Objective To compare the effectiveness between operative and non-operative treatment for 3- and 4-part proximal humeral fractures in elderly patients. Methods Between January 2009 and January 2011, 35 patients with 3- or 4-part proximal humeral fractures were treated with open reduction and locking plate internal fixation (n=20, operative group) and with closed reduction and splint or cast fixation (n=15, non-operative group). There was no significant difference in gender, age, etiology, fracture type, and disease duration between 2 groups (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. Results All patients of the operative group achieved healing of incision by first intention. All patients were followed up 16 months on average (range, 12-20 months). The X-ray films showed that the other fractures healed except 1 case (5.0%) nonunion in operative group. Varus malunion was found in 1 case (6.7%) of non-operative group and 2 cases (10.0%) of operative group. Humeral head necrosis was found in 1 case respectively in 2 groups (5.0% and 6.7%). There was no significant difference in complication incidence between 2 groups (P gt; 0.05). The Constant-Murley scores of non-operative group and operative group were 64.7 ± 9.9 and 66.8 ± 11.8 at last follow-up respectively, showing no significant difference (t=0.59, P=0.47). Conclusion Operative treatment has similar effectiveness to non-operative treatment for 3- and 4-part proximal humeral fractures. In elderly patients, non-operative treatment should be chosen.
Objective To evaluate the cl inical significance of minimally invasive percutaneous plate osteosynthesis (MIPPO) appl ied in Neer II, III parts fractures of proximal humeraus. Methods The cl inical data were retrospectively analyzed, from 30 patients with Neer II, III parts fractures of proximal humeraus in accordance with selection criteria, who were treated with manual reduction and plaster external fixation (11 cases, non-operative group) or with MIPPO (19 cases, operative group) between January 2008 and May 2010. In non-operative group, there were 6 males and 5 females with an average age of 60 years (range, 56-80 years) and with an average time of 10 hours (range, 3-24 hours) between injury and reduction, including 8 cases of Neer II and 3 cases of Neer III. In operative group, there were 13 males and 6 females with anaverage age of 65 years (range, 45-78 years) and with an average time of 3 days (range, 1-5 days) between injury and operation, including 9 cases of Neer II and 10 cases of Neer III. There was no significant difference in gender, age, fracture type, and time from injury to operation (P gt; 0.05). The shoulder joint function before and after treatments was evaluated according to Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons’ Form (ASES) scoring systems. Results Thirty patients were followed up. In operative group, the follow-up time ranged from 11 to 18 months (mean, 12 months); all incisions healed by first intention with no compl ication of internal fixation failure, infection, or nerve injury. In non-operative group, the follow-up time ranged from 9 to 15 months (mean, 11 months). The X-ray films showed that fractures healed without humeral head necrosis in 2 groups. The bone heal ing time in operative group and non-operative group was (11.47 ± 2.48) weeks and (11.82 ± 2.44) weeks, respectively, showing no significant difference (t=0.369, P=0.889). The CMS score and ASES score at each time point after treatment were significantly better than those before treatment (P lt; 0.05); the CMS scores in operative group were better than those in non-operative group at 3 weeks, 3 months, and 1 year after treatment (P lt; 0.05); and the ASES score in operative group was better than that in non-operative group at 3 weeks and 3 months after treatment (P lt; 0.05), but no significant difference was found at 1 year after treatment (P gt; 0.05). Conclusion MIPPO fixation using the locking compression plate is an effective option for Neer II, III parts fractures of proximal humeraus. It can provide good functional recovery of the shoulder joint so that patients can get back to their normal l ife as soon as possible.
Objective To review the biomechanics of internal fixators for proximal humeral fractures, and to compare the mechanical stabil ity of various internal fixators. Methods The l iterature concerning the biomechanics of internal fixators for proximal humeral fractures was extensively analyzed. Results The most important things for best shoulder functional results are optimal anatomical reduction and stable fixation. At present, there are a lot of methods to treat proximal humeral fractures. Locking-plate exhibites significant mechanical stabil ity and has many advantages over other internal fixators by biomechanical comparison. Conclusion Locking-plate has better fixation stabil ity than other internal fixators and is the first choice to treat proximal humeral fractures.
Objective To evaluate the cl inical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) in the treatment of proximal humeral shaft fracture. Methods From July 2004 to April 2008, 26 patients with displaced fractures of the proximal humeral shaft were recruited, including 8 males and 18 females. Age of patients averaged 66 years old (range, 34-82 years old). According to AO classification, there were 4 cases of type A1, 2 cases of type A2, 8 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1 and 2 cases of type C2. The time from injury to surgery averaged 2 days (range, 1-5 days). There were 8 osteoporotic fractures. Results All surgical wound healed primarily, and there was no wound infection. Three patients had postoperative radial nerve neurapraxia, which recovered at 4, 6, 8 months respectively. All patients were followed up for 6-24 months with an average of 14.1 months. Radiological examination revealed bony union within 6 months in 25 cases. There was 1 delayed union which remained asymptomatic and eventually healed at 8 months with acceptable Constant-Murley score. There were 3 cases of shoulder impingement syndrome diagnosed at 3 months post-operatively. After implant removal, they all achieved an acceptable Constant-Murley score. According to Constant-Murley scoring system, there were 11 excellent, 10 good and 5 acceptable results. The excellent or good rate was 80.8%. Conclusion MIPO technique using LCP is an effective method to treat proximal humeral shaft fractures, which facil itates functional recovery of the shoulder joint. During the surgery, it is important to achieve a good fracture reduction and to avoid compl ications.
ObjectiveTo assess the effect of surgical treatment or conservative treatment on the clinical outcomes for displaced 3-part or 4-part proximal humeral fractures in elderly patients. MethodsWe searched CNKI (between January 1979 and April 2014), Wanfang Data (between January 1982 and April 2014), Medline (between January 1946 and April 2014), PubMed (between January 1966 and April 2014), Embase (between January 1974 and April 2014) and Cochrane Database of Systematic Reviews (between January 2005 and April 2014) for randomized controlled trials comparing surgical treatment and conservative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients. The data were extracted and a Meta-analysis was made using RevMan 5.2. ResultsFive randomized controlled trials with a total of 226 patients were accepted in this Meta-analysis. The differences of Constant scores[WMD=0.48, 95%CI (-4.39, 5.35), P=0.85], incidences of avascular necrosisr of the humeral head[RR=0.66, 95%CI (0.37, 1.16), P=0.15], incidences of nonunion[RR=0.56, 95%CI (0.20, 1.58), P=0.27], incidences of osteoarthritis[RR=0.35, 95%CI (0.10, 1.22), P=0.10] between the two groups were not statistically different. The difference of incidences of additional surgery after primary treatment was statistically significant[RR=3.52, 95%CI (1.18, 10.45), P=0.02]. ConclusionThe results does not support the surgical treatment to improve the shoulder function when compared with conservative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures. But surgical treatment increases the incidence of additional surgery after primary treatment. Considering surgery can increase the trauma and economic burden of patients, so the conservative treatment is suggested.
ObjectiveTo investigate the clinical results of locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation. MethodsBetween January 2011 and August 2012, 16 patients with proximal humeral fractures (AO type C2) were treated by locking-plate with an intramedullary fibular allograft. The clinical data were retrospectively analysed. There were 5 males and 11 females with an average age of 64 years (range, 55-70 years). The injury causes were falling injury in 12 cases, traffic accident injury in 3 cases, and sports injury in 1 case. The duration between injury and operation ranged from 2 to 6 days (mean, 4.5 days). The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head; the disability of arm, shoulder, and hand (DASH) score, short-form 36 health survey scale (SF-36), and Neer score were used to evaluate the function of the shoulder after surgery. ResultsPrimary healing of incision was obtained in all patients; no complication of vascular and nerve injury occurred. Sixteen cases were followed up 12-24 months (mean, 18 months). All fractures healed at 18-24 weeks (mean, 20 weeks). No complication occurred as follows:re-displacement, necrosis, rejection reaction, and loosening or extraction of screws. At last follow-up, the neck-shaft angle was 126.6-136.9° (mean, 132.5°), showing a little lost when compared with intraoperative angle (130.5-138.0°, 134.0° on average). At 12 months after surgery, the height loss of humeral head was 1.8-4.6 mm (mean, 2.0 mm); the passive anteflexion of the shoulder was 130-160° (mean, 148°); the active anteflexion was 120-145° (mean, 136°); the external rotation was 30-65° (mean, 56°); the internal rotation was 15-25° (mean, 19°). And the DASH score was 2-53 (mean, 12); the SF-36 score was 50-95 (mean, 89). According to Neer score for shoulder function, the results were excellent in 10 cases, good in 4 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 87.5%. ConclusionLocking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation has satisfactory clinical results because of stable fixation, high clinical outcome scores, and low internal fixation failure.
ObjectiveTo evaluate the effectiveness of titanium elastic nails for severe displaced proximal humeral fractures in older children. MethodsBetween April 2009 and July 2012, 31 cases of severe displaced proximal humeral fractures were treated with closed or open reduction and fixation with 2 titanium elastic nails, and the clinical data were retrospectively analyzed. There were 23 boys and 8 girls, aged from 10 to 15 years (mean, 12.8 years). The causes of injury were sports injury (16 cases), traffic accident (11 cases), and falling from height (4 cases). The interval from injury to operation was 6 hours to 7 days (mean, 72 hours). According to Neer-Horwitz classification, 17 cases were rated as type III fracture and 14 cases as type IV fracture. There were 21 cases of metaphyseal fractures and 10 cases of epiphyseal fractures. ResultsSatisfactory reduction of fracture and stable fixation were obtained in all patients (closed reduction in 23 cases and open reduction in 8 cases). Primary healing was achieved in all incisions; no infection and neurovascular injury occurred. All patients were followed up 12-36 months with an average of 20 months. X-ray films showed that all fractures healed at 7-10 weeks (mean, 8 weeks). During follow-up, no disturbance of development or angulation deformity caused by premature physeal closure or bone bridge formation was observed. At last follow-up, the average Neer score of the shoulder was 95.7 (range, 83-100). The appearance and motion of the shoulder were normal. There was no significant difference in the upper extremity length between affected side and contralateral side[(67.68±2.56) cm vs. (67.61±2.54) cm; t=-1.867,P=0.072]. ConclusionTitanium elastic nails for severe displaced humeral fractures in older children is a safe and effective method with a low complication incidence.
ObjectiveTo observe the influence of different humeral neck-shaft angle on the efficacy in the treatment of proximal humeral fractures with locking plate. MethodsA total of 106 patients with proximal humeral fractures were treated by locking plate between March 2009 and March 2013, and the clinical data were retrospectively analyzed. Of 106 cases, 58 were male and 48 were female, aged from 26 to 71 years (mean, 52.3 years). The causes were traffic accident injury in 54 cases, falling injury from height in 23 cases, falling injury in 21 cases, and others in 8 cases. According to the Neer classification, there were 32 cases of two-part fractures, 65 cases of three-part fractures, and 9 cases of four-part fractures. The time from injury to operation was 1-7 days (mean, 2.7 days). According to neck-shaft angle by X-ray measurements at 1-3 days after operation, the patients were divided into 3 groups:valgus group (>145°), normal group (126-145°), and varus group (<126°) to observe the influence of neck-shaft angle on efficacy. ResultsAccording to postoperative humeral neck-shaft angle, there were 10 cases in valgus group, 75 cases in normal group, and 21 cases in varus group. There was no significant difference in general clinical data among 3 groups (P>0.05). The patients were followed up 6-12 months. The X-ray results showed fracture healing, and no significant difference was found in fracture healing time among 3 groups (P>0.05). After 6 months, the varus angle of femoral head and visual analogue scale (VAS) score of normal group were significantly lower than those of valgus group and varus group (P<0.05). The excellent and good rate of Constant-Murley score was 78.67% (59/75) in normal group, and it was significantly higher than that in valgus group (60.00%, 6/10) and varus group (42.86%, 9/21) (P<0.05), but there was no significant difference between valgus group and varus group (P>0.05). The complication rate was 28.57% (6/21) in varus group, was 10.67% (8/75) in normal group, and was 20.00% (2/10) in valgus group, showing no significant difference among 3 groups (χ2=4.31, P=0.12). ConclusionReconstruction of normal neck-shaft angle is the key to good shoulder function and clinical efficacy in the treatment of proximal humeral fracture.
Because of the complexity of proximal humeral fractures, the treatment of proximal humeral fractures has always been a challenge for clinicians. The MultiLoc intramedullary nail is a new type of internal fixation device which has been gradually used in the treatment of proximal humeral fractures in recent years. At present, it is mainly used in the Neer two- and three-part fractures, especially surgical neck fractures. Its flexible design can provide personalized and multi-plane fixation for fracture patients, “screw-in-screw” and medial supporting screw can effectively reduce the axial displacement and varus angle of humeral head, and minimally invasive surgical incision can reduce the injury of rotator cuff. This review focuses on the research status and related evidence of the design, operation, prognosis, and postoperative complications of MultiLoc intramedullary nail, in order to provide a theoretical basis for the application of MultiLoc intramedullary nail in fracture treatment, and enhance clinicians’ understanding of MultiLoc intramedullary nail as a new type of internal fixation device.
ObjectiveTo investigate the effectiveness of suspensory external fixation technique in treatment of proximal humeral fractures.MethodsBetween 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.ResultsAll 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.ConclusionFor proximal humeral fractures, the suspensory external fixation technique is a simple and reliable treatment method that can significantly improve joint function.