Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts: A retrospective, comparative cohort study.

BACKGROUND: Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support, which are important factors that lead to internal fixation failure. The appropriate treatment for proximal humerus comminuted fractures has not been established. Therefore, this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. AIM: To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. METHODS: This retrospective, comparative cohort study included two groups of patients. Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data. Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation. Group 2 was treated with open reduction and locking plates to enable internal fixation. The intraoperative blood loss volume from the shoulder wound, operative time, shoulder wound pain, bone fracture healing time, Constant-Murley score of the shoulder joint, preoperative Holden walking function score, Mallet score of the shoulder joint, and humeral neck-shaft angle during surgery of the two groups were compared, and the differences were analysed using an independent sample t-test. RESULTS: Group 1 had a shorter mean operative time than group 2 (2.25 ± 0.30 h vs 2.76 ± 0.44 h; P = 0.000). Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2 (7.91 ± 1.15 points vs 8.56 ± 1.00 points; P = 0.044). Group 1 had a shorter fracture healing time than group 2 (2.68 ± 0.48 mo vs 3.64 ± 0.64 mo; P = 0.000). Group 1 had higher Constant-Murley scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (76.64 ± 4.02 points vs 72.72 ± 3.02 points, 86.36 ± 3.53 points vs 82.96 ± 3.40 points, and 87.95 ± 2.77 points vs 84.68 ± 2.63 points, respectively; P = 0.000, 0.002, and 0.000, respectively). Group 1 had higher Mallet scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (10.32 ± 0.57 points vs 9.96 ± 0.54 points, 13.36 ± 1.00 points vs 12.60 ± 0.87 points, and 13.91 ± 0.75 points vs 13.36 ± 0.70 points, respectively; P = 0.032, 0.007, and 0.013, respectively). CONCLUSION: Using locking plates with a fibular autograft can recreate medial support, facilitate fracture healing, and improve shoulder function; therefore, this may be an effective treatment option for severe proximal humerus comminuted fractures.

[A case-control study of preserving the shape of iliac bone and traditional iliac osteotomy].

OBJECTIVE: To compare and study the traditional iliac bone extraction and iliac crest preserving bone extraction, and to observe their curative effects. METHODS: From January 2016 to December 2018, 50 patients were treated with traditional iliac bone extraction and iliac crest preserving iliac bone extraction, with 25 cases in each group. In the traditional iliac bone extraction group, there were 18 males and 7 females, aged (42.0±7.9) years, hospitalized for (20.0±5.5) days and followed up for (13.68±1.60) months. There were 16 males and 9 females in the iliac crest preserving osteotomy group, aged (44.0±8.2) years, hospitalized for (21.0±6.5) days and followed up for (14.04±1.54) months. The operation time, intraoperative bleeding, postoperative pain visual analgue scale(VAS), fracture healing and complications were recorded and compared between the two groups. RESULTS: In the traditional iliac bone extraction group, the operation time was (16.20±2.51) min, the amount of bleeding was (63.20±17.73) ml, the VAS score on the first day after operation was 4.72±1.21, and the fracture healing time was (4.84±0.90) months. In the iliac crest preserving osteotomy group, the operation time was (16.24±3.00) min, the amount of bleeding was (62.80±18.14) ml, the VAS score was 4.80±1.29 on the first day after operation, and the fracture healing time was (4.68±0.80) months. There was no significant difference in operation time, bleeding volume, pain VAS on the first day after operation and fracture healing time between the two groups(P>0.05). CONCLUSION: Compared with the traditional iliac bone removal surgery, this bone removal method of preserving the appearance of iliac bone is simple and convenient. While ensuring the amount of bone removal, it retains the appearance of iliac crest as much as possible and reduces local discomfort symptoms after operation. It is worth popularizing.

[Clinical analysis in treating lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration].

OBJECTIVE: To analyze effect of treatment of lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration,and to explore operative advantage and mattars needing attention. METHODS: Ninety-six patients with lumbar intervertebral disc herniation, including 48 males and 48 females with an average age of 46.4 years (ranging for 16-75 years) and an average course of 5 years (ranging from 1 month to 30 years), were treated with nucleus pulposus resection through small incision and lamina fenestration. The clinical effects were analyzed according to JOA scoring criteria of lower back pain. RESULTS: All patients were followed up from 6 months to 3.5 years with an average of 1.2 years. According to JOA scoring criteria, 34 cases obtained excellent result, 55 good, fair 7. The rate of excellent and good was 92.71% and the mean improvement rate was 54.53%. CONCLUSION: Nucleus pulposus resection through small incision and lamina fenestration can obtain satisfactory outcome in treating lumbar intertebral disc herniation. The incidence of lumbar instability and postoperative complications were low. It is one of the better method for the treatment of lumbar intertebral disc herniation.