Treatment of Bilateral Proximal Humeral Fracture in Patients with Parkinson’s Disease: A Case Report

There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.

Complications of the locking plate for displaced proximal humeral fractures

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.

Locking system strengthened by biomimetic mineralized collagen putty for the treatment of osteoporotic proximal humeral fractures

The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures.From January 2012 to December 2015,80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group,each group with a total of 40 cases.The control group was simply treated with locking plate.The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty.The therapeutic effect thereby was observed.The excellent and satisfactory rate was 90%in observation group and was 72.5%in control group.The difference between the two groups was statistically significant(χ^(2)=5.3312,P<0.05).The fracture healing time was 11.8263.62 weeks in observation group and 19.7865.46 weeks in control group.The shoulder joint function score was 89.6368.12 in observation group and 76.9268.18 in control group.There was significant difference between the two groups(t=7.1272;12.7834,P<0.05).The complication rate was 10%in the observation group and 32.5%in the control group(χ^(2)=7.3786,P<0.05).Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture,improving the therapeutic effect,reducing the complications.As one of the optimal internal fixation method,it provides a new option for better treatment of senile osteoporotic fracture.

Surgical treatment of proximal humerus fractures using PHILOS plate

Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Influence of Medial Support Screws on the Maintenance of Fracture Reduction after Locked Plating of Proximal Humerus Fractures

Background： Technical aspects of the correct placement of medial support locking screws in the locking plate for proximal humerus fractures remain incompletely understood. This study was to evaluate the clinical relationship between the number of medial support screws and the maintenance of fracture reduction after locked plating of proximal humerus fractures. Methods： We retrospectively evaluated 181 patients who had been surgically treated for proximal humeral fractures （PHFs） with a locking plate between September 2007 and June 2013. All cases were then subdivided into one of four groups as follows： 75 patients in the medial cortical support （MCS） group, 26 patients in the medial multiscrew support （MMSS） group, 29 patients in the medial single screw support （MSSS） group, and 51 patients in the 11o medial support （NMS） group. Clinical and radiographic evaluations included the Constant-Murley score （CM）, visual analogue scale （VAS）, complications, and revision surgeries. The neck-shaft angle （NSA） was measured in a true anteroposterior radiograph immediately postoperation and at final follow-up. One-way analysis of variance or KruskaI-Wallis test was used for statistical analysis of measurement data, and Chi-square test or Fisher＇s exact test was used for categorical data. Results： The mean postoperative NSAs were 133.46°± 6.01°, 132.39° ± 7.77°. 135.17° ± 10.15°, and 132.41° ± 7.16° in the MCS, MMSS, MSSS, and NMS groups, respectively, and no significant differences were found （F = 1.02, P= 0.387）. In the final follow-up, the NSAs were 132.79° ±6.02°, 130.19° ± 9.25°, 131.28° ± 12.85°, and 127.35° ± 8.50° in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 4.40, P = 0.008）. There were marked differences in the NSA at the final follow-up between the MCS and NMS groups （P = 0.004）. The median （interquartile range [IQR]） NSA losses were 0.0° （0.0-1.0）°, 1.3° （0.0-3.1）°, 1.5° （ 1.0-5.2）°, and 4.0° （ 1.2 -7.1 ）° in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 60.66, P 〈 0.001 ）. There were marked differences in NSA loss between the MCS and the other three groups （MCS vs. MMSS, Z = 3.16, P = 0.002; MCS vs. MSSS, Z = 4.78, P 〈 0.001; and MCS vs. NMS, Z = 7.34, P 〈 0.001）. There was also significantly less NSA loss observed in the MMSS group compared to the NMS group （Z = -3.16, P = 0.002）. However, there were no significant differences between the MMSS and MSSS groups （Z = -1.65, P = 0.225） or the MSSS and NMS groups （Z =- 1.21, P = 0.099）. The average CM scores were 81.35 ± 9.79, 78.04± 8.97, 72.76 ± 10.98, and 67.33 ± 12.31 points in the MCS, MMSS, MSSS, and NMS groups, respectively （F = 18.68, P 〈 0.001）. The rates of excellent and good CM scores were 86.67%, 80.77%, 65.52%, and 43.14% in the MCS, MMSS, MSSS, and NMS groups, respectively （ X^2 = 29.25, P 〈 0.001 ）. The median （IQR） VAS scores were 1 （0-2）, l （0 2）,2 （ 1-3）, and 3 （1-5） points in the MCS, MMSS, MSSS, and NMS groups, respectively （H = 27.80, P 〈 0.001）. Functional recovery was markedly better and VAS values were lower in the MCS and MMSS groups （for CM scores： MCS vs. MSSS, P 〈 0.001 ; MCS vs. N MS. P 〈 0.001; MMSS vs. MSSS, P= 0.031 and MMSS vs. NMS, P 〈 0.001 and for VAS values： MCS vs. MSSS, Z=3.31, P = 0.001： MCS vs. NMS, Z = 4.64, P 〈 0.001; MMSS vs. MSSS, Z = -2.09, P = 0.037： and MMSS vs. NMS, Z=-3.16, P = 0.003）.Conclusions： Medial support screws might help enhance mechanical stability and maintain fracture reduction when used to treat PHFs with medial metaphyseal comminution or malreduction.