Objective To evaluate the effectiveness of locking plates for Neer 3- and 4-part proximal humerus fractures. Methods A retrospective analysis was made on the clinical data of 77 patients with 3- or 4-part proximal humerus fractures, who underwent open reduction and internal fixation of locking plates and were followed up more than 12 months between July 2008 and May 2011. There were 39 males and 38 females with an average age of 54.2 years (range, 18-81 years). Fractures were caused by falling in 47 cases, by traffic accident in 16 cases, by falling from height in 4 cases, by sporting in 5 cases, and by other reasons in 5 cases. The time between injury and operation was 2-16 days (mean, 4.5 days). According to Neer classification, there were 54 cases of 3-part fracture and 23 cases of 4-part fracture. The Constant scores, visual analogue score (VAS), and the complications were evaluated during follow-up. Results After operation, healing of incisions by first intention was obtained in 76 cases and healing by second intention in 1 case. All patients were followed up 12-36 months (mean, 18.5 months). At last follow-up, the Constant score was 71.1 ± 11.9; the results were excellent in 18 cases, good in 24 cases, fair in 25 cases, and poor in 10 cases with an excellent and good rate of 54.5%. The VAS score was 2.8 ± 2.2. Bone nonunion occurred in 2 cases; the other patients had bone union within 2-6 months (mean, 3.2 months). The complications occurred in 25 cases (32.5%). Revision surgery was performed in 15 patients (19.5%). Conclusion The treatment of Neer 3- and 4-part proximal humerus fractures remains challenging. Anatomic reduction, stable fixation, and reduced humeral head blood supply disruption may lead to a satisfactory outcome.
ObjectiveTo analyze the outcome and prognostic factors of using locking plate for treating proximal humerus fracture. MethodsBetween January 2005 and January 2012, 45 aged patients with a displaced 3-part or 4-part fracture of the proximal humerus were treated by locking plate. Range of motion and Constant-Mudey score were observed during the follow-up. ResultsForty-three patients were followed up from 12 to 48 months with an average of 18 months. The mean final Constant-Mudey score was 72.3±9.5 and 6 of them needed a second surgery. In addition to fracture type, other prognostic factors included redisplacement (4 cases, 9.3%), nonunion (3 cases, 7.0%), crashing (3 cases, 7.0%), necrosis of the humeral head (6 cases, 14.0%) and screw cut-out (5 cases, 11.6%). Among the patients with disrupted medial calcar, 4 needed a second surgery at the final follow-up, 3 had redisplacement, 2 had nonunion, and 2 had screw cut-out. ConclusionLocked screw-plates provide more secure fixation of fracture in aged patients, but the complication rate remains high. We suggest anatomic reduction, and plate and screws position, length of the screws, the medial cortical contact and stability may be the chief prognostic factors affecting the shoulder function following a proximal humeral fracture.
ObjectiveTo analyze the effectiveness of proximal humeral internal locking system (Philos) plate for proximal humerus fracture. MethodsThirty-three patients with proximal humerus fracture were treated with open reduction and internal fixation with Philos plate between January 2009 and January 2014. There were 19 males and 14 females, aged 23-89 years (mean, 56.6 years). The left side was involved in 15 cases, and the right side in 18 cases. The injury causes included falling in 20 cases and traffic accident in 13 cases. All cases received X-ray and CT scan and three-dimensional reconstruction before operation. According to the Neer classification, 8 cases were rated as two-part fractures, 15 cases as three-part fractures, and 10 cases as four-part fractures. The interval time between injury and surgery was 1-7 days (mean, 3.67 days). Postoperative functional outcome was evaluated using the Constant-Murley score. ResultsInfection and liquefaction occurred in 2 cases respectively, which was cured after corresponding treatment; primary healing of wound was obtained in the other 29 cases. Five patients had shoulder pain. The patients were followed up 11-47 months (mean, 33 months). The mean time of fracture union was 7.5 months (range, 5-9 months) on the X-ray films. Humeral head necrosis occurred in 2 patients with Neer four-part fractures, and internal fixation failure occurred in 3 patients (2 screw broken and 1 plate broken) with four-part fractures (2 cases) and three-part fractures (1 case), which was cured after conservative treatment. At last follow-up, the mean Constant-Murley score was 70.5 (range, 42-90); the results were excellent in 3 cases, good in 21 cases, moderate in 6 cases, and poor in 3 cases. ConclusionSatisfactory results can be expected for proximal humeral fracture by using of the proximal humeral internal locking system plate based on strict indication and early rehabilitation training.
Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
ObjectiveTo explore the biomechanical stability of the medial column reconstructed with the exo-cortical placement of humeral calcar screw by three-dimensional finite element analysis. MethodsA 70-year-old female volunteer was selected for CT scan of the proximal humerus, and a wedge osteotomy was performed 5 mm medially inferior to the humeral head to form a three-dimensional finite element model of a 5 mm defect in the medial cortex. Then, the proximal humeral locking plate (PHILOS) was placed. According to distribution of 2 calcar screws, the study were divided into 3 groups: group A, in which 2 calcar screws were inserted into the lower quadrant of the humeral head in the normal direction for supporting the humeral head; group B, in which 1 calcar screw was inserted outside the cortex below the humeral head, and the other was inserted into the humeral head in the normal direction; group C, in which 2 calcar screws were inserted outside the cortex below the humeral head. The models were loaded with axial, shear, and rotational loadings, and the biomechanical stability of the 3 groups was compared by evaluating the peak von mises stress (PVMS) of the proximal humerus and the internal fixator, proximal humeral displacement, neck-shaft angle changes, and the rotational stability of the proximal humerus. Seven cases of proximal humeral fractures with comminuted medial cortex were retrospectively analyzed between January 2017 and December 2020. Locking proximal humeral plate surgery was performed, and one (5 cases) or two (2 cases) calcar screws were inserted into the inferior cortex of the humeral head during the operation, and the effectiveness was observed. Results Under axial and shear force, the PVMS of the proximal humerus in group B and group C was greater than that in group A, the PVMS of the internal fixator in group B and group C was less than that in group A, while the PVMS of the proximal humerus and internal fixator between group B and group C were similar. The displacement of the proximal humerus and the neck-shaft angle change among the 3 groups were similar under axial and shear force, respectively. Under the rotational torque, compared with group A, the rotation angle of humerus in group B and group C increased slightly, and the rotation stability decreased slightly. All the 7 patients were followed up 6-12 months. All the fractures healed, and the healing time was 8-14 weeks, with an average of 10.9 weeks; the neck-shaft angle changes (the difference between the last follow-up and the immediate postoperative neck-shaft angle) was (1.30±0.42)°, and the Constant score of shoulder joint function was 87.4±4.2; there was no complication such as humeral head varus collapse and screw penetrating the articular surface. ConclusionFor proximal humeral fractures with comminuted medial cortex, exo-cortical placement of 1 or 2 humeral calcar screw of the locking plate outside the inferior cortex of the humeral head can also effectively reconstruct medial column stability, providing an alternative approach for clinical practice.
ObjectiveTo review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF). MethodsThe domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized. Results PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum’s integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient’s age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option. ConclusionCurrently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.