Comparison of open reduction and locking plating versus closed reduction and interlocking intramedullary nailing in treatment of humeral surgical neck fractures / 中华创伤骨科杂志

Objective:To compare the curative efficacy in the treatment of humeral surgical neck fractures between open reduction and locking plating versus closed reduction and interlocking intramedullary nailing.Methods:From July 2018 to July 2020, 60 patients with humeral surgical neck fracture were treated at Department of Orthorpaedic Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine. They were 24 males and 36 females, aged from 40 to 70 years and injured at the left side in 35 cases and at the right side in 25 ones. Of them, 30 underwent open reduction and locking plating (open group) and the other 30 closed reduction and interlocking intramedullary nailing (closed group). The 2 groups were compared in terms of operation time, intraoperative blood loss, surgical incision length, fracture healing time, Neer shoulder function scoring 3 months after surgery, and postoperative complications.Results:There were no statistically significant differences between the open and closed groups in preoperative general data, showing they were comparable ( P>0.05). The length of surgical incision [(5.2±1.1) cm], operation time [(34.3±12.7) min], intraoperative blood loss [(52.5±7.3) mL] and fracture healing time [(9.2±1.5) weeks] in the closed group were significantly better than those in the open group [(11.1±2.5) cm, (69.4±21.4) min, (123.5±5.2) mL and (14.2±3.4) weeks)] ( P<0.05). The excellent and good rate by Neer shoulder function scoring at 3 months after operation in the closed group (93.3%, 28/30) was significantly higher than that in the open group (66.7%, 20/30) ( P<0.05). There were no postoperative complications in either group. Conclusion:In the treatment of humeral surgical neck fractures, the curative efficacy of closed reduction and interlocking intramedullary nailing is better than that of open reduction and locking plating.

Floating needle therapy for postoperative functional rehabilitation in patients with surgical neck fracture of humerus: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the effect of floating needle therapy on myofascial trigger point (MTrP) and conventional electroacupuncture on the recovery of shoulder joint function after surgical neck fracture of humerus on the basis of drugs and rehabilitation training.@*METHODS@#A total of 72 patients with unilateral surgical neck fracture of humerus were randomly divided into a floating needle group (35 cases) and an electroacupuncture group (37 cases). At the same time of the basic treatment, both groups were intervened on the 2nd day after operation. Touched the MTrP at the affected limb, and the floating needle was used to sweep around it in the floating needle group. In the electroacupuncture group, electroacupuncture was applied at Hegu (LI 4), Quchi (LI 11), Waiguan (TE 5) on the affected side, the dilatational wave (4 Hz/20 Hz) was selected. The treatment was given once every day for 2 weeks. Pain visual analogue scales (VAS) score, constant shoulder joint score, and changes in the number of MTrP were used to evaluate the pain and functional status of the shoulder joints before, after treatment, and 3 months after treatment.@*RESULTS@#Compared with that before treatment, the VAS scores were decreased, the constant scores were increased, and the numbers of MTrP were decreased in the two groups after treatment and 3 months after treatment (<0.05), but the improvement in the floating needle group was better than that in the electroacupuncture group (<0.05). Compared with that after treatment, the VAS scores were decreased and the constant scores were increased 3 months after treatment in the floating needle group (<0.05), and the VAS scores in the electroacupuncture group were decreased (<0.05).@*CONCLUSION@#Floating needle therapy is helpful for the rehabilitation of shoulder joint function after surgical neck fracture of the humerus, and its curative effect is better than conventional electroacupuncture.

A clinical study of management of proximal humeral fractures in adults.

Background: Fractures of the proximal humerus are one of the commonest fractures encountered by an orthopaedician. The incidence of this fracture has significantly increased perhaps due to the increased vehicular traffic and mechanized life. The approach towards the management of these fractures types of fractures has changed during the course of period. Since the appropriate treatment and results associated with each modality of treatment for these fractures is not defined this study was undertaken. Methods: This longitudinal study was done on 150 cases of proximal humerus fractures which were managed by both conservative and surgically. Initial preoperative clinical and radiological assessment was done and appropriate mode of treatment of given depending upon type of fracture according Neer’s classification. Follow up of patient was done both clinically and radiologically at 2nd, 6th and 8th weeks and assessed for any complications. Final assessment was done according to Neer`s shoulder scoring criteria. Results: The 90 cases were treated conservatively and 60 surgically. Maximum follow up was 9 months and minimum 4 month with an average follow- up of 6.67 months. Our series showed excellent result in 70 cases (46.6%), satisfactory in 65 cases (43.3%) and fair in 15 cases (10%). Conclusion: Undisplaced fractures of the proximal humerus can be managed conservatively and non-displaced tuberosity fractures, if managed conservatively, give good results. Displaced two or three part fractures in young patients need anatomical reduction with internal fixation. Conservative treatment of four part fractures, four part fracture dislocation and anatomical neck fractures gives poor results and so primary hemiarthroplasty is indicated. There is direct relationship between displaced proximal humeral fractures between fracture severity i.e. greater displacement, communition, and crushing and the eventual results that is more than the initial insult, worse the prognosis. Rehabilitation is the key to success.

Polarus Intramedullary Nail for Nonunion of Humerus neck

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

Surgical Treatment of Nonunions of the Surgical Neck of the Humerus in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment of nonunion of the surgical neck of the humerus in elderly patients. MATERIALS AND METHODS: Seven patients over 60 years of age surgically treated for nonunion of the surgical neck of the humerus with follow- up over 1 year were investigated. Of the three patients with severe osteoporosis, multiple K-wires were used in 1 patient, and Ender nails were used in 2. The other 4 patients with relatively good bone quality were treated with plate and screws. Functional results were evaluated using the University of California, Los Angeles (UCLA) shoulder rating scale and statistical significance was tested using the Wilcoxon signed rank test. RESULTS: Radiological union was obtained in six patients, and 1 patient had no evidence of union at a postoperative 5 years. Active elevation improved from an average of 73 (range, 20-100) degrees to 139 (range, 110-160) degrees. The UCLA score improved from 10.9(range, 7-16) points to 27.3 (range, 10-33) points on the average. CONCLUSION: Open reduction with internal fixation and bone grafting for nonunion of the surgical neck of the humerus in elderly patients may result in significant functional improvement.

Pushing scapula reset anterior dislocation of shoulder with fracture of surgical neck of humerus / 临床外科杂志

Objective To seek a new closed reduction for anterior dislocation of shoulder with fracture of surgical neck of humerus.Method 6 cases in present study were well followed up.There were 4 males and 2 females.The average age was 42.5 years old;the average time of injury to reduction was 3.5 hours.After local anesthesia,on prone position,one hand carried on the head of humerus, another pushed the scapula.All cases were treated successfully.Result According to the Neer criterion, 4 cases were excellent,2 cases were satisfactory.Conclusion Anterior dislocation of shoulder with fracture of surgical neck of humerus can be succeeded in manual reduction.

Treatment of displaced humeral surg ical neck fractures with closed reduction and percutaneous pin fixation / 中华创伤骨科杂志

Objective To summarize the methods and results of treatment of displaced humeral su rgical neck fractures with closed reductio n and percutaneous pin fixation.Methods We reviewed 46patients who had been diagnosed as the displaced hume ral surgical neck fractures and trea ted with closed reduction and percut aneous pin fixation using?2.5mm Kirschner wire with terminal t hread from January 2001to December 2002in our hospital.Results34patients received a complete follow-up.The mean follow-up time was 22months(10to 34months).Evaluation was done with Constant-M urley rating system.The mean absolu te Constant-Murley score was 92(76～100).86%(29/34)of the cases were excellent or good,14%(5/34)were fair,and none were poor.All the fractures united 6to 8weeks after operation,a nd no fixation failure or humeral hea d necrosis was found.Conclusion Treatment of displaced humeral surg ical neck fractures with closed reduction and percutaneous pin fixation can shorten operation time,lead to minimal soft tissue lesion and reliable fixation,and allow early functional exercis e after op-eration and easy removal of the wire. [

Tension Band Wiring as a Treatment of the Surgical Neck Fracture of the Humerus / 대한정형외과학회잡지

Fractures of the upper end of the humerus are common and account for 4% to 5% of all fractures. They occur more frequently in older patients. In older patient the fracture often results from a minor fall and can be extremely disabling and their management often demands experienced surgical skill and judgement. Fortunately, in 80% of upper humeral fractures none of the four major segment is significantly displaced. These lesions are amenable to simple treatment by early function exercises. In 15% to 20% of upper humeral fractures one or more of the major segment is displaced. They are often unstable, may not be reduced by closed method. Many different methods of open reduction and internal fixation has been used and are still employed. These include wire loops, screw, staples, plates, intramedullary nail, but adequate internal fixation was not easily achieved due to the osteoporosis, displacement and shape of fragment. We treated 8 cases of surgical neck fractures by Rush pin and tension band wiring method. We consider this method as effective, simple and rigid fixation technique to attempt early exercise and to restore normal range of motion.