 3 years after surgery 3.3°±2.6°. At 3 years after surgery, the VAS score was (2.2±1.3) points, the Constant score (79.2±9.1) points, and the ASES score (78.9±9.2) points; the range of forward extension was 143.2°±20.8°, the range of outward extension 139.3°±23.1°, and the range of outward rotation 55.1°±4.7°. Complications after surgery were found in 6 patients, including humeral head necrosis in 2 cases, ectopic ossification in 1 case, and infection in 3 cases.Conclusion:In the treatment of the aged patients with UPHF, a locking plate combined with an intramedullary titanium mesh can help to restore the medial column support, leading to fine radiological and clinical outcomes.

Treatment of four-part proximal humerus fractures with depressed humeral head collapse using strut allograft with locking plates / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of allogeneic femoral head as strut allograft combined with proximal humeral internal locking system (PHILOS) in the treatment of proximal humeral Neer grade Ⅳ fracture with humeral head collapse.@*METHODS@#From January 2018 to November 2020, 18 patients with Neer grade Ⅳ fracture with humeral head collapse were treated with strut allograft with PHILOS, including 4 males and 14 females, aged from 55 to 78 years old, with an average of (68.11±7.20) years old. The operation time, intraoperative bleeding, postoperative drainage volume, fracture healing time, neck-shaft angle and the height of the humeral head, failure of internal fixation the shoulder function at the last follow-up was assessed using Neer's scoring system.@*RESULTS@#All 18 patients were followed up, and the duration ranged from 10 to 12 months, with an average of (11.08±0.65) months. The operation time was (66.44±5.06) min, the intraoperative bleeding volume was (206.67±36.14) ml, the postoperative drainage volume was (76.11±9.63) ml, and the fracture healing time was (17.28±3.92) weeks. At the last follow-up, the degree of loss of neck-shaft angle was (5.44±0.86) ° and the loss of the height of humeral head was (1.43±0.27) mm. All 18 patients had healing without complications such as fracture, withdrawal, penetration of internal fixation and necrosis of humeral head. According to Neer's evaluation standard, the total score was (89.61±5.60), 10 cases got an excellent result, 6 good, 2 fair.@*CONCLUSION@#Allogeneic femoral head combined with PHILOS is an appropriate treatment for the four-part proximal humerus fractures with humeral head collapse, exhibiting good clinic outcome.

Clinical outcomes of reverse shoulder arthroplasty for the treatment of failed fixation of proximal humeral fracrtures in the elderly patients / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients.@*METHODS@#A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020, including 3 males and 5 females, aged from 65 to 75 years old. All 8 patients underwent reverse total shoulder arthroplasty, and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months. Range of motion(ROM), University of California at Los Angeles(UCLA) shoulder score, visual analogue scale (VAS), self-rating anxiety scale(SAS), and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up. Complications relating to the surgery were recorded.@*RESULTS@#All 8 patients successfully followed up. The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months. The range of motion (forward flexion, external rotation, abduction and internal rotation) of the affected shoulder was significantly improved after surgery, and the post-operative VAS, SAS and UCLA scores were also significantly improved. For the Constant-Murley score of shoulder joint function, the total scores and the subscores of pain, daily activities, range of motion and strength test at the last follow-up were all significantly improved. Scapular glenoid notch was observed in patient, which was evaluated as grade 1 on imaging. All the other patients did not develop specific or non-specific complications.@*CONCLUSION@#Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures. It has shown satisfactory clinical outcomes, accelerating the rehabilitation of shoulder function and improving the quality of life.

Conceptos actuales: ventajas del clavo endomedular para fracturas del húmero proximal / Current concepts: advantages of intramedullary nail for proximal humerus fractures

Las fracturas de húmero proximal (FHP) son una de las fracturas más frecuentes en la población anciana. La reducción abierta y fijación interna (RAFI) generalmente está indicada para pacientes con una FHP desplazada en jóvenes o pacientes mayores con alta demanda funcional y buena calidad ósea. No se ha llegado a un consenso sobre la técnica de fijación ideal. La RAFI con placas ha sido la más utilizada, pero se han reportado altas tasas de reintervenciones y complicaciones globales en la literatura. La necesidad de agregar técnicas de aumentación a la RAFI con placas bloqueadas en fracturas complejas puede resultar en un tiempo quirúrgico más largo, abordajes extensos y mayores costos. Debido a esto, se hace necesario considerar otras opciones para la osteosíntesis de FHP. Con una mayor comprensión de los mecanismos de falla de la osteosíntesis, la fijación intramedular se ha convertido en una opción de tratamiento aceptada para las FHP con ventajas biomecánicas y biológicas. La fijación intramedular para las FHP ha demostrado menor tiempo quirúrgico, sangrado intraoperatorio, tiempo hasta la unión ósea y menores tasas de infecciones, que las placas bloqueadas. La fijación intramedular es una opción válida para que las fracturas complejas se resuelvan con un implante que por sí solo puede satisfacer en gran medida todas las necesidades de aumento requeridas por una placa bloqueada

Proximal humeral fractures are one of the most frequent fractures in the elderly population. Open reduction and internal fixation (ORIF) is generally indicated for young patients and older patients with high functional demands and good bone quality. No consensus has been reached regarding the ideal fixation technique. Although ORIF with plates is the most widely used technique, high re-intervention rates and global complications with locked plate fixation have been reported in the literature. Addition of augmentation techniques to locked plate fixation in complex fractures may result in longer surgical times, extensive approaches, and higher costs. Therefore, considering other options for ORIF is necessary. With a greater understanding of the mechanisms of fixation failure, intramedullary fixation has become the accepted treatment option for proximal humeral fractures considering the specific biomechanical and biological advantages. Compared with ORIF with locked plates, intramedullary fixation for proximal humeral fractures has low surgical time, intraoperative bleeding, time to bone union, and rate of infections. Intramedullary fixation is a valid option to resolve complex fractures with an implant that may largely supply all the augmentation requirements of a locked plate.

Characterization of 20 cases of humeral head necrosis after complex proximal humeral fracture / 中华创伤骨科杂志

Objective:To characterize the humeral head necrosis after open reduction and anatomic locking plate fixation of complex proximal humeral fractures.Methods:A retrospective study was conducted of the 20 patients who had been treated for humeral head necrosis after surgery of complex proximal humeral fracture at Department of Traumatic Orthopaedics, Beijing Jishuitan Hospital from September 2012 to June 2020. They were 7 males and 13 females with an average age of 57.4 years (from 35 to 84 years). Analyzed were their fracture types, time for diagnosis of humeral head necrosis, length of the medial residual bone, thickness of the humeral head and shoulder function.Results:The 20 patients were followed up for 8 to 104 months (average, 48.3 months). According to the Neer classification, there were 8 three-part fractures and 12 four-part fractures; shoulder dislocation was complicated in 10 cases. According to the AO-OTA classification, there were 16 type C fractures and 4 type B fractures. The length of the medial residual bone averaged 4.8 mm (from 0 to 10.7 mm); the medial soft tissue hinge was damaged in 18 cases and the thickness of the humeral head averaged 20.6 mm (from 13.6 to 33.0 mm). All fractures got united at the first stage after an average time of 8.4 weeks (from 5 to 12 weeks). The time for diagnosis of humeral head necrosis averaged 16.5 months (from 8 to 24 months). At the final follow-up, the Constant-Murley score of the affected side averaged 53.4 (from 22 to 74) while that of the healthy side 85.5 (from 53 to 98), with a ratio of affected side to healthy side of 62.43% (from 27.95 to 82.70%).Conclusions:Necrosis of the humeral head was common after surgery for complex proximal humerus fractures, most of which were three- or four-part ones or combined with shoulder dislocation. In most of the patients, the medial soft tissue hinge was damaged and the length of the residual medial bone usually shorter than 8 mm. Necrosis of the humeral head happened late after surgery. The function of the affected shoulder was significantly lower than that of the healthy side.

Locking plate fixation with fibular strut allograft versus locking plate fixation alone for the treatment of proximal humeral fractures in adults:a Meta-analysis / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of locking plate fixation with a fibular strut allograft (FA group) and locking plate fixation alone (LP group) in the treatment of proximal humeral fractures in adults by Meta-analysis.@*METHODS@#Databases including PubMed, The Cochrane Library, Embase, Chinese BioMedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI), WanFang Data, and China Science and Technology Journal Database (cpvip Database) were searched by computer from establishing to March 2020 to collect studies about locking plate fixation with fibular strut allograft versus locking plate fixation alone for proximal humeral fractures in adults. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. The postoperative humeral head height changes, neck-shaft angle changes, Constant-Murley score, American Shoulder and Elbow Surgeons(ASES)score, visual analogue scale(VAS), varus malunion rate, and screw penetration rate were compared by RevMan 5.3 software for Meta-analysis.@*RESULTS@#Ten cohort studies were enrolled in a total of 749 patients, 300 patients in the FA group and 449 patients in the LP group. The results of Meta-analysis showed that locking plate with fibular strut allograft was superior to locking plate fixation alone in the changes in humeral head height [MD=-2.69, 95%CI(-3.24, -2.13), P<0.000 01], the changes in neck-shaft angle [MD=-5.65, 95%CI(-7.18, -4.12), P<0.000 01], Constant-Murley score [MD=9.00, 95%CI(4.26, 13.73), P=0.000 2], the ASES score [MD=5.56, 95%CI(4.29, 6.84), P=0.000 01], VAS score [MD=-0.23, 95%CI(-0.37, -0.09), P=0.001], the varus malunion rate [RR=0.22, 95%CI(0.09, 0.53), P=0.000 7] and the screw penetration rate [RR=0.26, 95%CI(0.13, 0.55), P=0.000 3], respectively.While there was no significant difference in the rate of osteonecrosis of the humeral head [RR=1.18, 95%CI(0.57, 2.45), P=0.65].@*CONCLUSION@#For proximal humeral fractures in adults, current evidence shows that locking plate fixation with fibular strut allograft is superior to single locking plate fixation in improving postoperative radiological outcomes and shoulder function, relieving postoperative pain, reducing varus malunion rate and screw penetration rate. However, the efficacy in decreasing the osteonecrosis rate is not clear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.

Finite element analysis of different fixation methods for poor medial column support proximal humeral fracture / 中国组织工程研究

BACKGROUND: The medial column fracture of the proximal humeral fracture is a type of fracture with high postoperative complications after internal fixation. Proximal humeral internal locking system is widely used in the proximal humeral fracture. The biomechanical stability of two different internal fixation models for the treatment of the poor medial column support proximal humeral fractures with proximal humeral internal locking system and proximal humeral intemal locking system with fibular allograft augmentation is still unclear. OBJECTIVE: To investigate the biomechanical stability of the proximal humeral internal locking system and proximal humeral internal locking system with fibular allograft augmentation in the poor medial column support proximal humeral fracture with finite element analysis, and to compare the difference in fixation modes in humeral calcar supporting screws under different fixing methods. METHODS: The proximal CT data of osteoporosis were obtained. According to the 5-mm osteotomy of the humerus, the posterior medial column of the humerus was established and divided into two groups. Group A was the proximal humeral intemal locking system plate group, in which the A1 group was placed in the proximal end of the plate, the A2 group was the E screw missing, the A3 group was the D screw missing; the B group received the proximal humeral intemal locking system plate combined with fibular allograft augmentation, and all screws was placed in the proximal end of the plate in the B1 group. In the B2 group, E screw was missing; in the B3 group, D screw was missing. The three-dimensional finite element method was used to analyze the biomechanical stability of different groups of models under indirect violence. RESULTS AND CONCLUSION: (1) In terms of structural stability, B group was significantly better than A group. The structural stability of A1 group and A3 group of A group was comparable and better than that in A2 group. In B group, the structural stability of B1 group and B2 group was comparable and superior to B3 group. (2) For the poor medial column support proximal humeral fracture, the mechanical stability of the proximal humeral intemal locking system plate combined with fibular allograft augmentation was better than that of the proximal humeral internal locking system plate alone. When the fibular support was combined, the screw placement in the proximal end of the plate is optimal, and D screw has an important stabilizing effect on the support of the poor medial column support proximal humeral fracture.

Meta-analysis of locking plate combined with fibular allograft and locking plate alone in the treatment of proximal humeral fractures / 中国组织工程研究

BACKGROUND: The best treatment of proximal humeral fracture has always been controversial. Open reduction and internal fixation with locking plate is a common method for the treatment of proximal humeral fractures. In recent years, many studies have pointed out that locking plate combined with fibular allograft can obtain better rigid structure. OBJECTIVE: To evaluate the clinical efficacy of locking plate and locking plate combined with fibular allograft in the treatment of proximal humeral fractures. METHODS: CNKI, Wanfang database, VIP, PubMed, EMBASE, and Cochrane Library were searched for articles concerning locking plate and locking plate combined with fibular allograft for proximal humeral fractures published from inception to January 2020 for quality evaluation. International Cochrane collaboration RevMan 5.0 software was used for meta-analysis. The difference in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, the change of humeral neck angle, incidence of postoperative complications, secondary surgery rate, screw cutout rate, and humeral head necrosis rate were compared between the locking plate group and locking plate combined with fibula group. RESULTS AND CONCLUSION: (1) Eight studies were included with a total of 623 patients. (2) Results analysis showed that there were significant differences between the locking plate group and locking plate combined with fibula group in American shoulder and elbow surgeons score (95%CI:4.29-6.84, P 0.05) and humeral head necrosis rate(95%CI:0.41-2.11, P > 0.05). (4) Locking plate combined with fibula with simple locking plate in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, neck stem Angle values, the incidence of postoperative complications, and screw cutout rate has a better clinical effect, but does not have significant difference in the second operation rate or humeral head avascular necrosis..

Shoulder Replacement Arthroplasty after Failed Proximal Humerus Fracture / 대한정형외과학회잡지

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.

Comparative study of three surgical methods for the treatment of complex proximal humeral fractures in elderly patients / 医学研究生学报

Objective There are few comparative researches on open reduction internal fixation, hemishoulder arthroplasty and reverse total shoulder arthroplasty for the treatment of complex proximal humeral fractures. The purpose of this study was to explore the clinical efficacy of three surgical Methods for the treatment of complex proximal humeral fractures.Methods A retrospective study of 55 cases of complex proximal humeral fractures treated in our department from November 2013 to May 2016. According to different surgical Methods , the patients were divided into three groups: open reduction internal fixation group of 20 cases (open reduction and internal fixation using locking plate), hemishoulder arthroplasty group of 20 cases (artificial humeral head replacement), reverse total shoulder arthroplasty group of 15 cases (head-glenoid inverted shoulder replacement). Regular postoperative review was done to record the ranges of motion. The function of shoulder joint was evaluated by ASES score, VAS pain score, UCLA score and SST score.Results 6 months after the operation, the internal rotation function of the hemishoulder arthroplasty group\[(49.1±3.3)°\] was better than those of reverse total shoulder arthroplasty group \[(43.7±4.5)°\] and open reduction internal fixation group \[(41.7±5.0)°\], but the external rotation function\[(25.7±5.4)°\] was worse than the other two groups\[(38.0±5.6)°, (39.5±4.6)°\], the differences representing statistical significance(P0.05).Conclusion Three surgical Methods can all be used in the treatment of complex proximal humeral fractures with equivalent efficacy. Reverse total shoulder arthroplasty leads to earlier shoulder joint range of motion, but lacks middle-term and long-term curative effect. Clinicians should take surgical indications and individualization into consideration comprehensively to make the choice among three surgical Methods .

Analysis on the clinical efficacy of locking plate fixation with different operative approaches for the treatment of proximal humeral fractures / 中国综合临床

Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.

Design and biomechanical study of a novel double-leaf proximal humeral locking plate / 医用生物力学

Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures,and evaluate its fixing stability by biomechanical tests.Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models.Specimens in Group A were fixed with the double-leaf proximal humeral locking plate,while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture,and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity.The tensile test on subscapularis,infraspinatus and teres,supraspi natus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups.Results For subscapularis tensile tests,displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P ＜ 0.05).For infraspinatus and teres tensile tests,there were no statistical differences between Group A and B in displacements under 150 N tensile stretch and after fatigue test (P ＞ 0.05).For supraspinatus tensile tests,there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P ＞ 0.05).For load-to-failure tests on lesser tuberosity,the failure load in Group A was significantly greater than that in Group B (P ＜ 0.05),and the failure displacement in Group A was significantly smaller than that in Group B (P ＜ 0.05).For load-to-failure tests on greater tuberosity,there were no statistical differences between Group A and B in both the failure load and failure displacement (P ＞ 0.05).Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity,the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability,with the advantage of simultaneously fixing greater and lesser tuberosities.The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.

Analysis on the clinical efficacy of locking plate fixation with different operative approaches for the treatment of proximal humeral fractures / 中国综合临床

Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.

Design and biomechanical study of a novel double-leaf proximal humeral locking plate / 医用生物力学

Objective To design a novel double-leaf proximal humeral locking plate for fixing greater and lesser tuberosities in complex proximal humeral fractures, and evaluate its fixing stability by biomechanical tests. Methods Twelve fresh-frozen humerus specimens with intact rotator cuff were randomly divided into two groups (Group A and Group B) to establish the same greater and lesser tuberosities fracture models. Specimens in Group A were fixed with the double-leaf proximal humeral locking plate, while specimens in Group B were fixed with the proximal humeral internal locking system (PHILOS) and tension band suture, and a 3.5-mm cannulated screw was added to stabilize the lesser tuberosity. The tensile test on subscapularis, infraspinatus and teres, supraspinatus as well as the load-to-failure test on greater and lesser tuberosities were performed on specimens in two groups. Results For subscapularis tensile tests, displacements under 150 N tensile stretch and after fatigue test in Group A were both significantly smaller than those in Group B (P0.05). For supraspinatus tensile tests, there were no statistical differences between Group A and B in displacements under 90 N tensile stretch and after fatigue test (P>0.05). For load-to-failure tests on lesser tuberosity, the failure load in Group A was significantly greater than that in Group B (P0.05). Conclusions Compared with the ordinary tension band suture plus cannulated screw for fixing lesser tuberosity, the novel double-leaf proximal humeral locking plate shows more obvious biomechanical stability, with the advantage of simultaneously fixing greater and lesser tuberosities. The research findings provide a new choice for the clinical treatment of complex proximal humeral fractures.

Three-dimensional finite element analysis on the novel locking plate and AO-PHILOS plate for fixing four-part proximal humeral fractures / 医用生物力学

Objective To compare biomechanical performance of four-part proximal humeral fractures fixed by novel locking plate or by AO-PHILOS plate. Methods The finite element fixation models of both the novel locking plate and AO-PHILOS plate for four-part proximal humeral fractures were established, respectively. The maximum Von Mises stress and displacement under 4 different functional positions of shoulder abduction in the two fixation models were compared by finite element analysis. Results The maximum displacement in shoulder abduction of 0°,30°,60°,90° were 6.644, 7.079, 5.850, 3.005 mm, respectively, in novel locking plate fixation model, and 6.293, 6.826, 5.774, 3.023 mm, respectively, in AO-PHILOS plate fixation model. Since the maximum displacements in both fracture fixation models were similar, it indicated that there was no significant difference in the stability for fixing proximal humeral fracture. The maximum Von Mises stress in shoulder abduction of 0°,30°,60°,90°were 1 033.0, 904.1, 888.1, 1 062.0 MPa in novel locking plate fixation model, while in AO-PHILOS plate fixation model, it showed 743.1, 692.4,486.4,393.5 MPa, respectively. During the process of shoulder abduction, the total stress in both fracture fixation models gradually decreased, but the new locking plate decreased in a larger range, showing an obvious stress dispersion. Conclusions Both the novel locking plate and AO-PHILOS plate can be used as internal fixation treatment for complex four-part proximal humeral fractures with no significant difference in stress distribution, and both showing a stable fixation effect. For fixing proximal humeral fractures with osteoporosis combined with the great and less tuberosity, the novel locking plate has an advantage over AO-PHILOS plate due to its unique anatomical wings and better fixing effect.

Efficacy of locking plate fixation with anti-osteoporosis drug treatment of older patients with proximal humeral fractures / 中国综合临床

Objective To investigate the effect of the locking plate fixation with anti-osteoporosis drug in the treatment of older patients with proximal humeral fractures. Methods Sixty-two patients with proximal humeral fractures who were treated in Yuzhou Mining Company Hospital of Kailuan Group of Hebei Province from Feb. 2011 to Oct. 2013 were divided into observation group(n=30)and control group(n=32). Patients in both groups were given locking plate fixation,and patients in the observer group were also received anti-osteoporosis treatment. The information including hospitalization periods,efficacy and bone mineral density of the two groups was recorded. Results The hospitalization periods of the observation group and control group were (6. 9 ± 1. 0)d,(9. 5 ± 1. 1)d,and the difference was statistically significant(t=8. 426,P﹤0. 05). The efficacy in observer group was excellent in 17 cases,good in 10 cases,fair in 2 cases and poor in 1 case,and the efficacy of the control group was excellent in 14 cases,good in 10 cases,fair in 5 cases and poor in 3 cases. The difference was statistically significant(χ2 =4. 617,P ﹤0. 05 ). After the anti-osteoporosis treatment,the bone mineral density of the observer group and control group were( 0. 79 ± 0. 13)g/cm2 and(0. 66 ± 0. 05)g/cm, the difference was statistically significant( t =10. 251,P ﹤0. 05 ). Conclusion The effect of locking plate fixation with anti-osteoporosis drug is better with shorter hospital stay,safe and reliable,and it is worthy of clinical application.

Clinical observation of proximal humeral locking plate combined with injectable bone graft in the treatment of proximal humeral fractures / 中国基层医药

Objective To explore the treatment effect and application value of proximal humeral locking plate combined with injectable bone graft in the treatment of proximal humeral fractures.Methods 86 patients with proximal humeral fractures were selected,using the random number table method they were randomly divided into the observation group and control group,each group had 43 cases.The control group was treated with locking plate method,and the observation group was treated by the combination of artificial bone and locking plate.The therapeutic effect of the two groups was observed.Results The excellent and good rate of the observation group was 93.03％,that of the control group was 74.42％,the difference was statistically significant between the two groups(x2 =5.460 3,P ＜0.05).In observation group,the fracture healing time was (11.78 ± 3.64) weeks,the shoulder joint function score was (96.87 ± 4.23) ; those of the control group were (19.65 ± 6.27) weeks,(78.73 ± 8.28),the differences were statistically significant between the two groups (t =7.118 2,12.793 4,all P ＜ 0.05).The incidence rate of complications of the observation group was 6.98％,which was significantly lower than 30.23％ of the control group (x2 =7.678 6,P ＜ 0.05).Conclusion Proximal humeral locking plate combined with injectable bone graft in the treatment of proximal humeral fracture has reliable curative effect,short fracture healing time and mild surgical complications,which is worth popularizing in clinical.

Percutaneous plate and anatomical locking plate fixation for the treatment of proximal humeral fractures / 中国组织工程研究

BACKGROUND:For the patients with proximal humeral fractures or serious complications, internal fixation is the effective method that cannot influence the activity of the shoulder with few trauma. OBJECTIVE:To investigate the biomechanical characteristics of percutaneous plate combined with anatomical locking plate fixation for the treatment of proximal humeral fractures. METHODS:Seventy-five patients with proximal humeral fractures were selected from Department of Orthopedics, the Third Affiliated Hospital of Guangzhou Medical University between March 2007 and December 2011. The healing after the locking plate fixation and the shoulder joint score after internal fixation were observed. The biomechanical advantages of locking plate fixation in the treatment of proximal humeral fractures were analyzed. RESUTLS AND CONCLUSION:Al the 75 patients were fol owed up for 6-24 months, average 13.3 months. The X-ray film after treatment showed al the screws were in correct position with satisfactory fracture reduction, and the fractures were healed without neurovascular injury and humeral head necrosis;one case had infection and healed after treatment, 72 cases had no shoulder pain, while three cases had occasional shoulder pain. The Neer score was excel ent in 57 cases, good in 11 cases, moderate in seven cases and poor in none, and the excel ent and good rate was 90.7%. Compared with other fixation implants, the locking plate fixation in the treatment of proximal humeral fractures has the advantages of high fixation strength and satisfactory effect, becoming the first choice for the clinical treatment of proximal humeral fractures.

A retrospective study after treatment of proximal humeral fractures with locking plates / 国际外科学杂志

Objective The purpose of our study was to evaluate the treatment of proximal humeral fractures with AO Philos plate. Methods From June 2007 to May 2009, 29 cases of proximal humeral fractures were fixed with AO Philos plate. According to Neer classification, 11 cases were two-part fractures, 16 cases three-part fractures and 2 cases four-part fractures. Results Twenty-nine cases were followed 9-16 months (averaging 11.3 months). The results were evaluated with Neer's evaluation system: 13 patients were graded as excellent,12 as good, 4 as fair. Conclusion AO Philos plate is less invasive comparing with traditional method. It can provide solid fixation, permit early functional rehabilitation and lead to a compromising clinical result.