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She R, Zhang B, Jiang K, Yang S, Zhang Y. Cement-Augmented Screw Fixation with PHILOS Plating for Osteoporotic Proximal Humeral Fractures: An Observation of Mid- and Long-Term Curative Efficacy. Orthop Surg 2023; 15:3108-3117. [PMID: 37828796 PMCID: PMC10694000 DOI: 10.1111/os.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES The mid- and long-term clinical outcomes of cement-augmented screws in the treatment of osteoporotic proximal humeral fractures have rarely been reported. The aim of this study was to observe the mid- and long-term efficacy of combined cement-augmented screw fixation and PHILOS plating in the treatment of osteoporotic fractures of the proximal humerus. METHODS This study retrospectively analyzed data from 19 patients with osteoporotic fractures of the proximal humerus who had undergone internal fixation at the Guizhou Provincial People's Hospital from February 2017 to May 2021. The cohort was comprised of six males and 13 females, aged 75-87 (mean age: 82.52 ± 1.24) years. According to the Neer classification, three, 12, and four patients had two-part, three-part, and four-part fractures, respectively. All patients were treated with open reduction internal fixation with cement-augmented screws and PHILOS plating. Time until fracture healing was recorded postoperatively. Patients were observed for postoperative complications, including humeral head necrosis, loosening or breaking of the augmented screws, screw perforation of the humeral head, and varus fracture displacement. Visual analog scale and Constant scores of the shoulder joint were compared 1, 3, 6, and 12 months after surgery. Scores at the most recent follow-up were used to evaluate shoulder joint function. Measured data conforming to a normal distribution were expressed as mean ± SD. Analysis of variance or rank sum tests were used for intergroup comparisons. A value of p < 0.05 was considered significant. RESULTS All 19 patients followed up for 1-4 (average: 2.13 ± 0.61) years. Fractures united in all cases, with a healing time of 8-14 (average: 10.25 ± 1.72) weeks. There were no cases of humeral head necrosis, screw loosening, fractures, or perforation of the humeral head. One patient had mild varus fracture displacement with a reduced neck-shaft angle. There were significant differences in visual analog scale and Constant scores 1, 3, and 6 months after surgery (p < 0.05). The visual analog scale score was 0 at final follow-up in all cases. The Constant score of the shoulder joint was excellent, good, fair, and poor in two, 12, four, and one case, respectively, yielding an excellent and good rate of 73.68%. CONCLUSIONS Cement-augmented screw fixation combined with PHILOS plating of osteoporotic proximal humeral fractures had good mid- and long-term clinical efficacy. It should be considered a new option for fracture treatment in such patients.
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Affiliation(s)
- Rongfeng She
- Guizhou Provincial People's HospitalGuiyangChina
| | - Bin Zhang
- Guizhou Provincial People's HospitalGuiyangChina
| | - Kundou Jiang
- Guizhou Provincial People's HospitalGuiyangChina
| | - Shuaiqi Yang
- Guizhou Provincial People's HospitalGuiyangChina
| | - Yi Zhang
- Guizhou Provincial People's HospitalGuiyangChina
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范 文, 崔 学, 石 柳, 谢 添, 芮 云, 陈 辉. [Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:274-278. [PMID: 35293166 PMCID: PMC8923928 DOI: 10.7507/1002-1892.202107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 01/24/2023]
Abstract
Objective To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups ( P>0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated. Results Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups ( t=-0.986, P=0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups ( t=2.250, P=0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups ( t=4.032, P<0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up ( P>0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant ( χ 2=4.498, P=0.034). Conclusion Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.
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Affiliation(s)
- 文斌 范
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 学良 崔
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 柳 石
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 添 谢
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 云峰 芮
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 辉 陈
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopaedics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学创伤骨科研究所(南京 210009)Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P. R. China
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Cognetti DJ, Ghali A, Gutierrez-Naranjo BJM, Handcox J, Karia R, Dutta AK. Technical Considerations and Early Results of Magnetic Compressive Intramedullary Nailing for Humeral Shaft Delayed Unions and Nonunions. JSES Int 2022; 6:385-390. [PMID: 35572440 PMCID: PMC9091776 DOI: 10.1016/j.jseint.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Expandable magnetic rods and intramedullary nails are being used in a number of innovative ways, including limb length discrepancy and scoliosis correction. However, recently, the full complement of these devices has been further explored, with the utilization of their compressive capacity to improve fracture healing. The purpose of the present study was to report on early results of compressive magnetic intramedullary nailing for humeral shaft delayed unions and nonunions. Methods This retrospective case series was completed at a level 1 trauma center, with adult patients who underwent compressive intramedullary nailing from 2017 to 2021 for humeral shaft nonunion or delayed union. The primary indication for this procedure was nonunion in the setting of previous conventional fixation, but a subset of patients with atrophic nonunions and risk factors for recalcitrant nonunion were also included. Results Fourteen patients, with a mean age of 51 ± 17 years, underwent compressive magnetic intramedullary nailing. Nine patients had previously underwent surgery, 6 of which had undergone multiple prior procedures. Five others were initially treated nonoperatively and underwent surgery 4.1 ± 2.9 months out from injury. Ten patients went on to union at a mean of 2.9 ± 2.4 months. One patient experienced hardware failure with nail cut-out at 2 weeks, and one required revision surgery for a wound infection. Three other patients were lost to follow-up, one of which was deceased for reasons unrelated to surgery. Conclusion Compressive magnetic intramedullary nails are a viable solution for complex humeral shaft nonunions, particularly in the setting of previously well-fixed fractures and those at risk of recalcitrant nonunion. However, comparative and prospective studies looking at union rates and secondary procedures are needed to more clearly define their role in treatment and assure their safety, given recent concerns regarding osteolysis at the nail modular junction.
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Mierke A, Shields TG, Williams NL, Zuckerman LM. Comparison of forces generated using compression plating versus a magnetic lengthening nail in a sawbones femur model. Clin Biomech (Bristol, Avon) 2021; 90:105508. [PMID: 34700236 DOI: 10.1016/j.clinbiomech.2021.105508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to compare compression generated by a Precice magnetic lengthening intramedullary nail and a 5.0 mm limited contact dynamic compression plate. METHODS Transverse osteotomy sites were created in the femoral shaft of ten Sawbones fourth generation composite femurs. Antegrade 10-degree trochanteric Precice nails and 8-hole, 5.0 mm plates were used for fixation. The plates were compressed by placing a neutral screw and three eccentrically drilled compression screws on alternating sides of the osteotomy. Average compression and distribution of compression were compared, and P-values <0.05 were considered statistically significant. FINDINGS The Precice nail generated an average of 2.38 megapascal across the osteotomy sites. The plate generated an average of 0.70 megapascal (P < 0.001) with the initial compression screw, 0.93 megapascal (P < 0.001) after the second screw, and 1.04 megapascal (p < 0.001) after the final screw. The distribution of compression was assessed utilizing a polar transformation to compare pressure values. We found that the distribution of compression was more circumferentially uniform in the Precice nail group (P = 0.046). INTERPRETATION This study demonstrates that an electromagnetic intramedullary device is capable of generating significantly higher compression, in a more uniform distribution, than a 5.0 mm limited contact dynamic compression plate in a Sawbones model. The results indicate that electromagnetic intramedullary nail systems may be an ideal alternative to compression plating for treatment of at-risk fractures, nonunions, delayed unions, and intercalary allograft reconstruction.
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Affiliation(s)
- Alex Mierke
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Troy G Shields
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Nadine L Williams
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Lee M Zuckerman
- Division of Orthopaedic Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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