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Sepehri A, Stockton DJ, Roffey DM, Lefaivre KA, Potter JM, Guy P. Effect of humeral rotation on the reliability of radiographic measurements for proximal humerus fractures. J Orthop Sci 2024; 29:1078-1084. [PMID: 37393111 DOI: 10.1016/j.jos.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. METHODS Twenty-four patients with proximal humerus fractures fixed surgically with locked plates received postoperative anteroposterior radiographs with the humerus in neutral rotation and in 30° of internal and external rotation. Radiographic measurements for head shaft angle, humeral offset and humeral head height were performed in each humeral rotation position. Intra-class correlation coefficient was used to assess inter-rater and intra-rater reliability. Mean differences (md) in measurements between humeral positions was evaluated using one-way ANOVA. RESULTS Head shaft angle demonstrated good-to-excellent reliability; the highest estimates for inter-rater reliability (ICC: 0.85; 95% CI: 0.76, 0.94) and intra-rater reliability (ICC: 0.96; 95% CI: 0.93, 0.98) were achieved in neutral rotation. There were significant differences in measurement values between each rotational position, with mean head shaft angle of 133.1° in external rotation, and increasingly valgus measurements in neutral (md: 7.6°; 95% CI: 5.0, 10.3°; p < 0.001) and internal rotation (md: 26.4°; 95% CI: 21.8, 30.9°; p < 0.001). Humeral head height and humeral offset showed good-to-excellent reliability in neutral and external rotation, but poor inter-rater reliability in internal rotation. Humeral head height was significantly greater using internal compared to external rotation (md: 4.5 mm; 95% CI: 1.7, 7.3 mm; p = 0.002). Humeral offset was significantly greater in external compared to internal rotation (md: 4.6 mm; 95% CI: 2.6, 6.6 mm; p < 0.001). CONCLUSIONS Views of the humerus in neutral rotation and 30° of external rotation displayed superior reliability. Differences in radiographic measurement values, depending on humeral rotation views, can make for problematic correlations with patient outcome measures. Studies assessing radiographic outcomes following proximal humerus fractures should ensure standardized humeral rotation for obtaining anteroposterior shoulder radiographs, with neutral rotation and external rotation views likely yielding the most reliable results. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David J Stockton
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada.
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
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Foruria AM. Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement. Curr Rev Musculoskelet Med 2023; 16:457-469. [PMID: 37572239 PMCID: PMC10497484 DOI: 10.1007/s12178-023-09853-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE OF REVIEW Open reduction and internal fixation with locking plates (ORIF-LP) has been used for decades for the surgical management of proximal humerus fractures. Despite good outcomes have been widely published in the literature, unacceptably high rates of complications (up to 40%), many of them yielding poor outcomes and requiring reoperation (up to 25%), have also been reported, especially in elderly patients. Most common complications are related to implant failure, with intra-articular screw penetration as the most frequent and devastating. RECENT FINDINGS Advances in patient selection and surgical technique, and implementation of bone or cement augmentation, have been developed to hopefully decrease complication rates. Mayo-FJD Classification offers prognostic information that can aid in the decision-making process for proximal humeral fractures. Displaced valgus impacted fractures seem to be associated with well over a 10% rate of avascular necrosis after ORIF-LP. A principle-based and stepwise surgical technique combining anatomic reduction and a short screw configuration can provide good outcome in most patients, even the elderly, decreasing implant failures to less than 10%. Acrylic cement augmentation has the potential to further decrease implant failure rate to 1%. Reoperation rates are higher partly due to the need to remove hardware for painful subacromial conflict. However, no studies to date definitively demonstrated the superiority of ORIF-LP compared to non-operative treatment, intramedullary nailing, or reverse shoulder arthroplasty. ORIF-LP can provide good results for the surgical management of displaced proximal humerus fractures even in elderly patients provided adequate patient selection and a principle based and stepwise surgical technique, supplemented with bone graft or acrylic cement when needed. Poor outcomes and high complication and reoperation rates should be expected when these recommendations are not followed.
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Affiliation(s)
- Antonio M Foruria
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery, Autónoma University, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos 2, Madrid, Spain.
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Luciani P, Procaccini R, Rotini M, Pettinari F, Gigante A. Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient. Musculoskelet Surg 2022; 106:43-48. [PMID: 32504451 DOI: 10.1007/s12306-020-00669-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.
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Affiliation(s)
- P Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy.
| | - R Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - M Rotini
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - F Pettinari
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
| | - A Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Marche Polytechnic University, Via Tronto 10/A, 60126, Ancona, Italy
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Boyer P, Couffignal C, Bahman M, Mylle G, Rousseau MA, Dukan R. Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate. INTERNATIONAL ORTHOPAEDICS 2021; 45:2917-2926. [PMID: 34554308 DOI: 10.1007/s00264-021-05217-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was (1) to compare clinical and radiological outcomes of 3- and 4-part proximal humeral fractures using either IMN or LP (2) and to report complications related to each technique. METHODS A prospective controlled randomized open-label two-arm study was performed. Ninety-nine consecutive adult patients with a 3- and 4-part displaced acute proximal humeral fractures were randomized to be treated with IMN (n = 49) or LP (n = 50). Constant, ASES and SST scores were recorded by the surgeon. Range of motion was evaluated. A visual analog scale (VAS) was used to assess shoulder pain. Complications and revision surgeries were reported. RESULTS Eighty-five patients were analyzed, nine were lost, and five died during the follow-up period. The mean age was 73.7 years (± 13.3,, and the mean follow-up was 66 months (± 13.5). At last follow-up, VAS was lower in the IMN group (0.9 (± 1.1) vs. 1.9 (± 1.7), p = 0.001). The median Constant score was significantly higher in the IMN group (81.6 (± 10.9) points) vs. in the LP group (75.6 (± 19.5) points) (p = 0.043), and ASES score was also significantly higher in the IMN group (86.3 (± 9.5) vs. 75.2 (± 19.6), p = 0.001). There was no difference in the range of motion or SST scores between the two groups. Complications were seen higher in the LP group (9 (21%) vs. 22 (52%), p = 0.003). Revision surgery was higher in the LP group (37% vs. 21%). CONCLUSION Satisfactory results were accomplished in both groups according to the reported clinical outcomes. Complication and revision rates were higher in LP group.
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Affiliation(s)
- Patrick Boyer
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Camille Couffignal
- Clinical Research, Biostatistics and Epidemiology Department, AP-HP, Hôpital Bichat, F-75018, Paris, France
| | - Mohammad Bahman
- Alrazi Hospital, University of Kuwait, Al Sabah Medical Area, Kuwait, Kuwait
| | - Guy Mylle
- Clinique Hartmann, Neuilly Sur Seine, France
| | - Marc-Antoine Rousseau
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France
| | - Ruben Dukan
- Orthopaedic Surgery Department, Université de Paris, Hôpital, Bichat 46 Henri Huchard, 75018, Paris, France.
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García-Virto V, Santiago-Maniega S, Llorente-Peris A, Simón-Pérez C, Álvarez-Ramos BA, García-Florez L, Aguado HJ. MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results. Injury 2021; 52 Suppl 4:S125-S130. [PMID: 33678466 DOI: 10.1016/j.injury.2021.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to determine the feasibility of applying the MIPO technique with a helical-shaped plate in the treatment of humeral shaft fractures with proximal extension. PATIENTS AND METHODS We present an observational prospective study of patients with a humeral shaft fracture involving the proximal humerus fixed with a long proximal humerus polyaxial locking plate with an anterior curvature and helical shape (ALPS® Zimmerbiomet, Warsaw, Indianapolis, USA), using a MIPO technique. Between January 2017 and July 2020, 15 patients were treated at our institution. Proximally a 4-5 cm anterolateral transdeltoid approach was made. And distally, a 5-7 cm incision was made 4 cm proximal to the elbow crease. At each follow-up, radiographs were taken to evaluate fracture healing. Funtional scales were applied to evaluate clinical results. RESULTS Ten women and five men were included, with a mean age of 62 yo (range 26-86). All but one fracture healed uneventfully. The mean time to union was 28 weeks (range 12-48 weeks). Two out of 15 patients presented complications (an atrophic nonunion and a peri‑implant distal fracture). None of the patients had a nerve palsy prior neither after the surgery. No other complications, including infection, were registered during follow-up. Shoulder range of motion showed the following means: abduction of 147° (range 50°-180°), anterior flexion of 144° (range 80°-180°), external rotation of 77,5 ° (range 70°-80°) and internal rotation of 54.5° (range 45°-60°). All patients recovered their pre-fracture elbow range of motion. All patients presented less than 10° of angular deviation in varus/valgus or ante/recurvatum after the surgical procedure. At the end of the follow-up, all final functional scores were "good" or "excellent": mean Constant-Murley score was 72 ± 13 (range 38-91), ASES score was 73 ± 12 (range 41-88), UCLA shoulder scale was 30 ± 3,5 (range 10-35), and Q-DASH score was 16.5 ± 0,11 (range 4-57). CONCLUSION When applied correctly, the treatment of diaphyseal humeral fractures involving the proximal humerus using a polyaxial locking helical plate with a MIPO technique is a reliable treatment method. It has high union rates with low complications.
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Affiliation(s)
| | | | | | - Clarisa Simón-Pérez
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain).
| | | | - Luis García-Florez
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain)
| | - Héctor J Aguado
- Trauma Unit, Hospital Clínico Universitario de Valladolid, 47003 Valladolid (Spain)
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Zhao Y, Pu S, Yin H, Lü Q, Xu Y, Zhu Y. [Application of suspensory external fixation technique in treatment of proximal humeral fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:144-148. [PMID: 33624464 DOI: 10.7507/1002-1892.202009016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Yonghui Zhao
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China;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
| | - Shaoquan Pu
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China
| | - Hao Yin
- Department of Clinical Medical College of Fudan University, Shanghai, 200032, P.R.China
| | - Qian Lü
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China
| | - Yongqing Xu
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China
| | - Yueliang Zhu
- Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China
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Oh JC, Kim HS, Lee GH, Kang HJ. Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report. Arch Orthop Trauma Surg 2020; 140:1901-1907. [PMID: 32140828 DOI: 10.1007/s00402-020-03402-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. MATERIALS AND METHODS A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. RESULTS We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability CONCLUSIONS: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture.
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Affiliation(s)
- Jin-Chul Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Gi-Hoon Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
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Zhao Y, Pu S, Yin H, Zhao Z, Lv Q, Cao P, Xu Y, Gubin A, Zhu Y. "Suspension bridge" external fixation technique for the treatment of proximal humeral fractures. J Shoulder Elbow Surg 2020; 29:2326-2331. [PMID: 32631642 DOI: 10.1016/j.jse.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical efficacy of the "suspension bridge" external fixation technique for the treatment of proximal humeral fractures with or without soft tissue defects and infection, as well as postoperative revision. METHODS From August 2013 to June 2018, 9 patients with proximal humeral fractures were selected. There were 5 males and 4 females, with an average age of 55.2 years (range: 32-74 years). Five patients were diagnosed with acute fractures (soft tissue defects in 2 patients). Of these patients, 1 patient was diagnosed with a fracture of the anatomic neck, 2 patients with 3-part fractures, and 2 patients with 4-part fractures. Internal fixation failure occurred in 4 patients, who needed revision surgery. Of these 4 patients, 1 patient was diagnosed with an anatomic neck fracture and 3 patients with 4-part fractures before surgery. Postoperative plate and screw fixation failure was the main cause of revision. One patient had an accompanying skin defect, and 1 had an infection. The "suspension bridge" external fixation technique was used to treat the fractures in the revision surgeries. RESULTS The operative time was 84.1 minutes (range: 63-120 minutes), and the blood loss was 224.4 mL (range: 140-320 mL). The follow-up period was 35.1 months (range: 16-72 months). All fractures unioned, with an average unioning time of 12.7 weeks (range: 8-16 weeks). At the final follow-up, the flexion was 131.8° (range 108°-152°), extension 39.9° (range 32°-47°), abduction 128.6° (range 110°-150°), internal rotation 43.9° (range 34°-55°), and external rotation 60.7° (range 46°-72°); the mean visual analog scale score for pain was 1.3 (range 0-3), and the mean Neer score was 87.4 points (range 75-98 points). Efficacy was assessed as excellent in 4 patients, good in 3 patients, and acceptable in 2 patients; the excellent or good rate was 77.8%. No adverse events, such as postoperative infection, fixation failure, and nonunion, occurred during the follow-up. CONCLUSION The "suspension bridge" external fixation technique is an effective method for the treatment of proximal humerus fractures, and it can also be used for the treatment of skin defects and infections.
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Affiliation(s)
- Yonghui Zhao
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
| | - Shaoquan Pu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
| | - Hao Yin
- Department of Clinical Medical College of Fudan University, Shanghai, China
| | - Zeyu Zhao
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
| | - Qian Lv
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
| | - Pengchong Cao
- General Hospital of the Tibet Military Region of the Chinese People's Liberation Army, Tibet, China
| | - Yongqing Xu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China
| | - Alexander Gubin
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopedics, Kurgan, Russia
| | - Yueliang Zhu
- Department of Orthopedic Surgery, 920th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming, China.
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Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury 2019; 50:2176-2195. [PMID: 31727401 DOI: 10.1016/j.injury.2019.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Locking plating is a common surgical treatment of proximal humeral fractures with satisfactory clinical results. Implant-related complications, especially screw-related, have been reported, however, the lack of information regarding their onset, used surgical technique, complexity of the fracture, bone quality etc., prevents from understanding the causes for them. The aim of this systematic review is to identify the potential risk factors for late screw complications by gathering information about the patient characteristics, comorbidities, fracture types, surgical approaches and implant types. A PubMed search was performed using humerus, fractures, bone and locking as keywords in clinical papers written in English. All abstracts and manuscripts on distal or humerus shaft fractures, and those on proximal humerus fractures without any or with only iatrogenic complications were excluded. One hundred studies met the inclusion criteria, resulting in 33% of the reported cases having at least one complication, with 11% of all complications being screw-related. Most of the latter were secondary screw perforations and screw cut-outs, being predominantly linked to poor bone quality, while screw loosening and retraction were found less frequently as a result of locking mechanism failure. Overall, the amount of information for complications was limited and screw perforation was the most frequent screw-related complication, mostly reported in female patients older than 50 years, following four-part or AO/OTA type C fractures and detected four weeks postoperatively. The sparse information in the literature could be an indicator that the late screw complications might have been under-reported and under-described, making the understanding of the screw-related complications even more challenging.
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Affiliation(s)
- Vasiliki C Panagiotopoulou
- AO Research Institute Davos, Davos, Switzerland; School of Chemical and Processing Engineering, Engineering Building, University of Leeds, UK.
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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[Reduction techniques for minimally invasive stabilization of proximal humeral fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:63-80. [PMID: 30683977 DOI: 10.1007/s00064-018-0586-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of surgical stabilization of proximal humerus fractures is to restore the anatomical relations between the greater and lesser tubercle, to reconstruct the joint and preserve the vascular supply of the fragments. INDICATIONS Approximately 80% of proximal humeral fractures can be treated conservatively. Surgical treatment is indicated based on the fracture pattern, patient-related factors and the risk of avascular head necrosis. Two-part fractures with a metaphyseal comminution zone and 3/4-part fractures can benefit from near to anatomic reconstruction depending on the patient's demands and bone quality. Minimally invasive stabilization procedures allow for an anatomical reconstruction in the majority of fresh proximal humeral fractures with or without a proximal shaft fracture, provided that intraoperative traction allows the fracture to be aligned axially in the image intensifier by ligamentotaxis. Indirect, combined with direct reduction maneuvers, allow for an almost anatomical reconstruction, despite minimal invasive approaches. SURGICAL TECHNIQUE Beach chair position. The arm is held in a pneumatic articulating traction device. Evaluation of the indirect reduction potential by ligamentotaxis with visualization of the alignment of the head fragments in relation to the shaft by traction, abduction/adduction, flexion/extension and rotation. The traction device and a foam roll in the axilla to neutralize the tension of the pectoralis major and teres major muscles while simultaneously adducting the elbow hold the reduction. Insufficient reduction of the fragments requires additional direct reduction maneuvers. Opening of the bursa and fixation of the rotator cuff with sutures to adjust reposition. A 2.5 mm-threaded K‑wire is inserted into the head fragment as a joystick. Under protection of the axillary nerve, the plate is inserted under protection of the axillary nerve. Temporary fixation of the plate with Kirschner wires for positioning the plate 5-8 mm below the greater tubercle and 2-3 mm laterally of the sulcus of the long biceps tendon and subsequent radiographic control. Reduction of the shaft against the plate with a cortex screw. The threaded K‑wire in the head can be used to adjust the varus and valgus alignment and to achieve adequate support of the calcar. Finally, complete the osteosynthesis with angular stable screws. POSTOPERATIVE MANAGEMENT Immediate active assisted exercise in the shoulder under physiotherapeutic supervision. Temporary immobilization for patient comfort. Standard active and resistive mobilization after the first clinical and radiological checkup 6 weeks after surgery. Further radiological checks after 3 and 6 months and 1 year. No routine plate removal.
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Cho CH. Is Minimal Invasive Plate Osteosynthesis a Viable Treatment Option for 4-part Proximal Humerus Fractures? Clin Shoulder Elb 2018; 21:177-178. [PMID: 33330173 PMCID: PMC7726403 DOI: 10.5397/cise.2018.21.4.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Aguado HJ, Ariño B, Moreno-Mateo F, Bustinza EY, Simón-Pérez C, Martínez-Zarzuela M, García-Virto V, Ventura PS, Martín-Ferrero MÁ. Does an early mobilization and immediate home-based self-therapy exercise program displace proximal humeral fractures in conservative treatment? Observational study. J Shoulder Elbow Surg 2018; 27:2021-2029. [PMID: 29803503 DOI: 10.1016/j.jse.2018.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonoperative management of proximal humeral fractures (PHFs) is the most common treatment, but its functional outcome may improve with early mobilization. In frail osteoporotic patients, quick recovery of prefracture independency is mandatory. This study assessed fracture displacement in PHFs managed with conservative treatment after early mobilization and a home-based self-exercise program. METHODS We retrospectively analyzed the radiologic displacement of fracture fragments of PHFs treated conservatively with early mobilization and a home-based self-exercise program. RESULTS Included were 99 patients with 26 one-part, 32 two-part, 32 three-part, and 9 four-part PHFs managed conservatively, followed by early mobilization and a home-based self-exercise program. In the x-ray examinations, the head displaced from varus into valgus 55° ± 23° to 42° ± 22°, in the normal range of anatomic values. The medial hinge displaced from medial to the diaphysis (+1 ± 6 mm) to lateral to the head (-0.6 ± 6 mm). The greater tuberosity displaced cranially from -1 ± 7 mm to 2 ± 5 mm. The Constant score at the 1-year follow-up was 79.69 ± 16.3. DISCUSSION AND CONCLUSIONS The home-based self-exercise program for conservative treatment of PHFs displaces the head-diaphysis angle and the medial hinge toward anatomic reduction, but there is a risk of greater tuberosity cranial displacement. Functional results are fairly good, allowing frail patients to keep on with their independency and life style. Because a large number of patients might need further physiotherapy, the quality of the home-based self-exercises should be supervised.
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Affiliation(s)
- Héctor J Aguado
- Orthopedic and Trauma Surgery (Trauma Unit), Hospital Clínico Universitario, Valladolid, Spain; Medical School, University of Valladolid, Valladolid, Spain.
| | - Blanca Ariño
- Orthopedic and Trauma Surgery, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Elías Y Bustinza
- Orthopedic and Trauma Surgery, Hospital Clínico Universitario, Valladolid, Spain
| | - Clarisa Simón-Pérez
- Medical School, University of Valladolid, Valladolid, Spain; Orthopedic and Trauma Surgery (Upper Limb Unit), Hospital Clínico Universitario, Valladolid, Spain
| | | | - Virginia García-Virto
- Orthopedic and Trauma Surgery (Trauma Unit), Hospital Clínico Universitario, Valladolid, Spain
| | | | - Miguel Ángel Martín-Ferrero
- Medical School, University of Valladolid, Valladolid, Spain; Orthopedic and Trauma Surgery, Hospital Clínico Universitario, Valladolid, Spain
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Zang JC, Du JJ, Li C, Wang JB, Ma XL. Comparison between minimally invasive plate osteosynthesis and open plating for proximal humeral fractures: a meta-analysis. J Comp Eff Res 2018; 7:1001-1008. [PMID: 30270641 DOI: 10.2217/cer-2018-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We conducted this meta-analysis for comparing the efficacy and safety in proximal humeral fractures by treatment minimally invasive plate osteosynthesis and open plating. METHODS The potential academic literature were identified from the Cochrane Library, Springer, PubMed, Embase and ScienceDirect. Pooled data were analyzed by RevMan 5.1. RESULTS Seven studies marched with the inclusion criteria. Meta-analysis showed the significant differences in terms of blood loss, operative time, length of hospital stays and constant score between two groups. No significant differences were found in time to union, the union rate and complications. CONCLUSION Minimally invasive plate osteosynthesis in proximal humeral fractures provided significantly shorter operative times, length of hospital stays, less blood loss and better clinical outcomes without increasing complications.
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Affiliation(s)
- Jia-Cheng Zang
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, PR China, 3002111
| | - Jing-Jing Du
- Tianjin Hexi District Guajiasi Community Health Service Center, Tianjin, PR China, 300211
| | - Chen Li
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, PR China, 3002111
| | - Jing-Bo Wang
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, PR China, 3002111
| | - Xin-Long Ma
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, PR China, 3002111
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Zhang Z, Zhang G, Peng Y, Wang X, Guo H, Zhang W, Tang P, Zhang L. Modified minimally invasive approach and intra-osseous portal for three-part proximal humeral fractures: a comparative study. J Orthop Surg Res 2018; 13:24. [PMID: 29391036 PMCID: PMC5796346 DOI: 10.1186/s13018-017-0701-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proximal humeral fracture is a common fracture. Different approaches have been utilized in the surgical intervention of three-part fractures. Our study is to evaluate the clinical outcomes and effectiveness of a modified anterolateral approach and intra-osseous portal in minimally invasive treatment for three-part proximal humeral fractures in comparison to the traditional deltopectoral approach. METHODS From March 2015 to September 2016, 13 patients with three-part proximal humeral fractures were treated with internal fixation through the modified anterolateral minimally invasive approach (MIPO). These cases were compared to 20 additional cases using the deltopectoral approach (DP). Clinical and radiographic evaluations were performed, including the constant score (CS) and range of motion in abduction, flexion/extension and external/internal rotation. Complications were recorded as well. RESULTS All patients were followed up for a mean time of 12.12 ± 4.01 months. At the latest follow-up, no significant differences (p < 0.05) were observed in terms of length of stay, range of motion for abduction, flexion or internal/external rotation of the shoulder, Constant score or visual analog scors (VAS) for pain. Elbow flexion (142.31 ± 8.32 vs. 123.00 ± 10.18), posterior shoulder extension (41.92 ± 5.22 vs. 35.50 ± 5.83) and postoperative VAS (4.38 ± 1.04 vs. 6.15 ± 0.99) were significantly better in the MIPO group than in the DP group (p < 0.05). No significant differences were detected in the radiographic evaluation, and complications including axillary nerve injury were not present. CONCLUSION The use of the modified anterolateral approach and intra-osseous portal is safe and effective for minimally invasive reduction and plating treatment for three-part proximal humeral fractures.
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Affiliation(s)
- Zhuo Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Gongzi Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Ye Peng
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Xiang Wang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Hui Guo
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Wei Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China
| | - Peifu Tang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China.
| | - Lihai Zhang
- Orthopedic Department, Chinese PLA General Hospital, Fuxing Road, 28, Beijing, 100853, People's Republic of China.
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Abstract
PURPOSE It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious complication, but there is little evidence to indicate whether the axillary nerve is at risk of injury during an anterolateral acromial approach for minimally-invasive plate osteosynthesis (MIPO) of proximal humerus fractures. We hypothesised that this surgical method is safe for the axillary nerve and would preserve it from iatrogenic injury. MATERIALS AND METHODS We conducted a prospective follow-up cohort study on 49 consecutive patients with proximal humerus fractures who were managed with MIPO through an anterolateral approach. All patients underwent standardised electroneurographic testing, with assessment of amplitudes of evoked compound muscle action potentials (CMAP) and distal motor latencies (DML) of the axillary nerves, pre- and post-operatively. Six weeks after injury, all patients underwent needle electromyographic (EMG) testing of anterior, middle, posterior deltoid, teres minor and paraspinal muscles for detecting abnormal muscle activity as a sign of acute denervation. After six months of physical rehabilitation, patients with axillary nerve injury underwent control electroneurographic testing to check the recovery of neurographic features (CMAP, DML). All nerve measurements were compared to reference values, and between right and left side. RESULTS Five patients had a mild-to-moderate traumatic axillary nerve injury before surgery. There were no significant differences between amplitudes of CMAP (p = 0.575) and DML (p = 0.857) pre- and post-surgical procedure. CONCLUSIONS These results confirmed safety of this surgical method in the preservation of axillary nerve from iatrogenic injury, but the course of the axillary nerve must be kept in mind.
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Meselhy MA, Singer MS. Management of proximal humeral fractures by the Ilizarov external fixator. Arch Orthop Trauma Surg 2017; 137:1279-1284. [PMID: 28710670 DOI: 10.1007/s00402-017-2749-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION External fixation can be performed in poor bone and soft tissue conditions, and can be used in patients with poor general conditions or multiple injuries as a rapid, mini-invasive procedure. The purpose of the current study was to evaluate the effectiveness and safety of the Ilizarov external fixator in the management of proximal humeral fractures. MATERIALS AND METHODS Between May 2011 and December 2013, 14 patients with displaced proximal humeral fractures were enrolled in the current study. Nine patients were males and five were females, with mean age 42.9 years (range 21-55). All fractures were acute. The mode of injury was road traffic accident in eight patients and fall in six patients. There were six patients with two-part fracture, one of them with fracture dislocation, and eight patients presented with three-part fracture, two of them with fracture dislocation. All fractures were fixed using the Ilizarov external fixation. RESULTS The average operative time was about 67 min (range 50-90). The mean follow-up period was (18) months (range 12-28). Healing was obtained in all 14 patients in a mean of 10.4 weeks (range 8-14). At the final follow-up, the mean constant score was 73.1 points (range 60-97 points), the mean visual analog score (VAS) for pain 3.2 (range 1-5), the mean DASH score 31.8 points (range 10-55 points), and the mean satisfaction VAS 7.6 (range 4-10). CONCLUSION The Ilizarov external fixation is an effective technique in managing proximal humeral fractures with good outcome and low complication rates. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Mohamed Salah Singer
- Orthopedic Department, Benha University, El-Shaheed Farid Nada Street, Banha, 13511, Qalyubia, Egypt
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Repetto I, Alessio-Mazzola M, Cerruti P, Sanguineti F, Formica M, Felli L. Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty : Clinical results and functional outcome on retrospective series of patients. Musculoskelet Surg 2017; 101:153-158. [PMID: 28120283 DOI: 10.1007/s12306-017-0451-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/15/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients. METHODS Between 2007 and 2011, 92 consecutive patients with diagnosis of three-four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant-Murley score, disability of arm, shoulder and hand score and simple shoulder test. RESULTS All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (p < 0.05) for: locked plating versus HA, locked plating versus RSA and RSA versus HA. No differences between postoperative range of motion, complication rate and overall revision rate of the treatment groups were found at the end of follow-up (p > 0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (p < 0.05). CONCLUSIONS The treatment of complex PHF is nowadays a challenge even for skilled shoulder surgeons. The several viable operative options give good results whenever used for the correct indication. The range of reported complications from 18.2 to 37.5% remains concerning, but most of them did not affect clinical outcome in this series. Accurate preoperative characterization of the fracture pattern is necessary, and high surgical skills of the different operative techniques, including arthroplasty, are recommended to meet the increased functional expectations of patients. LEVEL OF EVIDENCE Therapeutic series, Level IV.
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Affiliation(s)
- I Repetto
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Alessio-Mazzola
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - P Cerruti
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - F Sanguineti
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - M Formica
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - L Felli
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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Zhao L, Yang P, Zhu L, Chen AM. Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures. BMC Musculoskelet Disord 2017; 18:187. [PMID: 28499431 PMCID: PMC5429512 DOI: 10.1186/s12891-017-1538-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. The aim of this study was to evaluate the clinical outcome of MIPPO versus ORIF via the deltoid-pectoralis approach in elderly patients with proximal humeral fractures. METHODS Thirty-six patients with proximal humeral fractures were enrolled in this study. Following the randomized block and single-blinded principle, the patients were assigned to two groups and treated with either conventional ORIF or MIPPO, both through the deltoid-pectoralis approach. Surgical outcomes were evaluated by the NEER score, Constant-Murley score, blood loss, length of operation, radiological imaging and clinical examination. The patients were followed up for 4-24 (mean 10) months. RESULTS According to Constant-Murley score, the surgical outcome was excellent in 14 cases, satisfactory in 2 cases and unsatisfactory in one case in MIPPO group versus 10, 5 and 4 in conventional ORIF group. MIPPO was significantly advantageous over conventional ORIF in terms of NEER score, Constant-Murley, length of operation and intraoperative blood loss. In addition, MIPPO was also more advantageous in several indexes in patients with BMI > 26.0 and NEER type III fracture. CONCLUSION The results of our study have demonstrated that MIPPO through the deltoid-pectoralis approach is an effective alternative for the treatment of proximal humeral fractures in elderly patients. TRIAL REGISTRATION The trial registration number (TRN): ChiCTR-INR-17011098 (retrospectively registered at 2017-04-09).
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Affiliation(s)
- Li Zhao
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, the Second Military Medical University, 415 Feng Yang Rd., Huang Pu district, Shanghai, 200003 China
| | - Peng Yang
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, the Second Military Medical University, 415 Feng Yang Rd., Huang Pu district, Shanghai, 200003 China
| | - Lei Zhu
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, the Second Military Medical University, 415 Feng Yang Rd., Huang Pu district, Shanghai, 200003 China
| | - Ai-min Chen
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, the Second Military Medical University, 415 Feng Yang Rd., Huang Pu district, Shanghai, 200003 China
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