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OBJECTIVE@#To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery.@*METHODS@#From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups.@*RESULTS@#All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups.@*CONCLUSION@#Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.
Subject(s)
Male , Female , Humans , Aged , Middle Aged , Treatment Outcome , Shoulder Fractures/surgery , Fracture Fixation, Internal , Shoulder , Humeral Head , Bone Plates , Humeral Fractures/surgeryABSTRACT
BACKGROUND: The medial support nail restored the triangular stable structure of the proximal femur through the reconstruction of the medial femoral support. The early finite element analysis and biomechanics showed that the stability of the nail was better than that of the commonly used proximal femoral nail antirotation, but the specific performance in the model of severe osteoporosis was unknown. OBJECTIVE: To compare the biomechanical differences between medial support nail and proximal femoral nail antirotation in the treatment of severe osteoporotic intertrochanteric fractures without medical support. METHODS: The medial unsupported intertrochanteric fracture model was made of artificial bone with severe osteoporosis. Axial and torsional failure experiments were conducted after the medial support nail and the proximal femoral nail antirotation were respectively fixed, and the axial stiffness and torsional stiffness of the two under axial and torsional loads were recorded. RESULTS AND CONCLUSION: (1) Axial failure experiment showed that the ultimate load yield load and axial stiffness of the medial support nail group were all greater than those of the proximal femoral nail antirotation group, but there was no significant difference between the two groups (P > 0.05). (2) The torsional failure experiment showed that the torsional stiffness of the medial support nail group was higher than that of the proximal femoral nail antirotation group (P > 0.05). (3) The findings confirmed that the mechanical stability of the medial support nail, especially torsion resistance, is better than that of the proximal femoral nail antirotation, which may be a good choice for the treatment of severe osteoporotic intertrochanteric fracture.
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BACKGROUND: In recent years, some scholars have proposed the use of medial femoral neck support plate combined with cannulated screw internal fixation to treat Pauwels type III femoral neck fracture. This method can reduce the incidence of complications such as nonunion of the femoral neck fracture and femoral head necrosis. However, it is still controversial whether this treatment can accelerate fracture healing and reduce femoral head necrosis in clinic. OBJECTIVE: Meta-analysis was performed to evaluate the difference in the efficacy of femoral medial support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation for the treatment of Pauwels type III femoral neck fracture. METHODS: Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search for and collect the clinical Chinese and English literature of the trials regarding Pauwels III femoral neck fracture treated with internal femoral support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation. Two evaluators independently conducted quality evaluation, data extraction and cross-checking of the included studies, and finally performed meta-analysis on the collected data using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) After screening, 5 related clinical trials were included, including 4 randomized controlled trials and 1 retrospective cohort study, for a total of 243 patients with Pauwels III femoral neck fracture. (2) Meta-analysis results showed that compared with simple cannulated internal fixation, operation time was longer [MD=23.19, 95%C/(8.32, 38.06), P=0.002], intraoperative blood loss was more [MD=83.48, 95%C/(32.08, 134.89), P=0.001], and healing time was shorter [MD=-1.56, 95%C/(-1.89, -1.24), P < 0.000 01], the incidence of complications was lower [RD=-0.07, 95%C/(-0.11, -0.02), P=0.003], and hip Harris score was higher [MD=7.39, 95%C/(3.18, 60), P=0.000 6] in the femoral medial support plate combined with cannulated screw internal fixation. However, there was no statistically significant difference in the excellent and good rate of hip function between the two treatments [OR=1.29, 95%C/(0.02, 74.86), P=0.90]. (3) In the treatment of Pauwels type III femoral neck fracture, compared with simple cannulated nail fixation, cannulated screws combined with medial support plate can shorten healing time, reduce postoperative complications and elevate postoperative Harris score.
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OBJECTIVE@#A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.@*METHODS@#The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.@*RESULTS@#The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant.@*CONCLUSION@#The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.
Subject(s)
Humans , Biomechanical Phenomena , Bone Nails , Bone Screws , Femur , Fracture Fixation, Intramedullary , Hip Fractures/surgeryABSTRACT
Objective To investigate the advantage of the technique of static compression screws with medial support using one ordinary cannulated compression screw (OCCS) and 2 headless cannulated compression screws (HCCSs) in reducing complications in the treatment of vertical femoral neck fractures.Methods From December 2014 to July 2017,79 patients were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai for vertical femoral neck fractures.They were 51 men and 28 women,aged from 20 to 65 years (average,49.1 years).Their injury involved 45 left sides and 34 right sides.Of them,37 were treated with one OCCS at the top and 2 HCCSs at the bottom of a triangle arrangement for fixation of the vertical femoral neck fracture (the experimental group);the other 42 were treated with 3OCCSs at a triangle arrangement for fixation of the vertical femoral neck fracture (the control group).Their fracture healing and complications were followed up at postoperative 6 weeks,3,6 12,18,24 months and any time of discomfort by anteroposterior and lateral X-ray films of the knee joint.Results The 2 groups were compatible due to insignificant differences between their preoperative general data (P ＞ 0.05).This cohort was followed up for 9 to 24 months (average,17.5 months).Of them,52 achieved fracture union.Of the 27 patients who failed,8 were in the experimental group (21.6％) and 19 in the control group (45.2％),showing a significant difference in the rate of failure between the 2 groups (P ＜ 0.05).In the experimental group,the rate of nonunion was 8.1％ (3/37),the rate of implant failure 18.9％ (7/37),and the rate of fermoral neck varus 8.1％ (3/37),all significantly lower than those in the control group [26.2％ (11/42),40.5％ (17/42) and 23.8％ (13/42),respectively] (P ＜0.05).Conclusion For treatment of vertical femoral neck fractures,the technique of static compression screws with medial support is not only easy but also leads to a lower rate of complications.