期刊文献+
共找到6,608篇文章
< 1 2 250 >
每页显示 20 50 100
Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials 被引量:6
1
作者 Santa Rabi Nathan Evaniew +2 位作者 Sheila A Sprague Mohit Bhandari Gerard P Slobogean 《World Journal of Orthopedics》 2015年第10期838-846,共9页
AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed us... AIM: To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.METHODS: A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface,CINAHL,the Cochrane Central Register of Controlled Trials(CENTRAL),Proquest,Web of Science,SAE digital library,and Transportation Research Board's TRID database.Searches of conference proceedings were also conducted.All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included.The primary outcomes measures included physical function,pain,health related quality of life,mortality,and the re-operation rate.RESULTS: Six randomized controlled trials(n = 287) were included.There was no statistically significant difference in function(MD = 1.72,95%CI:-2.90-6.34,P = 0.47),as measured by the Constant score,between the operative and the non-operative treatment groups.There was no statistically significance difference insecondary outcomes of health related quality of life(standardized MD = 0.27,95%CI:-0.05-0.59,P = 0.09),and mortality(relative risk 1.29,95%CI: 0.50-3.35,P = 0.60).Operative treatment had a statistically significant higher re-operation rate(relative risk 4.09,95%CI: 1.50-11.15,P = 0.006),and statistically significant decreased pain(MD = 1.26,95%CI: 0.02-2.49,P = 0.05).CONCLUSION: There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments.Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management. 展开更多
关键词 proximal HUMERUS fracture Outcomes OPERATIVE TREATMENT NON-OPERATIVE TREATMENT Metaanalysis
下载PDF
Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts:A retrospective,comparative cohort study
2
作者 Na Liu Bing-Gang Wang Li-Feng Zhang 《World Journal of Clinical Cases》 SCIE 2023年第27期6363-6373,共11页
BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The app... BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures. 展开更多
关键词 proximal humerus fracture Fibular segment Structural bone grafting Fibular autograft Bone graft Medial calcar
下载PDF
Plate vs reverse shoulder arthroplasty for proximal humeral fractures:The psychological health influence the choice of device?
3
作者 Giuseppe Maccagnano Giuseppe Solarino +6 位作者 Vito Pesce Giovanni Vicenti Michele Coviello Vittorio Saverio Nappi Orazio Valerio Giannico Angela Notarnicola Biagio Moretti 《World Journal of Orthopedics》 2022年第3期297-306,共10页
BACKGROUND Proximal humeral fractures represent the third most common observed osteoporotic fracture;the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial.Amo... BACKGROUND Proximal humeral fractures represent the third most common observed osteoporotic fracture;the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial.Among the treatments described in literature,open reduction and internal fixation(O.R.I.F)and reverse shoulder arthroplasty(RSA)are gaining an increasing popularity.AIM To investigate the correct treatment for three and four-part proximal humeral fractures according to psychological aspects.METHODS It was conducted a prospective study with a series of 63 patients treated with O.R.I.F.(group A)and with RSA(group B)for three and four-part proximal humeral fractures according to Neer classification system.A conservative treatment group,as control,was finally introduced.One independent observer performed clinical and a psychological evaluation at one(T0),six(T1)and twelve months(T2)postoperatively.The Constant’s score and The Disabilities of the Arm,Shoulder and Hand(DASH score)were used for clinical evaluation,while General Anxiety Disorder-7(GAD-7)and Caregiver Strain Scale(CSS)were used for psychological evaluation.RESULTS At one month follow up in group A the mean values were DASH score 50.8,Constant score 36.1,GAD-7 score 5.4,CSS 5.0.For the group B,the average values at T0 were:DASH score 54.6,Constant score 32.0;GAD-7 score 6.4,CSS 6.2.At six months in group A the average values were DASH score 42.1,Constant score 47.3,GAD-7 score 4.3,CSS 3.9.For the group B,the average values at T1 were:DASH score 39.1,Constant score 43.2,GAD-7 score 5.7,CSS 5.5.At twelve months in the group A,the mean values were DASH score 32.8,Constant score 60.0,GAD-7 score 3.2,CSS 3.1.For the group B shown these mean values:DASH score 33.6,Constant score 52.9,GAD-7 score 4.3,CSS 4.5.We demonstrated a better clinical and psychological outcome at T2 in the group treated with osteosynthesis compared to the group treated with arthroplasty(Constant P=0.049,GAD-7 P=0.012 and CSS P=0.005).A better clinical and psychological outcome emerged in control group at T2 comparing with surgical group(DASH score P=0.014,Constant score P<0.001,GAD-7 P=0.002 and CSS P=0.001).CONCLUSION Both open osteosynthesis and reverse shoulder arthroplasty are valid treatments for proximal humeral fractures.According to the best osteosynthesis results the authors suggested to perform a psychological analysis for each patient in order to choose the appropriate treatment. 展开更多
关键词 proximal humerus fractures Open reduction and fixation Reverse shoulder arthroplasty Psychological health General Anxiety Disorder-7 scale Caregiver Strain scale
下载PDF
Humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus
4
作者 柳昱 《外科研究与新技术》 2011年第2期107-108,共2页
Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated f... Objective To investigate the clinical outcome of humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus,to provide clinical guideline of treating complicated fractures of 展开更多
关键词 HEAD humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus
下载PDF
Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures 被引量:1
5
作者 Ahmed Mohamed Yousif Mohamed Monzir Salih +2 位作者 Mohanad Abdulgadir Ayman E Abbas Duha Lutfi Turjuman 《World Journal of Orthopedics》 2024年第8期796-806,共11页
BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment ... BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence. 展开更多
关键词 Intertrochanteric fracture UNSTABLE Dynamic condylar screw proximal femoral nail META-ANALYSIS Comparative study
下载PDF
Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting
6
作者 Loïc Fonkoue Gaspary Fodjeu +6 位作者 Kennedy Olivier Muluem Olivier Ngongang Theophile Nana Marie Ange Ngo Yamben DésiréAkaba Urich Tambekou Daniel Eone Handy 《Open Journal of Orthopedics》 2024年第4期173-186,共14页
Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified techn... Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world. 展开更多
关键词 proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting
下载PDF
Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus 被引量:1
7
作者 Piyush Wasudeo Gadegone Wasudeo Gadegone Vijayanand Lokhande 《Open Journal of Orthopedics》 2020年第12期359-370,共12页
<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protoc... <b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct </span><span>are</span><span> used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. </span><b><span>Patients & Methods</span></b><b><span>:</span></b><b><span> </span></b><span>Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study,</span><span> </span><span>conducted between March 2015 </span><span>and </span><span>December 2019.</span><span> </span><span>Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed</span><span> </span><span>up for a mean time of 16.3 months (range: 13 </span><span>to </span><span>40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. </span><b><span>Results</span></b><b><span>:</span></b><b><span> </span></b><span>Union at the fracture site was achieved in all patients at a mean </span><span>of </span><span>8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n</span><span> </span><span>=</span><span> </span><span>11, this difference was found to be statistically significant (p</span><span> </span><span><</span><span> </span><span>0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p</span><span> </span><span><</span><span> </span><span>0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. </span><b><span>Conclusions</span></b><b><span>:</span></b><b><span> </span></b><span>An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.</span> 展开更多
关键词 proximal Humerus Endosteal Fibular Graft Neglected fractures Locking Plate Cortico-Cancellous Bone Grafts
下载PDF
Treatment of Pathological Fractures of the Proximal Femur Due to Advanced Metastasis of Highly Malignant Tumors: A Clinical Controlled Study of Enterostenosis Reconstruction and Conservative Treatment 被引量:1
8
作者 Weikun Zheng Junfen Tang +1 位作者 Wende Xiao Weishan Cai 《Journal of Biosciences and Medicines》 2020年第8期127-137,共11页
<strong>Objective:</strong> To investigate whether different treatment methods have an impact on the quality of life and life span after fracture of patients with proximal femoral pathological fractures ca... <strong>Objective:</strong> To investigate whether different treatment methods have an impact on the quality of life and life span after fracture of patients with proximal femoral pathological fractures caused by advanced metastasis of highly malignant tumors. <strong>Methods: </strong>Karnofsky performance status (KPS) and visual analogue score (VAS) were counted at the time of admission and 2 months after the treatments. Survival analysis was implemented to compare the median survival time and 6-month survival rate of the 2 groups. Musculoskeletal score (MSTS) was used to evaluate limb function in the surgical group at 2 months after the treatment. <strong>Results: </strong>There was no significant difference in KPS score and VAS score between the two groups at the time of admission (p > 0.05). At 2 months after treatment, the KPS score of the surgical group was higher than that of the conservative group (P < 0.05), and the VAS score of the survivors of the surgical group was lower than that of the conservative group (P < 0.05). Survival analysis showed that the median survival time and 6-month survival rate after fracture in the surgical group were higher than those in the conservative group (P < 0.05). After 2 months of treatment, the average MTST score of survivors in the surgical group was 20.38 ± 0.9 (16 - 26 points). <strong>Conclusion:</strong> Surgical intervention can benefit patients with pathological fractures of the proximal femur due to metastasis of highly malignant tumors in terms of quality of life and survival. Local tumor resection and endoparasitic replacement, which can be tolerated by most patients, can effectively reconstruct the limb function of these patients and restore their self-care ability. 展开更多
关键词 Malignant Tumors proximal Femoral Pathological Fracture Endoparasitic proximal Femoral Replacement Conservative Treatment
下载PDF
Surgical Treatment for Proximal Humerus Fractures Comparison between Plate Fixation and Kapandji’s Pinning
9
作者 Issam Ait Hadj Sliman Amine Abdelaoui +4 位作者 Elhoussain Zim Mohamed Haddou Amine Benhima Imad Abkari Youssef Najeb 《Open Journal of Orthopedics》 2022年第12期474-484,共11页
Introduction: Proximal humerus fractures are common, however, there is no consensus on a decision-making algorithm for the therapeutic management of these fractures, the aim of this study is to evaluate and compare fu... Introduction: Proximal humerus fractures are common, however, there is no consensus on a decision-making algorithm for the therapeutic management of these fractures, the aim of this study is to evaluate and compare functional results between two surgical techniques and to deduce the satisfactory results of the Kapandji’s pinning which, compared to the screw plate, should keep its place in the therapeutic arsenal. Patients and Methods: It’s a retrospective study, including two groups: The first of 18 patients treated with palm-tree pinning using kapandji’s technique, the second of 16 patients treated with anatomical screw plate at the orthopedic trauma service of the Mohamed VI university hospital between July 2013 and July 2018. We compared the results of the two techniques by studying three parameters which are the healing time, the anatomical reduction, and the functional outcomes. The average age was 46 years, and the sex ratio (M/F) was 2.3. Results: The statistical analysis of functional and radiological results showed no significant difference between the two techniques, indeed the average healing time was 56.3 days in the group treated by screw plate and 55.2 days in the group treated by Kapandji’s pinning (p = 0.46), Constant’s score was 73.18 and 79.05 respectively (p = 0.27) and the average cephalodiaphyseal angle was 49.03° and 52.07°, respectively (p = 0.35). Discussion: This study has clearly shown, as reported in the literature, that there is no conclusive evidence to suggest superiority of os-teosynthesis by anatomical plate versus kapandji’s pinning. However, the simple achievement of pinning according to kapandji’s technique, the preservation of soft tissues and the low cost make us prefer this technique. Furthermore, despite the progress noted in the development of osteosynthesis means of the proximal humerus, percutaneous pinning should always keep its place. 展开更多
关键词 Fracture of proximal Humerus OSTEOSYNTHESIS humeral Anatomical Plate Kapindji’s Pinning
下载PDF
Application of proximal femur locking compression plate for unstable four part intertrochanteric fractures 被引量:2
10
作者 夏青 《外科研究与新技术》 2011年第2期108-108,共1页
Objective To evaluate the clinical results of proximal femur locking compression plate (LCP) for unstable four-part intertrochanteric femoral fractures.Methods Clinical data of53patients wiith unstable four-part inter... Objective To evaluate the clinical results of proximal femur locking compression plate (LCP) for unstable four-part intertrochanteric femoral fractures.Methods Clinical data of53patients wiith unstable four-part intertrochanteric 展开更多
关键词 Application of proximal femur locking compression plate for unstable four part intertrochanteric fractures
下载PDF
The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports
11
作者 Amadou N. Kassé Malick Diallo +4 位作者 Souleymane Diao Mohamed Tall Babacar Thiam Jean Claude F. Sané Mouhamadou H. Sy 《Open Journal of Orthopedics》 2016年第3期52-57,共6页
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar... Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines. 展开更多
关键词 ENTRAPMENT Radial Nerve Exploration Supracondylar humeral fractures
下载PDF
Complications of the locking plate for displaced proximal humeral fractures 被引量:6
12
作者 LU Yi WANG Man-yi ZHU Yi-ming JIANG Chun-yan 《Chinese Medical Journal》 SCIE CAS CSCD 2010年第19期2671-2675,共5页
Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors t... Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications. Methods From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months (12-36 months). The range of motion, Visual Analog Score (VAS) for pain, American Shoulder and Elbow Surgeons' Form (ASES), Constant-Murley, University of California-Los Angles scoring system (UCLA) score, and Simple Shoulder Test (SST) for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications. Results There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1°±24.3°, 24.1°±19.6°, and up to T10 level on average. The mean VAS score was 1.0±1.1, the ASES score was 82.9±13.8, the Constant 82.1±11.8, the UCLA 28.5±4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores (P 〈0.05). A significant difference in results was seen between patients with complications and those without complications. Conclusion The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures. 展开更多
关键词 proximal humeral fractures locking plate COMPLICATION
原文传递
Management of proximal humerus fractures in adults 被引量:23
13
作者 Leonidas Vachtsevanos Lydia Hayden +1 位作者 Aravind S Desai Asterios Dramis 《World Journal of Orthopedics》 2014年第5期685-693,共9页
The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered rend... The majority of proximal humerus fractures are lowenergy osteoporotic injuries in the elderly and their incidence is increasing in the light of an ageing population. The diversity of fracture patterns encountered renders objective classification of prognostic value challenging. Non-operative management has been associated with good functional outcomes in stable, minimally displaced and certain types of displaced fractures.Absolute indications for surgery are infrequent and comprise compound, pathological, multi-fragmentary head-splitting fractures and fracture dislocations, as well as those associated with neurovascular injury. A constantly expanding range of reconstructive and replacement options however has been extending the indications for surgical management of complex proximal humerus fractures. As a result, management decisions are becoming increasingly complicated, in an attempt to provide the best possible treatment for each indi-vidual patient, that will successfully address their specific fracture configuration, comorbidities and functional expectations. Our aim was to review the management options available for the full range of proximal humerus fractures in adults, along with their specific advantages, disadvantages and outcomes. 展开更多
关键词 proximal HUMERUS fracture Reconstruction NON-OPERATIVE MANAGEMENT HEMIARTHROPLASTY Reverse polarity total shoulder ARTHROPLASTY
下载PDF
Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and metaanalysis 被引量:5
14
作者 Wen-Huan Chen Wen-Xuan Guo +3 位作者 Shi-Hua Gao Qiu-Shi Wei Zi-Qi Li Wei He 《World Journal of Clinical Cases》 SCIE 2021年第32期9878-9888,共11页
BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss du... BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals. 展开更多
关键词 ARTHROPLASTY proximal femoral nail Intertrochanteric femoral fracture ELDERLY META-ANALYSIS Systematic review
下载PDF
Use of Ligament Advanced Reinforcement System tube in stabilization of proximal humeral endoprostheses 被引量:1
15
作者 Nikolaos A Stavropoulos Hassan Sawan +1 位作者 Firas Dandachli Robert E Turcotte 《World Journal of Orthopedics》 2016年第4期265-271,共7页
AIM:To review outcomes following usage of the Ligament Advanced Reinforcement System(LARS?)in shoulder tumors.METHODS:Medical records of nineteen patients(19 shoulders)that underwent tumor excisional procedure and rec... AIM:To review outcomes following usage of the Ligament Advanced Reinforcement System(LARS?)in shoulder tumors.METHODS:Medical records of nineteen patients(19 shoulders)that underwent tumor excisional procedure and reconstruction with the LARS synthetic fabric,were retrospectively reviewed.RESULTS:Patients’median age was 58 years old,while the median length of resection was 110 mm(range 60-210 mm).Compared to immediate post-operative radiographs,the prosthesis mean end-point position migrated superiorly at a mean follow up period of 26 mo(P=0.002).No statistical significant correlations between the prosthesis head size(P=0.87);the implant stem body length(P=0.949);and the length of resection(P=0.125)with the position of the head,were found at last follow up.Two cases of radiological dislocation were noted but only one was clinically symptomatic.A minor superficial wound dehiscence,healed without surgery,occurred.There was no evidence of aseptic loosening either,and no prosthetic failure.CONCLUSION:LARS?use ensured stability of the shoulder following endoprosthetic reconstruction in most patients. 展开更多
关键词 proximal humeral endoprostheses LIGAMENT ADVANCED REINFORCEMENT SYSTEM
下载PDF
Treatment of Complex Proximal Tibial Fractures (Types V &VI of Schautzker Classification) by Double Plate Fixation with Single Anterior Incision 被引量:3
16
作者 Ebrahim Ghayem Hassankhani Farzad Omidi Kashani Golnaz Ghayem Hassankhani 《Open Journal of Orthopedics》 2013年第4期208-212,共5页
Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in tr... Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification). 展开更多
关键词 proximal Tibial fractures TYPES V & VI of Schautzker CLASSIFICATION Double Plate Fixation SINGLE ANTERIOR INCISION
下载PDF
Shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures
17
《Chinese Journal of Traumatology》 CAS 2009年第1期-,共4页
Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total... Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total of 55 patients who suffered from com-plex proximal humeral fractures were treated by shoulder hemiarthroplasty. The mean age was 55.6 years and mean follow-up period was 25.1 months. The scoring system modi-fication for hemiarthroplasty (SSMH) had been adopted for evaluation at the latest follow-up.Results: The pain was obviously relieved in all patients. Fifty patients were painless and 5 patients had slight pain. The mean range of motion was 100°(90°-110°) in abduction, 95°(80°-100°) in forward flexion, 35°(30°-40°) in extemal rotation and internal rotation was confined at L2 level (L1-L3). The mean SSMH score was 27.9 (24-29). Fifty patients (90.1%) were satisfied with the clinical outcome.Conclusions: Shoulder hemiarthroplasty is an effective method to treat complex proximal humeral fractures. The proper selection of patients and prosthesis, good operation skill and enough functional exercise are the key points of successful treatment. 展开更多
关键词 SHOULDER ARTHROPLASTY humeral fractures Prosthesis implantation
原文传递
Effect of proximal femur nail anti-rotation on unstable intertrochanteric fractures: A prospective observational study 被引量:2
18
作者 Faizan Iqbal Osama Bin Zia +2 位作者 Noman Memon Sajid Younus Akram Aliuddin 《Journal of Acute Disease》 2020年第5期218-222,共5页
Objective:To assess the effect of proximal femur nail anti-rotation on the functional and radiological outcome of unstable intertrochanteric fractures.Methods:This prospective observational study was conducted in the ... Objective:To assess the effect of proximal femur nail anti-rotation on the functional and radiological outcome of unstable intertrochanteric fractures.Methods:This prospective observational study was conducted in the orthopedic department of a tertiary care hospital.Altogether 86 patients with unstable intertrochanteric fractures treated with proximal femur nail anti-rotation between January 2010 and January 2015 were included.Patients were followed in the outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications.The functional outcomes were evaluated after 2 years by Harris hip score.Results:All patients achieved a radiological union of fractures after a mean duration of 24.6 weeks.The follow up showed 23 complications(systemic and local).Eight patients developed urinary tract infections,and three patients developed chest infections,two patients had screw cut-out,one patient had knee stiffness,one patient developed superficial surgical site infection,and four patients developed varus collapse and shortening subsequently.The two year follow up showed that 69(80.2%)patients had an excellent and good functional outcome according to Harris hip score.Conclusions:With lower complication rates,proximal femur nail is a valid and reasonable option especially in treating unstable intertrochanteric fractures. 展开更多
关键词 HIP Motor vehicle accident Intertrochanteric fractures proximal femur nail anti-rotation
下载PDF
Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ 被引量:1
19
作者 Mustafa Al-Gburi Ali Al-Hamdani +1 位作者 Jeppe Vejlgaard Rasmussen Bo Sanderhoff Olsen 《World Journal of Orthopedics》 2023年第7期526-532,共7页
BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular struct... BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided. 展开更多
关键词 humeral fracture Arthroplasties Internal fixation Ulnar nerve affection In situ release
下载PDF
Risk Assessment of Retrograde Intramedullary Nailing for Proximal Humeral Fracture
20
作者 Rina Sakai Uchino Masataka +1 位作者 Kazuhiro Yoshida Masanobu Ujihira 《Journal of Biomedical Science and Engineering》 2019年第5期277-284,共8页
In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation... In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing. 展开更多
关键词 proximal humeral Fracture RETROGRADE INTRAMEDULLARY NAILING ANTEROGRADE INTRAMEDULLARY NAILING Locking Plate Internal Fixation
下载PDF
上一页 1 2 250 下一页 到第
使用帮助 返回顶部