Percutaneous Multi-angle Thread Needle for Two- or Three-part Unstable Fractures of the Proximal Humerus in Older Population

OBJECTIVE

This study aimed to evaluate the clinical functional and radiological outcomes of percutaneous repositioning with multi-angle thread needles in older patients with two- or three-part displaced fractures of the proximal humerus.

METHODS

About 48 patients treated with multi-angle thread needles for two- or three-part displaced fractures of the proximal humerus were enrolled. The patients were followed up for 12 to 24 months (with an average follow-up of 18 months). Imaging examinations were performed at week 4, week 8, week 12, month 6, and year 1 postoperation. The functional and radiological outcomes, including the fracture healing time, American Shoulder and Elbow Surgeons Association (ASES) score, Constant-Murley score, and visual analog score questionnaire, were followed up and assessed.

RESULTS

The fracture healing time was 14.6 weeks (12-41 weeks). The interval from the end of surgery to the resumption of functional shoulder exercise was 16.2 weeks (14-36 weeks), and all the fractures healed by the last follow-up. The ASES score, the average Constant-Murley score, and the VAS pain score at the 1-year postoperative follow-up were 88.9 ± 9.6, 87.5 ± 8.4, and 0.37 ± 0.29, respectively. In the present group, 24 cases were assessed as excellent healing, 12 cases were good, 7 cases were average, and 5 cases were poor.

CONCLUSION

The percutaneous multi-angle thread needle was a reliable method for the treatment of two- or three-part displaced fractures of the proximal humerus in older people, especially for those who could not tolerate traumatic surgery.

A case of bilateral horizontal gaze palsy and concurrent esotropia

Purpose

To report a unique case of bilateral horizontal pontine gaze palsy with concurrent esotropia, surgical management, and post-operative follow-up.

Observations

A 39-year-old male presented with diplopia and a history of neurocysticercosis. He was found to have bilateral horizontal gaze palsy and concurrent esotropia, R > L. Classic bimedial rectus recess-resect surgery was done to include resection of the right lateral rectus muscle. Follow-up three months post-op demonstrates markedly improved diplopia.

Conclusion and importance

We present a recommended therapeutic approach for the rare case of concurrent bilateral horizontal gaze palsy and esotropia, which should be further evaluated in longitudinal studies.