PFNA2 versus 95 Degree Condylar Blade Plate in the Management of Unstable Trochanteric Fractures

Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.

Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus

Purpose: The purpose of 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 are used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. Patients & Methods: Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study, conducted between March 2015 and December 2019. 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 up for a mean time of 16.3 months (range: 13 to 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. Results: Union at the fracture site was achieved in all patients at a mean of 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 = 11, this difference was found to be statistically significant (p < 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 < 0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. Conclusions: An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.

Mortality following combined fractures of the hip and proximal humerus

BACKGROUND Hip fractures and proximal humerus fractures are known to be associated with increased mortality,but the impact on mortality of combining these two common injuries is not well known.AIM To compare mortality,inpatient stay and discharge destination for patients with combined hip and proximal humerus fractures with those sustaining isolated hip fractures.METHODS Using the United Kingdom national hip fracture database,we identified all hip fracture patients over the age of 60 admitted to a single trauma unit from 2010-2016.Patients sustaining a proximal humerus fracture in addition to their hip fracture were identified using hospital coding data.We calculated the 30-d and one-year mortality for both the hip fracture cohort and the combined hip and proximal humerus fracture cohort.Other variables recorded included age,gender and whether the proximal humerus was treated with or without an operation.RESULTS We identified 4131 patients with hip fractures within the study period and out of those 40 had sustained both a hip and a proximal humerus fracture.Mean age in the hip fracture cohort was 80.9 years and in the combined fracture group 80.3 years.Out of the 40 patients in the combined group four were treated operatively.The 30-d mortality for our hip fracture cohort was 7.2%compared to the mortality of our combined cohort of 12.5%(P=0.163).The one-year mortality for our hip fracture cohort was 26.4%compared to 40%for the combined fracture cohort(P=0.038).We also found patients with combined injuries were less likely to return to their own home.CONCLUSION The 30-d and one-year mortality is higher for those patients who have sustained a combined hip and proximal humerus fracture when compared to those with a hip fracture alone.

Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts:A retrospective,comparative cohort study

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.

Management of proximal humerus fractures in adults

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.

Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

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.

Reduction of postoperative bleeding following operative treatment of proximal humerus fractures using a collagen sponge

Aim of the present study is to investigate the efficacy and safety of TachoSil? to reduce afterbleeding and hematoma following operative treatment of proximal humerus fractures. In a prospective randomized study we included a consecutive series of 40 patients with a proximal humeral fracture in this study. All fractures were stabilized surgically with a fixed-angle “Philos plate” from May 2008 through May 2009. All patients were divided in two groups: Group I with plate osteosynthesis without TachoSil, Group II with plate osteosynthesis with TachoSil. For statistical analysis Chi2- Test and U- Test were used. There were 4 perioperative complica- tions in group II and one complication in group I (Chi2-Test: p=0.233). In group II one hardware failure occurred due to osteoporosis requiring revision and reosteosynthesis. Another patient suffered from paralysis of the radial nerve which healed uneventfully. One superficial postopera-tive infection and one superficial hematoma re-quired revision surgery, too. In this group no subfascial hematoma developed. One subfascial hematoma which required no revision occurred in group I. Blood transfusion was required 2 times in group I and 3 times in group II (Chi2-Test: p = 0.549). In sum in group II there was a sig-nificant lower blood loss for the subfascial drain, the region where TachoSil was applied. No ad-verse affects related to TachoSil could be de-tected. TachoSil was found to be safe and effective for reduction of postoperative bleeding following operative treatment of proximal hume-rus fractures. Further studies with larger sample size are required to confirm the efficacy of TachoSil? in orthopedic surgery.

Plate vs reverse shoulder arthroplasty for proximal humeral fractures:The psychological health influence the choice of device?

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.

Humeral head replacement and individualized rehabilitation for displaced four-part fractures of proximal humerus

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

Fractures around the shoulder in the skeletally immature:A scoping review

Fractures around the shoulder girdle in children are mainly caused by sports accidents.The clavicle and the proximal humerus are most commonly involved.Both the clavicle and the proximal humerus have a remarkable potential for remodeling,which is why most of these fractures in children can be treated conservatively.However,the key is to understand when a child benefits from surgical management.Clear indications for surgery of these fractures are lacking.This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children.The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures,tenting of the skin with necrosis,associated neurovascular injury,or a floating shoulder.There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic.In the rare case of a symptomatic malunion of the clavicle in children,corrective osteosynthesis is a viable treatment option.For proximal humerus fractures in children,treatment is dictated by the patient's age(and thus remodeling potential)and the amount of fracture displacement.Under ten years of age,even severely displaced fractures can be treated conservatively.From the age of 13 and onwards,surgery has better outcomes for severely displaced(Neer types III and IV)fractures.Between 10 and 13 years of age,the indications for surgical treatment are less clear,with varying cut-off values of angulation(30-60 degrees)or displacement(1/3–2/3 shaft width)in the current literature.

Mechanisms of shoulder trauma: Current concepts

Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions.Therefore,when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns.Here,we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation,dislocation with fracture of the humeral head,and the proximal humerus fracture.We have focused on common injury mechanisms and the correlation with radiological diagnostics.Radiological and laboratory findings of distinct types of injury were also discussed.

Surgical Treatment for Proximal Humerus Fractures Comparison between Plate Fixation and Kapandji’s Pinning

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.

Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures

Purpose:Unsatisfactory results of hemiarthroplasty in Neer’’s 3- and 4-part proximal humerus fractures in elderly,have led to the shift towards reverse shoulder arthroplasty (RSA).The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores.Methods:We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head.Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded.According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month,the patients were divided into 2 groups,as the group with successful tuberosity repair and the other with failed tuberosity repair.Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independentt-test for normally distributed parameters and Mann-Whitney test for the parameters,where data was not normally distributed.Results:Of 41 patients,tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases.Lysis of the tuberosity occurred in 5 patients,tuberosity displacement in 2,and nonunion in 2.Mean age was 70.4 years (range 65 – 79 years) and mean follow-up was 58.7 months (range 18 – 93 months).There were no major complications.Group with successful tuberosity repair showed improvement in mean active range of movements,like anterior elevation (165.1°± 4.9°vs.144.6°± 9.4°,p < 0.000),lateral elevation (158.9°± 7.2°vs.138.4°± 9.6°,p < 0.000),external rotation (30.5°± 6.9°vs.35.0°± 6.3°,p = 0.367),internal rotation (33.7°± 7.5°vs.32.6°± 6.9°,p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1vs.55.5 ± 5.7,p < 0.000),American shoulder and elbow surgeons score (90.3 ± 2.4vs.69.0 ± 5.7,p < 0.000),disability of arm shoulder and hand score (22.1 ± 2.3vs.37.6 ± 2.6,p < 0.000).Conclusion:Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion,strength and shoulder scores.Standardized repair technique and interposition of cancellous bone grafts,harvested from the humeral head can improve the rate of tuberosity healing.

Functional Outcome Following Reverse Total Shoulder Replacement in the Setting of Trauma with Minimum 1 Year Follow-Up

Aims: To evaluate the short term functional outcomes following a reverse total shoulder replacement for complex neck of humerus fractures. Methods: A single centre retrospective case series evaluating all patients who underwent reverse shoulder arthroplasty following a complex neck of humerus fracture. Functional shoulder movements were assessed by two orthopaedic trainees at 1 year follow-up and compared to the opposite shoulder. Subjective assessment was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Oxford Shoulder Score (OSS). Documentation of any complications was also noted. Findings: The reverse total shoulder replacement showed favourable outcomes both subjectively and objectively. Subjectively patients in this study scored a mean of 27.5 +/- 24.4 (range 0 - 57.8) in the DASH and 37.9 +/- 9.2 (range 26 - 48) in the OSS. There was a high negative linear correlation between the 2 scoring systems (r = -0.95, p Conclusion: A reverse total shoulder replacement shows favourable subjective and objective outcomes for complex neck of humerus fractures in the trauma setting.

基于加速康复外科理念的骨水泥强化型防旋股骨近端髓内钉治疗在老年骨质疏松性股骨转子间骨折中的应用效果

目的探讨基于加速康复外科(ERAS)理念的骨水泥强化型防旋股骨近端髓内钉(PFNA)治疗在老年骨质疏松性股骨转子间骨折中的应用效果。方法选取东台市人民医院2021年1月至2022年10月收治的40例老年骨质疏松性股骨转子间骨折患者为研究对象,采用随机数字表法分为对照组(20例)和观察组(20例)。对照组采用ERAS理念联合PFNA治疗,观察组采用ERAS理念联合骨水泥强化型PFNA治疗,并对两组进行为期6个月的随访。比较两组髋关节Harris评分优良率、髋关节活动角度、手术及恢复情况、生活质量及并发症。结果观察组术后6个月髋关节Harris评分优良率高于对照组,观察组住院时间、骨折愈合时间、术后下地行走时间、负重练习时间均短于对照组,总并发症发生率低于对照组,差异有统计学意义(P<0.05);两组的手术时间、术中出血量的比较,差异无统计学意义(P>0.05);观察组术后6个月的欧洲五维健康量表(ED-5Q)各项评分低于对照组,髋关节活动角度大于对照组,差异有统计学意义(P<0.05)。结论ERAS理念下的骨水泥强化型PFNA治疗老年骨质疏松性股骨转子间骨折患者能提高治疗优良率,提高患者生活质量,增加髋关节活动角度,且并发症发生率低。

异体腓骨髓内支撑结合钢板内固定治疗NeerⅣ型肱骨近端骨折的临床疗效

目的:探讨异体腓骨髓内支撑结合钢板内固定治疗NeerⅣ型肱骨近端骨折的临床疗效。方法:自2017年12月至2020年12月采用异体腓骨髓内支撑结合钢板内固定治疗NeerⅣ型肱骨近端骨折患者12例,男7例,女5例;年龄56~78岁;受伤至手术时间1~7 d。观察患者手术时间、骨折愈合时间及并发症情况,末次随访时采用Constant-Murley评分进行疗效评价。结果:12例患者获得随访,时间20~29个月。所有患者获得骨性愈合,手术切口Ⅰ期愈合,手术时间95~138 min,出血量210~275 ml,骨折愈合时间14~18周。术后2例出现肩关节僵硬,经被动锻炼2周后恢复。所有患者未发生感染、切口愈合不良、内固定物失效(断裂、松动)等并发症。末次随访时,Constant-Murley肩关节功能评分69~89分,优2例,良9例,可1例。结论:采用异体腓骨髓内置入能够为肱骨内侧提供有效支撑,有利于辅助骨折端复位,降低肱骨头内翻塌陷及螺钉穿出致内固定失效等情况出现,显著改善肩关节功能。

肱骨头置换联合和营止痛汤加减治疗骨质疏松性肱骨近端骨折的疗效分析

目的分析肱骨头置换联合和营止痛汤加减治疗骨质疏松性肱骨近端骨折的疗效。方法选择2015年1月—2020年10月本院收治的进行手术治疗的骨质疏松性肱骨近端骨折患者50例作为研究对象,以抽签法随机分为肱骨头置换术组(单纯手术组)20例,和肱骨头置换术联合和营止痛汤加减治疗(手术联合中药组)30例。评估临床疗效;记录术后肿胀消失时间、肩关节开始康复训练时间;术前、术后1个月、2个月评估VAS评分;术后随访2年评估肩关节功能;并记录术后并发症情况。结果手术联合中药组临床优良率高于单纯手术组,差异具有统计学意义(P<0.05)。手术联合中药组术后关节肿胀消失时间及肩关节开始康复训练时间较单纯手术组短(P<0.05)。手术联合中药组术后1个月及术后2个月VAS评分较单纯手术组低(P<0.05)。术后6个月、术后1年及术后2年随访,手术联合中药组Neer评分明显高于单纯手术组(P<0.05);手术联合中药组术后并发症发生率3.33%较单纯手术组的30.00%低(P<0.05)。结论相较而言,肱骨头置换术配合中医治疗用于骨质疏松性肱骨头骨折治疗效果更佳,可有效缓解术后疼痛及水肿等症状,利于术后早期康复锻炼的实施,并促进术后肩关节功能恢复,且术后并发症发生率较低,值得临床推广。

三种手术方法治疗肱骨大结节骨折的疗效比较

目的探讨肱骨近端钢板、微型解剖钢板和关节镜下缝线桥技术治疗肱骨大结节骨折的疗效。方法选择78例肱骨大结节骨折接受手术治疗并随访1年以上的患者。根据手术方式分为3组:肱骨近端钢板组33例、微型解剖钢板组24例和关节镜组21例。结果所有患者获得满意的骨折复位和愈合。肱骨近端钢板组切口明显长于微型钢板组和关节镜组,差异有统计学意义(P<0.01)。三组患者手术时间和骨折愈合时间,差异无统计学意义(P>0.05)。术后1年随访时,微型解剖钢板组和关节镜组的肩关节外展上举活动度和ASES评分明显优于肱骨近端钢板组,差异有统计学意义(P<0.01)。术后发生15例并发症,肱骨近端钢板组9例,微型解剖钢板组4例,关节镜组2例。结论三种手术方法治疗肱骨大结节骨折均可获得满意的骨折愈合和功能恢复。关节镜下缝线桥技术联合中空螺钉固定是治疗肱骨大结节骨折微创、安全、有效的首选方法。

带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果比较

目的:比较带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果。方法:选取2021年2月至2022年2月该院收治的64例肱骨近端Neer二部分骨折患者进行前瞻性研究,按照随机数字表法将其分为观察组与对照组各32例。对照组采用锁定钢板内固定术治疗,观察组采用带锁髓内钉内固定术治疗,比较两组手术时间、术中出血量、住院时间、骨性愈合时间、ConstantMurley肩关节功能评分量表(CMS)评分、健康调查简表(SF-36)评分和并发症发生率。结果:观察组术中出血量少于对照组,住院时间和骨性愈合时间短于对照组,差异均有统计学意义(P<0.05);术后6个月,两组SF-36各维度评分高于术前,且观察组高于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率为3.12%,明显低于对照组的25.00%,差异有统计学意义(P<0.05);两组手术时间和手术前后CMS评分比较,差异无统计学意义(P>0.05)。结论:带锁髓内钉内固定术治疗肱骨近端Neer二部分骨折患者可提高术后SF-36评分,缩短住院时间和骨性愈合时间,以及降低术中出血量和并发症发生率,效果优于锁定钢板内固定术治疗。

肱骨近端锁定内固定系统钢板治疗肱骨近端骨折肱骨头螺钉的分布特点

背景:肱骨近端锁定内固定系统钢板是肱骨近端骨折最常用的固定方式,但临床上其失败率仍较高,螺钉的合理置入是影响内固定稳定性的重要因素。目的:探讨在肱骨近端锁定内固定系统钢板治疗肱骨近端骨折中肱骨头螺钉的分布特点及对内固定失效的影响。方法:对2017年1月至2021年12月在广州中医药大学第三附属医院收治的采用肱骨近端锁定内固定系统钢板内固定治疗的老年肱骨近端骨折患者进行回顾性分析,共纳入124例,其中男16例,女108例,年龄≥60岁,根据其术后是否出现内固定失效分为正常组(101例)和内固定失效组(23例)。收集患者年龄、性别、骨折类型、内侧柱完整性、钢板高度、颈干角、是否置入肱骨距螺钉、肱骨头螺钉数量,并根据术后数字X射线摄影正位片将肱骨头分为8个区,收集患者肱骨头螺钉在各区螺钉分布特点,绘制螺钉分布热力图。结果与结论:①两组患者在年龄、性别、骨折类型、内侧柱完整性、钢板高度、颈干角、是否置入肱骨距螺钉、肱骨头螺钉数量方面均无统计学差异(P>0.05);②但热力图显示,在正常组中肱骨头螺钉分布均匀,主要分散在4,6,7区;而内固定失效组的螺钉分布不均匀,主要集中在4,6区;此外,在肱骨距螺钉理想区域(7/8区)中,正常组螺钉明显多于内固定失效组;③提示在肱骨近端锁定内固定系统钢板治疗肱骨近端骨折过程中,肱骨头螺钉均匀分布是保证内固定效果的关键,合理的肱骨头螺钉分布有助于提高治疗效果和内固定成功率。