Application of suspensory external fixation technique in treatment of proximal humeral fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Yonghui ^1,2 , PU Shaoquan ¹ , YIN Hao ³ , LÜ Qian ¹ , XU Yongqing ¹ ,  ZHU Yueliang ¹

1. Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China;
2. Department of Orthopedics, the First People’s Hospital of Yunnan Province/the Affiliated Hospital of Kunming University of Science and Technology, Kunming Yunnan, 650032, P.R.China;
3. Department of Clinical Medical College of Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

ZHU Yueliang, Email: zhuyuelianghu@sina.com

Keywords：

Proximal humeral fracture; suspensory external fixation technique; shoulder joint

DOI：

10.7507/1002-1892.202009016

Video：

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Objective To investigate the effectiveness of suspensory external fixation technique in treatment of proximal humeral fractures.Methods Between August 2013 and October 2018, 14 patients with proximal humeral fractures were treated with suspensory external fixation technique. There were 10 males and 4 females with an average age of 55.9 years (range, 43-76 years). There were 10 cases of falling injury and 4 cases of traffic accident injury. Among them, there were 9 cases of Neer type Ⅲ and 5 cases of Neer type Ⅳ. The time from injury to operation was 3-7 days (mean, 4.6 days). Nine cases were complicated with osteoporosis. The preoperative visual analogue scale (VAS) score was 6.1±1.2. The effectiveness was comprehensively evaluated by hospital stay, fracture healing time, removal time of external fixator, postoperative complications, VAS score, and Neer score of shoulder joint function.Results All operations were successfully completed, and the hospital stay was 6-14 days, with an average of 9.4 days. All the incisions healed by first intention, and no infection or other complications occurred. All patients were followed up 16-60 months (mean, 35.4 months). X-ray films examination showed that all fractures healed, the healing time was 4-7 months (mean, 4.9 months). The removal time of external fixator was 5-8 months (mean, 6.3 months). VAS scores were 1.5±0.8 at 1 month after operation and 1.0±0.9 at last follow-up, both of which were significantly improved when compared with preoperative score, the differences were significant between different time points (P<0.05). Neer score of shoulder joint function was 75-100 (mean, 91.1); 9 cases were excellent, 4 cases were good, and 1 case was fair. The excellent and good rate was 92.9%. During follow-up, there was no adverse events such as acromion impingement, nonunion, or pseudoarthrosis.Conclusion For proximal humeral fractures, the suspensory external fixation technique is a simple and reliable treatment method that can significantly improve joint function.

Citation： ZHAO Yonghui, PU Shaoquan, YIN Hao, LÜ Qian, XU Yongqing, ZHU Yueliang. Application of suspensory external fixation technique in treatment of proximal humeral fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 144-148. doi: 10.7507/1002-1892.202009016 Copy

1.	Passaretti D, Candela V, Sessa P, et al. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg, 2017, 26(12): 2117-2124.
2.	Khatib O, Onyekwelu I, Zuckerman JD. The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elbow Surg, 2014, 23(9): 1356-1362.
3.	金开基, 邢志利, 安帅. 老年复杂肱骨近端骨折的治疗选择: 保守治疗, 切开复位还是肱骨头置换? 系统评价及 Meta 分析. 中华肩肘外科电子杂志, 2019, 7(4): 319-328.
4.	Slobogean GP, Johal H, Lefaivre KA, et al. A scoping review of the proximal humerus fracture literature. BMC Musculoskelet Disord, 2015, 16: 112-122.
5.	Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury, 2007, 38(38 Suppl 3): S59-S-S68.
6.	孙淑建, 刘效志, 王金华, 等. 锁定钢板内固定并打压植骨治疗老年肱骨近端骨折疗效分析. 中国骨与关节损伤杂志, 2018, 33(1): 70-71.
7.	Newman JM, Kahn M, Gruson KI. Reducing postoperative fracture displacement after locked plating of proximal humerus fractures: current concepts. Am J Orthop (Belle Mead NJ), 2015, 44(7): 312-320.
8.	谢继勇, 谭响, 皮昌军, 等. 锁定钢板治疗老年肱骨近端骨折的疗效. 中华创伤杂志, 2017, 33(5): 414-418.
9.	Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
10.	Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
11.	Aguado HJ, Mingo J, Torres M, et al. Minimally invasive polyaxial locking plate osteosynthesis for 3-4 part proximal humeral fractures: our institutional experience. Injury, 2016, 47(47 Suppl 3): S22-S28.
12.	Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma, 2011, 71(6): 1737-1744.
13.	Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 85-95.
14.	Krappinger D, Roth T, Gschwentner M, et al. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol, 2012, 41(3): 299-304.
15.	Meier RA, Messmer P, Regazzoni P, et al. Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma, 2006, 20(4): 253-260.
16.	Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
17.	王明辉, 王秀会, 蔡攀, 等. 锁定钢板与髓内钉治疗复杂肱骨近端骨折临床疗效分析. 生物骨科材料与临床研究, 2020, 17(5): 41-45.
18.	曹鑫, 付鹏, 崔华安, 等. 锁定钢板与髓内钉治疗肱骨近端骨折临床疗效的荟萃分析. 骨科临床与研究杂志, 2020, 5(5): 290-297.
19.	陈锦涛, 韩树峰. 髓内钉与锁定钢板固定治疗肱骨近端骨折的 Meta 分析. 中国组织工程研究, 2020, 24(6): 938-946.
20.	Zhu Y, Lu Y, Wang M, et al. Treatment of proximal humeral fracture with a proximal humeral nail. J Shoulder Elbow Surg, 2010, 19(2): 297-302.
21.	Verbruggen JP, Stapert JW. Humeral fractures in the elderly: treatment with a reamed intramedullary locking nail. Injury, 2007, 38(8): 945-953.
22.	Chalmers PN, Slikker W, Mall NA, et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg, 2014, 23(2): 197-204.
23.	Gallinet D, Clappaz P, Garbuio P, et al. Three or four parts complex proximal humerus fractures: Hemiarthroplasty versus reverse prosthesis: A comparative study of 40 cases. Orthop Traumatol Surg Res, 2009, 95(1): 48-55.

1. Passaretti D, Candela V, Sessa P, et al. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg, 2017, 26(12): 2117-2124.
2. Khatib O, Onyekwelu I, Zuckerman JD. The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elbow Surg, 2014, 23(9): 1356-1362.
3. 金开基, 邢志利, 安帅. 老年复杂肱骨近端骨折的治疗选择: 保守治疗, 切开复位还是肱骨头置换? 系统评价及 Meta 分析. 中华肩肘外科电子杂志, 2019, 7(4): 319-328.
4. Slobogean GP, Johal H, Lefaivre KA, et al. A scoping review of the proximal humerus fracture literature. BMC Musculoskelet Disord, 2015, 16: 112-122.
5. Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury, 2007, 38(38 Suppl 3): S59-S-S68.
6. 孙淑建, 刘效志, 王金华, 等. 锁定钢板内固定并打压植骨治疗老年肱骨近端骨折疗效分析. 中国骨与关节损伤杂志, 2018, 33(1): 70-71.
7. Newman JM, Kahn M, Gruson KI. Reducing postoperative fracture displacement after locked plating of proximal humerus fractures: current concepts. Am J Orthop (Belle Mead NJ), 2015, 44(7): 312-320.
8. 谢继勇, 谭响, 皮昌军, 等. 锁定钢板治疗老年肱骨近端骨折的疗效. 中华创伤杂志, 2017, 33(5): 414-418.
9. Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
10. Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
11. Aguado HJ, Mingo J, Torres M, et al. Minimally invasive polyaxial locking plate osteosynthesis for 3-4 part proximal humeral fractures: our institutional experience. Injury, 2016, 47(47 Suppl 3): S22-S28.
12. Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma, 2011, 71(6): 1737-1744.
13. Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 85-95.
14. Krappinger D, Roth T, Gschwentner M, et al. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol, 2012, 41(3): 299-304.
15. Meier RA, Messmer P, Regazzoni P, et al. Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma, 2006, 20(4): 253-260.
16. Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
17. 王明辉, 王秀会, 蔡攀, 等. 锁定钢板与髓内钉治疗复杂肱骨近端骨折临床疗效分析. 生物骨科材料与临床研究, 2020, 17(5): 41-45.
18. 曹鑫, 付鹏, 崔华安, 等. 锁定钢板与髓内钉治疗肱骨近端骨折临床疗效的荟萃分析. 骨科临床与研究杂志, 2020, 5(5): 290-297.
19. 陈锦涛, 韩树峰. 髓内钉与锁定钢板固定治疗肱骨近端骨折的 Meta 分析. 中国组织工程研究, 2020, 24(6): 938-946.
20. Zhu Y, Lu Y, Wang M, et al. Treatment of proximal humeral fracture with a proximal humeral nail. J Shoulder Elbow Surg, 2010, 19(2): 297-302.
21. Verbruggen JP, Stapert JW. Humeral fractures in the elderly: treatment with a reamed intramedullary locking nail. Injury, 2007, 38(8): 945-953.
22. Chalmers PN, Slikker W, Mall NA, et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg, 2014, 23(2): 197-204.
23. Gallinet D, Clappaz P, Garbuio P, et al. Three or four parts complex proximal humerus fractures: Hemiarthroplasty versus reverse prosthesis: A comparative study of 40 cases. Orthop Traumatol Surg Res, 2009, 95(1): 48-55.

Chinese Journal of Reparative and Reconstructive Surgery

Application of suspensory external fixation technique in treatment of proximal humeral fracture

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