Significance and Clinical Effect of Anteromedial Support Plate Assisted Reduction and Fixation in The Treatment of Complex Proximal Humeral Fractures

Abstract Background There are more and more complex consolidated proximal fractures, and the postoperative effect is not very satisfactory. Therefore, we propose a surgical method and evaluate its effect. Method A total of 77 patients with complicated proximal humeral fractures who underwent surgical treatment in the Affiliated Hospital of Nantong University from June 2015 to January 2019 were collected. Among them, the internodal groove medial support plate assisted reduction and fixation technique and the lateral locking plate were used. A total of 15 cases of complicated proximal humeral fractures were used as the study group, and 62 patients with the same type of proximal humeral fractures treated with traditional reduction methods and internal fixation with lateral locking plates during the same period were used as the control group.The operation time of the two groups; intraoperative blood loss; number of effective intraoperative fluoroscopy; postoperative humeral neck shaft angle loss after reduction; postoperative shoulder joint Constant-Murley score; upper limb function DASH score and postoperative complications were retrospectively reviewed comparative analysis. Results The number of effective intraoperative fluoroscopy was (6.18±1.869) times in the control group, more than (3.93±1.387) times in the study group, and the difference between the two was statistically significant (P<0.05);The operation time of the study group was longer than that of the control group, and the intraoperative blood loss of the study group was more than that of the control group, but the difference between the two was not statistically significant (P>0.05).In the first 1, 3, 6, and 12 months after surgery, in terms of imaging measurement, the loss angle after reduction of the humeral neck shaft angle in the control group and the study group increased with the increase in postoperative time. There was no significant difference in the lost angle after reduction of the humeral neck shaft angle between the two groups at month and 3 months (P>0.05).At the 6th and 12th months after surgery, the lost angle after reduction of the humeral neck shaft angle in the study group was smaller than that in the control group, and the difference between the two groups was statistically significant (P<0.05).For the recovery of shoulder joint function after surgery, the Constant-Murley score of the shoulder joint and the DASH score of upper limb function of the control group and the study group increased with the increase of postoperative time, while the Constant score and DASH score of the two groups were 1 after surgery. There was no significant difference at months, 3 months, 6 months and 12 months (P>0.05). Conclusion The anteromedial support plate assisted reduction of the internodal groove can be used as a single locking plate for the treatment of complex proximal humeral fractures with medial column instability. It is an option when reduction is difficult or it is difficult to maintain stable reduction, which improves the quality of reduction and reduces surgery. Loss of posterior fracture reduction.

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Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2907-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Xueliang Cui ◽

Hui Chen ◽

Binbin Ma ◽

Wenbin Fan ◽

He Li

Keyword(s):

Elderly Patients ◽

Clinical Outcomes ◽

Locking Plate ◽

External Rotation ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Head Height

Abstract Background Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001). Conclusion For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

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Fibular strut allograft influences reduction and outcome after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

10.21203/rs.2.11169/v1 ◽

2019 ◽

Author(s):

Xueliang Cui ◽

Hui chen ◽

Binbin Ma ◽

Wenbin Fan ◽

He Li

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plate Fixation ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Head Height ◽

Fibular Strut ◽

Fibular Strut Allograft

Abstract Purpose: The purpose of this study was to determine if fibular strut allograft influence reduction and clinical outcomes after locking plate fixation of comminuted proximal humeral fractures (PHFs). Methods: A retrospective review was performed on sixty 3- and 4-part PHFs treated with either locking plate only or locking plate with a fibular allograft. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5°or if the change of humeral head height (HHH) was more than 3 mm. Clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result: The average radiological changes were higher in the locking compression plate (LCP) group than in the locking plate with fibular allograft (FA) group ( HHH of 4.16mm versus 1.18mm [p﹤0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). Final average outcome scores were lower in LCP group than in FA group ( CMS of 73.00 versus 78.96 [p = 0.024] and ASES score of 72.80 versus 78.64 [p = 0.022]). FA group showed better forward elevation (P=0.010) and abduction (P=0.002), but no significant differences were observed for shoulder external rotation or internal rotation. Conclusion: For comminuted proximal humerus fractures in elderly patients with severe osteoporosis, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Key words: proximal humeral fractures; locking compression plate; fibular allograft

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Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

10.21203/rs.2.14214/v2 ◽

2019 ◽

Author(s):

Won Chul Shin ◽

Suk-Woong Kang ◽

Seung Min Son ◽

Hyuk Bae

Keyword(s):

Surgical Treatment ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Bone Union ◽

Neck Shaft Angle ◽

Radiological Results ◽

Comminuted Fracture ◽

Shaft Angle ◽

The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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Surgical Treatment of Proximal Humeral Fractures with Short Straight Intramedullary Nail

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522417-20 ◽

2015 ◽

Vol 22 (4) ◽

pp. 17-20

Author(s):

P. V Bondarenko ◽

N. V Zagorodniy ◽

S. I Gil’fanov ◽

A. Yu Semenistyi ◽

A. A Semenistyi ◽

...

Keyword(s):

Surgical Treatment ◽

Intramedullary Nail ◽

Varus Deformity ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Treatment Results ◽

Neck Shaft Angle ◽

Case Evaluation ◽

Fracture Consolidation ◽

The Difference

Long term surgical treatment results were studied for 30 patients (10 male and 20 female) with two- and three-fragment proximal humeral fractures with short intramedullary nail. Mean age of patients was 68.8 (37-84) years. All patients were examined clinically and roentgenologically. In postoperative period secondary varus deformity was observed in18 (60%) patients and made up 4.3° at an average. Roentgenologic signs of delayed fracture consolidation due to the loss of reposition and decrease of neck-shaft angle under 120° were observed in one case. Evaluation by ASES scale made up 90.73±7.01 points, by SST scale - 10.47±1.41 points. Treatment results for three-fragment fractures were not as good as for two-fragment ones however the difference was not statistically significant ( p >0.05). Obtained data showed the high efficacy of short straight intramedullary nail application in two- and three-fragment proximal humeral fractures.

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Surgical Treatment of Proximal Humeral Fractures with Short Straight Intramedullary Nail

N N Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2015-4-17-20 ◽

2015 ◽

pp. 17-20 ◽

Cited By ~ 2

Author(s):

P. V. Bondarenko ◽

N. V. Zagorodniy ◽

S. I. Gil’Fanov ◽

A. Yu. Semenistyi ◽

A. A. Semenistyi ◽

...

Keyword(s):

Surgical Treatment ◽

Intramedullary Nail ◽

Varus Deformity ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Treatment Results ◽

Neck Shaft Angle ◽

Case Evaluation ◽

Fracture Consolidation ◽

The Difference

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Review of Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals.

10.21203/rs.3.rs-568751/v1 ◽

2021 ◽

Author(s):

R M Chandak ◽

Mohit Sharma ◽

Amrit Jha

Keyword(s):

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Radiological Outcome ◽

Neck Shaft Angle ◽

Clinical And Radiological Outcome ◽

Shaft Angle ◽

Pin Site ◽

The Mean

Abstract Introduction: Proximal humeral fracture is 3rd most common fracture in elderly population.Selection of appropriate implant is always challenging to get optimum results in theseosteoporotic bones. Though locking plates are gold standard, major complications range from9% to 36%. Many percutaneous fixation techniques described in the literature are associated with pin site infections, pin backout and loss of reduction.Objective: To study clinical and radiological outcome of J nail technique for Neer’s three orfour part proximal humeral fractures in patients more than 60 years age.Materials and Method: We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, >60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip L (Lambrinudi) wires. At final follow-up, clinical outcome was assessed using Constant Score and radiological evaluation was done according to the Bahr criteria. Statistical analysis was performed.Results: The mean Constant Score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up upto 2 yrs.Conclusions: Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections. This surgical technique can be considered as one of the effective technique for fixation of proximal humeral fractures in elderly osteoporotics.

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Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214177 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1122

Author(s):

R. M. Chandak ◽

Mohit Sharma ◽

Amrit Jha

Keyword(s):

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Radiological Outcome ◽

Neck Shaft Angle ◽

Clinical And Radiological Outcome ◽

Shaft Angle ◽

The Mean

Background: Proximal humeral fracture is 3rd most common fracture in elderly population. Selection of appropriate implant is always challenging to get optimum results in these osteoporotic bones. Though locking plates are gold standard, major complications range from 9% to 36%. To study clinical and radiological outcome of J nail technique for Neer’s three or four part proximal humeral fractures in patients more than 60 years age.Methods: We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, >60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip Lambrinudi wires. At final follow-up, clinical outcome was assessed using constant score and radiological evaluation was done according to the Bahr criteria.Results: The mean constant score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up to 2 years.Conclusions: Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections.

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Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

10.21203/rs.2.14214/v1 ◽

2019 ◽

Author(s):

Won Chul Shin ◽

Suk-Woong Kang ◽

Seung Min Son ◽

Hyuk Bae

Keyword(s):

Surgical Treatment ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Bone Union ◽

Neck Shaft Angle ◽

Radiological Results ◽

Surgical Methods ◽

Shaft Angle ◽

The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not.Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture.Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

10.2196/preprints.20947 ◽

2020 ◽

Author(s):

Yuan Gao ◽

Xiaojie Fu ◽

Mingxing Lei ◽

Pengbin Yin ◽

Qingmei Wang ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Subgroup Analysis ◽

Nursing Intervention ◽

Control Group ◽

Study Group ◽

Drug Compliance ◽

Information Platform ◽

The Difference ◽

Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

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Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

BMC Surgery ◽

10.1186/s12893-021-01235-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiantao Li ◽

Yuan Gao ◽

Caixia Yin ◽

Hao Zhang ◽

Shaobo Nie ◽

...

Keyword(s):

Mechanical Stability ◽

Humeral Fracture ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Dash Score ◽

Peek Cage ◽

Polyether Ether Ketone ◽

Stable Osteosynthesis ◽

Long Term Follow Up

Abstract Background The treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP). Methods A total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up. Results The average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients. Conclusion The use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

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