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.

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.

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.

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.

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.

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.

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.

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.

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.

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature.

Background: Displaced proximal humerus fractures generally result in long-term functional disability. Recently, the advances in treatment for proximal humerus fracture have involved minimally invasive plating which offer minimal soft tissue damage and rapid and improved healing of the fracture. In recent literature, there has been a shift towards the deltoid splitting approach for the fixation of proximal humeral fractures due to the increased visualization of the posterior fragments as well as the less amount of soft tissue stripping. We used the deltoid splitting approach to evaluate the feasibility and outcomes as regards to axillary nerve injury, complications and functional deficits. Methods: Out of a total of 35 patients included in this study, 28 were male and 7 were female; with a mean age of 44 (range26 - 62yrs.). Results: In patients, the fracture of the proximal humerus was classified as type III; while 30 % (n=6) had type II fracture, according to Neer’s classification. Depending upon the fracture anatomy and the need for exposure, the skin incision was a continuous long incision in 7cases, with complete exploration of axillary nerve in the substance of deltoid; while in 13 cases, fixation was done using two separate skin windows. The mean follow up period was 26weeks (range 18-32 weeks). The average time to radiological union was14 weeks (range12-2 0 weeks). At final follow up, there were no cases of nonunion. There were 2 cases (10%) with varus malunion of the head fragment, and 1 case (5%) of acromial impingement. Axillary nerve palsy or deltoid dysfunction was not seen in any of the patients. The mean Constant- Murley score of shoulder function, at final follow up, was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, by calculating the difference of score between the involved shoulder and the uninvolved shoulder, 60% patients(n=12) had excellent, 35% (n=7) had good and 5% (n=1) had fair functional results. Conclusion: Thus deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits.

Preventing Varus Deformity in Senile Patients with Proximal Humerus Fractures and Poor Medial Support

BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

Preventing Varus Deformity in Senile Patients with Proximal Humerus Fractures and Poor Medial Support

BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

Analysis of postoperative complications and long-term curative effect of elderly patients with proximal humerus fractures by locking proximal humerus plate / 局解手术学杂志

Objective To analyze the postoperative complications and long-term curative effect analysis of elderly patients with proximal humerus fractures by locking proximal humerus plate,and provide reference for such patients’clinical treatment.Methods A total of 92 elder patients with proximal humerus fractures in our hospital from September 2012 to September 2014 were included in the research.They were divided into control group (who were treated with anatomical bone plates)and observation group (who were treated with locking plates),according to different sugrical methods.The postoperative complications situation and long-term curative effect analysis of two groups were compared.Results The proportions of humerus head varus malunion and humerus head necrosis of observation group were less than those of control group,with statistically significant difference(P <0.05).And after six months of follow-up,the excellent rate of observation group were 89.1%,significantly more than control group 67.4%,with statistically significant difference(P <0.05).Conclusion The loc-king plate used in elderly patients with proximal humerus fractures can effectively reduce the occurrence of postoperative complications,and it has excellent long-term curative effect.

Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly

This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1), who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS) plate and 30 patients(Group 2) who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS) and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100) in Group 1 and - 76.4 points(range:56-100) in Group2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10) in Group 1 and 3.8(range:0-10) in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-ofmotionexercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.

The comparison of the effect of open reduction and internal fixation in the treatment of fractures of the proxi-mal humerus manipulative reduction and splint external fixation / 中国基层医药

Objective To compare the clinical efficacy of manipulative reduction and splint external fixation and open reduction and internal fixation in the treatment of fractures of the proximal humerus .Methods 62 patients with proximal humeral fractures were randomly divided into the two groups .31 cases in the manipulation group re-ceived manual reduction and splint external fixation;31 patients in the open reduction and internal fixation group were treated by open reduction and internal fixation .The clinical efficacy was compared between the two groups .Results The average healing time of the manual reduction group was (98.34 ±0.42) d,which was shorter than (121.53 ± 0.45)d of open reduction and internal fixation group (t=209.76,P<0.05).The incidence rate of pain in the manu-al reduction group was 22.58%,which was lower than 48.39% in the open reduction and internal fixation group (χ2 =4.51,P<0.05).The excellent and good rate of the manual reduction group was 96.77%,which was higher than 80.65%of the open reduction and internal fixation group (χ2 =4.03,P<0.05).Conclusion The clinical curative effect of manual reduction and splint external fixation in the treatment of proximal humerus fractures is better than open reduction and internal fixation ,it is a reliable choice for treatment of fractures of the proximal humerus .