A comparative study of three internal fixation techniques for split fractures of humeral greater tuberosity / 中华创伤骨科杂志

Objective:To compare the clinical effectiveness between arthroscopic hollow screws combined with a suture anchor, hollow screws and proximal humerus internal locking system (PHILOS) in the treatment of split-type fractures of humeral greater tuberosity.Methods:A retrospective study was conducted to analyze the 54 patients with split-type fracture of humeral greater tuberosity who had been admitted to Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University from May 2015 to August 2020. There were 17 males and 37 females with an age of (58.4±12.1) years. According to different treatment methods, they were divided into 3 groups. Group A of 18 cases was treated with arthroscopic hollow screws combined with a suture anchor, group B of 18 cases with hollow screws, and group C of 18 cases with PHILOS. The length of surgical incision, and range of shoulder motion, visual analogue scale (VAS), and American Shoulder and Elbow Surgeons (ASES) score at the last follow-up were recorded and compared between the 3 groups.Results:There was no statistically significant difference in the preoperative general information between the 3 groups, indicating the 3 groups were comparable ( P>0.05). The surgical incision in group A [(0.7±0.1) cm] was the shortest, followed by (5.0±1.4) cm in group B, and (12.8±2.1) cm in group C, showing statistically significant differences in pairwise comparison ( P<0.05). In the 3 groups at the last follow-up, respectively, the shoulder forward flexion was 159.7°±13.4°, 154.9°±16.2°, and 160.5°±12.9°, and the shoulder abduction 149.6°±11.3°, 142.4°±12.0°, and 145.1°±10.4°, showing no statistically significant difference among the 3 groups ( P>0.05); the external rotation was 41.1°±8.1°, 38.1°±7.8° and 43.7°±6.2°, showing a statistically significant difference between groups B and C ( P<0.05); the dorsal extension was T 12 (L 5 to T 6), T 12 (L 5 to T 7), and T 12 (L 3 to T 6), showing no statistically significant difference among the 3 groups ( P>0.05). There was no statistically significant difference among the 3 groups in the VAS score or ASES score at the last follow-up ( P>0.05). Respectively, there were 2, 6, and 4 patients in groups A, B and C who developed complications, showing statistically significant differences between the 3 groups ( P<0.05). Conclusions:In the treatment of split fractures of humeral greater tuberosity, arthroscopic hollow screws combined with a suture anchor, hollow screws and PHILOS can all relieve pain and restore joint function of the shoulder. However, arthroscopic hollow screws combined with a suture anchor are the most recommendable due to their advantages in minimally invasiveness and reduction in complications.

Arthroscopic double-row bridging suture versus minimally invasive locking plate system in treatment of avulsion fracture of humeral greater tuberosity / 中华创伤骨科杂志

Objective To compare arthroscopic double-row bridging suture and minimally invasive locking plate system in the treatment of simple avulsion fracture of humeral greater tuberosity.Methods A retrospective study was conducted of the 93 patients with avulsion fracture of humeral greater tuberosity who had been treated at Orthopaedic Center,Beijing Luhe Hospital from January 2012 to December 2016.Of them,38 were treated by arthroscopic double-row bridging suture (ADRB) and 55 by open reduction and internal fixation with minimally invasive locking plate system (MIPS).Regular X-ray follow-ups were carried out at 3,6 and 12 months postoperatively and every 6 months afterwards.Surgical time,range of motion (ROM) of the shoulder,American Shoulder and Elbow Surgeons (ASES) score,Visual Analogue Scale (VAS) and complications were recorded preoperatively and at the last follow-up.Results The patients of the arthroscopy and plate groups were comparable because there were no significant differences in the preoperative general data between them (P ＞ 0.05).The average follow-up time for the 93 patients was 35.9months (from 12 to 60 months).The operation time for the arthroscopy group (97.0 ± 20.1 min) was significantly longer than that for the plate group (67.5 ± 19.0 min) (P ＜ 0.05).At the last follow-up,anteflexion lift (152.6° ± 12.9°),abduction lift (154.0° ± 13.5°) and internal rotation angle at 90° (57.7° ±12.2°) in the arthroscopy group were significantly better than those in the plate group (134.9° ± 17.8°,129.5° ± 18.6° and 50.8° ± 12.9°,respectively) (P ＜ 0.05).At the last follow-up,the ASES scores for the arthroscopy and plate groups were 88.5 ± 7.6 and 85.1 ± 11.3,respectively,showing no statistically significant difference (P ＞ 0.05);the VAS scores for the 2 groups were 1.5 ± 1.2 and 2.2 ± 1.5 respectively,showing a statistically significant difference between the 2 groups (P ＜ 0.05).There was no significant difference between the2 groups in improvement of ASES scores (P ＞ 0.05).Ninety fractures healed after 3 months while 3 fractures in the arthroscopy group did after 6 months.In the plate group,7 patients developed shoulder stiffness 3 to 6 months after surgery and 3 ones reported pain during abduction.Conclusions Both ADRB and MIPS are an effective treatment for simple avulsion fracture of humeral greater tuberosity.MIPS fixation needs shorter surgical time while ADRB leads to better postoperative shoulder ROM.

Surgical treatment of proximal humeral fracture in the elderly with anatomical plate internal fixation / 中国医师进修杂志

Objective To investigate the effects of treatment of proximal humeral fracture in the elderly with anatomical plate internal fixation.Methods Twenty-seven cases of proximal humeral fractures received operative treatment with anatomical plate.According to Neer classification,there were 18 patients with three-part fractures of the bone,there were 9 patients with four-part fractures of the bone.Results Twenty-seven patients were followed up for 6-24 months.According to the evaluation of Herscovici scales,the result were excellent in 17 cases,and good in 8,92.6％ (25/27) of all reductions were excellent or good.The excellent and good rate of Constant-Murley score was 88.9％(24/27 ).Conclusion It is an ideal way to treat the displaced proximal humeral fracture with anatomical plate,which can provide rigid fixation,it allows early functional treating.

Open reduction and rehabilitation of the deformity after humeral lateral condyle fractures in children / 中国矫形外科杂志

[Objective]To investigate etiopathogenisis,modus operandi and rehabilitation in treatment of bone nonunion and residual deformity (cubitus valgus) after humeral lateral condyle fractures in children. [Method]The author retrospective summarized a total of 27 patients diagnosed with humeral lateral condyle fracture follow with bone nonunion and/or cubitus valgus consecutive enrolled in Children’s Hospital of Chongqing Medical University from 2001 to 2006,including 19 cases of male,8 cases of female,16 cases of right humeral lateral condyle fracture and 11 cases of left. The mean age at injured for all the patients (n =27) was 5.6 yr (range 3-10 yr).The mean age at suigical operation for all the patients (n =27) was 9 yr (range 5-14 yr).The average time from injury to operation was 2.8 yr (range 8mon-10 yr).There were three modus operations including direct normal position internal fixation of 7 cases,open reduction following os illium bone graft internal fixation of 11 cases,distant humerus varus wedge shape cut orthopaedic for 9 cases.[Result]Thirteen patients were followed up ranging from 6 month to 2 years,and 14 patients over 2 years. All the patients were achieved union for 8 to 16 weeks after surgery. Elbow deformity had been corrected and function of elbow joint had been recoverd satisfactorily. All of them,excellent rerult were found in 13 cases,good in 11 cases,and poor in 3 cases,the excellent and good rates was 88.9%. None of the cases happened with osteonecrosis,traumatic arthritis and myositis ossificans.[Conclusion]It is common that delay treatment of humeral lateral condyle fractures in children can result in bone nonunion and residual deformity (cubitus valgus) and it is difficult for treatment. Corresponding surgical treatment with different condition and early exercise can improve the appearance and function of elbow joint.

Clinical analysis of treatment of nonunion of humeral shaft fracture with bidentate intramedullary interlocking nails / 中国矫形外科杂志

[Objective]To observe the effect of the nonunion of humeral shaft fracture treated by bidentate intramedullary locking nails.[Method]Twenty-five cases of fracture nonunion of humeral shaft were cured by bidentate intramedullary locking nails from January 2000 to November 2004.and they received operations to remove their previous instruments.After the bidentate intramedullary nails was inserted via antegrade approach,and autogenous cancellous bone was grafted.[Result]Twenty of the 25 cases were available for follow up.The follow up lasted 10 to 26 months.All cases achieved solid union within 4 to 10 months.There were no complication such as incision infection or occurring of osteomyelitis.[Conclusion]Bidentate intramedullary locking nails can provide the effective control of harmful shearstress,it can provide firm internal fixation,And this methods is an ideal method for treatment of humeral shaft fracture nonunion.

The treatment of the nonunion of humeral shaft with the interlocking medullary nail / 中国康复理论与实践

@#ObjectiveTo observe effects of the nonunion of stale humeral shaft fracture treated by using the interlocking medullary nail.Methods21cases with the stale fracture of humeral shaft were treated with the interlocking medullary nail. The effect over post operation 1 year was evaluated.ResultsAll cases were recovery after treated by the interlocking medullary nail. Conclusions It shows that the effect of treating the fracture of humeral shaft with the interlocking medullary nail is very satisfactory.