Humeral Fractures
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2021 ◽  
Author(s):  
Yuelei Zhang ◽  
Lifu Wan ◽  
Lecheng Zhang ◽  
Chao Yan ◽  
Gang Wang

Abstract Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 minutes (range, 70–130 minutes), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuelei Zhang ◽  
Lifu Wan ◽  
Lecheng Zhang ◽  
Chao Yan ◽  
Gang Wang

Abstract Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.


2021 ◽  
Vol 27 (4) ◽  
pp. 4072-4076
Author(s):  
Konstantin Totev ◽  
◽  
Georgi Dimitrov ◽  
Lyubomira Toteva ◽  
Svilen Todorov ◽  
...  

Proximal humerus presents the second most frequent site of posttraumatic osteonecrosis. This complication is usually related to poor functional outcomes. The aim of this study is to identify and analyze the risk factors for posttraumatic humeral head osteonecrosis in surgically treated patients. Ninety-one patients with 92 acute proximal humeral fractures were operated on for a period of 39 months. Operative methods include open reduction and internal fixation and closed reduction and percutaneous fixation. Fractures were classified according to Neer, AO and LEGO classifications. The mean age of patients was 60.9 years. From 91 operated patients for follow-up were available 82. The mean follow-up period was 15 months. Patient data was collected prospectively. Functional results are present using age and gender adjusted Constant score. In 41 patients, the result is excellent, in 28-good, in 11-fair and in 3 poor. Bone union was evident in all cases. No deep wound infections, nerve injuries, vascular injuries and implant failure were observed. Osteonecrosis was seen in 5 (6.1%) patients. Patients with posttraumatic osteonecrosis had significant lower Constant results. Analyzing the pre- and intraoperative factors in patients with osteonecrosis, we find that the most significant factors for this complication are increasing fracture severity and а combination of short medial metaphyseal extension and disrupted medial hinge.


2021 ◽  
Author(s):  
XiaoTian Ma ◽  
WeiYa Zhang ◽  
Zheng Xu

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.


Author(s):  
R. M. Chandak ◽  
Mohit Sharma ◽  
Amrit Jha

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, &gt;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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andrew B. Rees ◽  
Jacob D. Schultz ◽  
Lucas C. Wollenman ◽  
Stephanie N. Moore-Lotridge ◽  
Jeffrey E. Martus ◽  
...  

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