Treatment of two-part proximal humerus fractures？由两部分组
成的肱骨近端骨折，: intramedullary nail(髓内钉)compared to
Lekic N, Montero NM, Takemoto RC, Davidovitch RI, Egol KA.
Georgetown University School of Medicine, Washington, DC 20057 USA.
Two-part proximal humerus fractures are common orthopedic ？骨科、整形外科，injuries for
which surgical intervention？介入， is often indicated.？指出， Choosing a fixation device
remains a topic of debate.
The purpose of this study is to compare two methods of fixation for two-part proximal humerus fractures, locking plate (LP) with screws versus intramedullary nailing (IMN), with respect to alignment, healing, patient outcomes, and complications. To our knowledge, a direct comparison of these two devices in treating two-part proximal humerus fractures has never before been studied. We hope that our results will help surgeons assess the utility of LP versus IMN.
A retrospective chart review was performed on 24 cases of displaced two-part surgical neck fractures of the humerus. Twelve shoulders were treated using IMN fixation and 12 others were fixated with LP. Data collected included sociodemographic, operative details, and postoperative care and function.
Radiographic comparison of fixation demonstrated an average neck-shaft angle of 124? and 120? in the IMN group and LP group, respectively. Adjusted postoperative 6-month follow-up range of motion was 134? of forward elevation in the IMN group and 141 in the LP group. The differences in range of motion and in complication rates were not found to be significant.
Our results suggest that either LP fixation or IMN fixation for a two-part proximal humerus fracture provides acceptable fixation and results in a similar range of shoulder motion. Although complication rates were low and insignificant between the two groups, a trend toward increased complications in the IMN group is noted.
intramedullary nail, locking plate, outcomes of proximal humerus fractures, two-part proximal humerus fracture
Free PMC Article
Eur J Orthop Surg Traumatol. 2013 May 21. [Epub ahead of print]
A new approach for the treatment of
proximal humeral fractures？肱骨近端骨折， using the
TRIGEN proximal humeral nail(髓内钉).
Liu QH, Sun W, Zhou JL, Ren XB, Lu T, Shan L, Liu Y.
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, Chaoyang District, Beijing, 100020, People's Republic of China. Abstract
The optimal ？最佳的，surgical treatment for displaced？移位，
proximal humeral fractures continues to be controversial. One of the new treatment options is the minimally invasive？？微创，， intramedullary nail. The purpose of this study was to evaluate the functional outcome of using the TRIGEN proximal humeral nail (PHN) for the treatment of displaced proximal humeral fractures in elderly patients. From January 2004 to December 2008, 64 elderly patients (age > 60 years old) with displaced proximal humeral fractures were treated using TRIGEN PHN. A complete 12-month postoperative follow-up was available for 54 patients. The study cohort included two-part (29 shoulders), three-part (22 shoulders), and four-part (3 shoulders) Neer classification fracture types. The Constant-Murley score was used to assess functional outcome. Radiological outcomes were evaluated, and all complications were recorded. All fractures were united. The Constant-Murley score data indicated that the patients experienced improvement from 6 to 12 months postoperatively. The mean absolute
Constant-Murley score on the injured side increased from 71.2 ? 11.2 points at 6 months to 82.4 ? 16.4 points at 12 months (P = 0.01). The mean neck-shaft angle 1 year after surgery was 125? ? 8.1? (95?-140?). Secondary complications were minimal and observed in only 6 of 54 patients. In conclusion, the TRIGEN intramedullary humeral nail is effective for the treatment of proximal humeral fractures.
[PubMed - as supplied by publisher]
Arch Orthop Trauma Surg. 2013 Jun;133(6):811-7. doi: 10.1007/s00402-013-1727-4. Epub 2013 Mar 27.
Healing process after rigid plate fixation
of humeral shaft fractures revisited.？刚性钢板内固定后重新
Yi JW, Oh JK, Han SB, Shin SJ, Oh CW, Yoon YC.
W Hospital, 1616 Dalgubeol-Daero, Dalseo-Gu, Daegu, South Korea. email@example.com Abstract
The purpose of this study was to describe the radiological healing process after open reduction and internal fixation 9内固定(ORIF) of humeralshaft fractures with plate.钢板
MATERIALS AND METHODS:
We reviewed the data of 53 consecutive patients who had undergone rigid plate fixation of OTA 12 A or B humeralshaft fracture. The mean age of the patients at the time of surgery was 39.4 (range 16-82). Quality of reduction and healing process was analysed on radiographs. Clinical symptom and disabilities of the arm, shoulder and hand (DASH) scores were recorded at follow-up visits.
There were 28 compression 压缩and 25 neutralization中和 platings. The mean gap size on
the postoperative radiograph was 1.4 (range 0.1-6.1). 50 cases (94.3 %) healed, while three cases ended up with non-union愈合. 28 (52.8 %) cases showed primary healing and 22 cases
(41.5 %) showed secondary healing with callus bridging骨痂桥接. Among the cases with
secondary healing,二期愈合 callus formation with resorption was identified in 13 cases. The type of fracture, mode of compression and size of gap on radiographs after rigid plate fixation were found to be statistically significant factors for healing type (p = 0.026, 0.002, and <0.001, respectively). Three cases with non-union showed no improvement in DASH scores.
Both primary and secondary healing processes were observed after rigid plate fixation of OTA 12 A or B humeral shaft fractures. Our study revealed that size of gap, mode of compression, type of fracture could affect the type of healing, and that periosteal callus formation can occur after rigid plate fixation.
[PubMed - indexed for MEDLINE]
Chir Main. 2013 Apr;32(2):85-91. doi: 10.1016/j.main.2013.02.003. Epub 2013 Feb 28. [Aseptic无菌 non-union 愈合
of humeral shaft fractures treated by plating 钢板
and bone grafting 骨移植术(about 20 cases)].
[Article in French]
Dahmani O, Bouziane A, Shimi M, Elibrahimi A, Elmrini A.
Service de chirurgie ostéo-articulaire (B4), CHU Hassan II, 30000 Fès, Maroc. firstname.lastname@example.org
Although aseptic non-union of humeral shaft fractures is generally considered to be an exceptional 异常的complication并发症, rates in the literature have varied from 1 to 10%. The aim of this retrospective study was to study the results of treatment by plating and bone grafting for aseptic non-union of humeralshaft fractures. The retrospective study gathered 20 patients, the mean age was 41 years. The most common fracture site was the middle third. For the follow-up evaluation, we used the Steward and Hundley score. According to this score, we noted: 13 very good results, five good results and two poor results. Management of non-union of the humerus should be optimal at immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.
Copyright ? 2013 Elsevier Masson SAS. All rights reserved.
[PubMed - in process]
Arch Orthop Trauma Surg. 2013 May;133(5):649-57. doi: 10.1007/s00402-013-1708-7. Epub
2013 Mar 5.
Minimally invasive plate osteosynthesis
for humeral shaft fracture: a reproducible technique with the assistance of an external fixator.
Lee HJ, Oh CW, Oh JK, Apivatthakakul T, Kim JW, Yoon JP, Lee DJ, Jung JW.
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, Korea.
Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients
with humeral shaft fracture.
Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique. RESULTS:
There was no case of mal-union >10?, and mean angulation was 1.3? (range 0?-9?) in the coronal plane and 1.2? (range 0?-8?) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3-38.4 weeks) and a mean follow-up of 20.8 months (range 13.5-31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation.
Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates.
[PubMed - indexed for MEDLINE]
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Jan;27(1):21-4.
[Elastic stable intramedullary nailing for treatment of benign lesions of humerus complicating by pathological fracture in children].
[Article in Chinese]
Luo L, Lu X, Ge J, Ye L, Wang Y.
Department of Bone and Joint Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, PR China.
To explore the effectiveness and advantages of elastic stable intramedullary nail (ESIN) combined with curettage and graft for thetreatment of benign lesions of humerus complicating by pathological fracture in children.
ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years (mean, 9.4 years). The disease duration ranged from 2 to 14 days (mean, 6 days). All fractures were closed fracture, which locations were the proximalhumerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days.
Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months (range, 12-36 months). All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation (mean, 3.3 months). No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation (mean, 12.5 months). The lesion disappeared completely in 8
cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases.
It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
[PubMed - indexed for MEDLINE]
Eur J Orthop Surg Traumatol. 2013 Apr;23(3):323-8. doi: 10.1007/s00590-012-0982-3. Epub
2012 Apr 7.
Study on outcome of fracture shaft of the humerus treated non-operatively with a functional brace.
Kapil Mani KC, Gopal Sagar DC, Rijal L, Govinda KC, Shrestha BL.
Department of Orthopaedics, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. email@example.com
Non-operatively treated fractures of the humeral diaphysis have a high rate of union with good functional results. The objective of this study is to find out the outcome of fractures of the humeral diaphysis treated with a functional brace that permits motion of shoulder and elbow joints and progressive use of the injured extremity.
MATERIALS AND METHODS:
This was a descriptive analytical study in patients of 16 years and above with closed fracture shaft of humerus treated with a functional brace that permits the motion of shoulder and elbow joints. The fracture arms were initially stabilized with U slab or hanging cast for an average of 11 days before application of brace. Radiographs were made at each follow-up visit until the fracture union occured. Angulation at fracture site, motion at shoulder and elbow joint were measured at the time of removal of brace.
One hundred and five out of 108 fractures (97.2 %) were united with mean duration of 12.16 weeks (range, 7.5-19.3 weeks). Radial nerve injury was present in 6 cases (5.5 %).
Varus angulation of ?15? was present in 90.9 % out of 99 patients, while no angulation was
present in 6 cases (5.7 %) out of 105 patients. Apex anterior angulation of ?10? was present in
100 % out of 48 patients, whereas apex posterior angulation of ?10? was present in 94.1 % out
of 51 patients.
Functional bracing for the treatment of fractures of the humeral diaphysis is associated with a high rate of union with nearly normal elbow motion and some restriction of shoulder motion. PMID:
[PubMed - in process]
Acta Orthop Belg. 2012 Dec;78(6):708-13.
A simple technique for double plating of extraarticular distal humeral shaft fractures.
Sharaby M, Elhawary A.
Mansoura University Emergency Hospital, Mansoura, Egypt. firstname.lastname@example.org Abstract
Plate fixation of extraarticular distal humeral shaft fracture is often difficult. Traditional techniques do not allow for stable fixation. A single DCP plate may have inadequate purchase in the distal fragment. The use of large plates extending distally over the lateral supracondylar ridge is often associated with pain and sometimes interferes with elbow range of motion. In this study, 22 patients with extra articular distal humeral fractures were managed with dual plating using a paratricipital approach. The first plate--a narrow DCP--was fixed on the dorsal surface of the humerus. The second plate--a small 3.5 reconstruction plate--was fixed on the dorsolateral surface. Elbow motion was started immediately after surgery. The average follow-up duration was 25 months. The mean elbow flexion/extension are was 4 degrees to 138 degrees. Infection was reported in two cases and was managed successfully with conservative measures. Postoperative radial nerve contusion was reported in one case with complete resolution within 3 months.
[PubMed - indexed for MEDLINE]
Chin J Traumatol. 2013 Feb 1;16(1):22-6.
Role of locking plates in treatment of difficult
ununited fractures: a clinical study.
Kumar A, Gupta H, Yadav CS, Khan SA, Rastogi S.
Dubai Bone and Joint Center, Mohammed Bin Rashid Al Makotoum Academic Medical Center, Dubai Health Carecity, Dubai 118855, UAE.
Objective: To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods: Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture (3 patients), supracondylar fracture of femur (gap nonunion), fracture of clavicle, fracture of both forearm bones (radius and ulna) fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each). Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results: Minimum follow-up was 6 months (range, 6 months to 2.5 years). Average time for union was 3.4 months (range 2.5 to 6 months). None of the patients had plate-related complications or postoperative wound infections. Conclusion: Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique andbone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.
[PubMed - in process]
Free full text
J Orthop Trauma. 2013 Feb;27(2):68-72. doi: 10.1097/BOT.0b013e31824a3e66.
Outcomes of nails versus plates
for humeral shaft fractures: a Medicare cohort study. Chen F, Wang Z, Bhattacharyya T.
National Institutes of Health, Bethesda, MD 20892-1150, USA.
This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality.
Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed.
Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures. MAIN OUTCOME MEASUREMENT:
The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards.
We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality.
Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality. LEVEL OF EVIDENCE:
: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
[PubMed - indexed for MEDLINE]