Objective To explore the cl inical effects of different operative procedures in treatment of upper humerus fracture nonunion. Methods From May 2001 to September 2007, 43 cases of upper humerus fractures nonunion were treated, including 31 males and 12 females with an average age of 37 years (range, 20-57 years). The causes were trafficaccident injury in 14 cases, fall ing injury from height in 11 cases, tumbl ing injury in 7 cases, heavy pound injury in 6 cases, machine injury in 4 cases, and pathological injury in 1 case. The time from fracture to hospital ization was 10-52 months (23 months on average). After open reduction, patients were treated respectively by bone-graft plus locking compression plate fixation (9 cases), scapula flap rotation displacement plus locking compression plate fixation (15 cases), and scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation (19 cases). Results All incisions healed by first intention. The X-ray films showed good fracture reduction. No symptoms of infection and nerve injury occurred. Forty-three patients were followed up 12 to 25 months with an average of 18 months. All of them achieved radiographic union within 3.0 to 7.5 months (4.9 months on average). According to comprehensive assessing standard of X-ray film and functions of shoulder and elbow, the results were excellent in 21 cases, good in 15 cases, fair in 4 cases, and poor in 3 cases; the excellent and good rate was 83.7%. Conclusion In the treatment of upper humerus fractures nonunion, locking compression plate can provide stable fixation. It can achieve satisfactory results so long as the right method of bone graft is chosen according to fracture site situation. But for patients undergoing repeated surgery or having nonunion for long times and poor fracture site situation, after open reduction, scapula flap rotation displacement plus locking compression plate plus tibia bone lamella fixation has good outcome.
Objective To evaluate the result of treating nonunion of lower segment of humerus with combination of rib flaps of cross chest and double plates. Methods From Feburary 2000 to May 2006, 21 cases of nounion of lower segment of humerus were treated. There were 13 males and 8 females with an average age of 36.5 years (range, 17-56 years). Accordingto AO classification, there were 5 cases of type A1.3, 7 cases of type B1.3, 6 cases of type B2.3, 2 cases of type B3.3, and 1 case of type C1.3. All nonunion occurred after internal fixation, which was caused by bone resorption at fracture end in 12 cases, by plates breakage in 3 cases, and by internal fixation loosening in 6 cases; including 8 cases of hypertrophic nonunion and 13 cases of atrophy nonunion without pseudoarthrosis. An average time of nonunion was 1.5 years (from 8 months to 3 years). All cases were treated with combination of rib flaps of cross chest (length, 3.0-3.5 cm) and double plates. The pedicle was divided 8 to 10 weeks after operation and all cases carried out functional exercise. Results The patients were followed up for an average time of 18.2 months (range, 1-3 years). All nounion of lower segment of humerus were healed and no radial nerve injury occurred. Primary heal ing of wound was achieved at both donor and recipient sites. Bony union was achieved in all cases after an average time of 3.5 months (range, 3-5 months) after operation. According to the the Hospital for Special Surgery (HSS) functional elbow index, the average score was 89.3 (range, 81.7-92.5) and the outcome was excellent in 14 cases, good in 4 cases, and poor in 3 cases, the excellent and good rate was 85.7%. Conclusion Combination of rib flaps of cross chest and double plates is an effective method of treating nonunion of lower segment of humerus.
Objective To summarize a new type of proximal humerus fracture—proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. Methods The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. Results All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer’s shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. Conclusion The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.
Objective To explore the effectiveness of distal humeral dual-planar osteotomy followed with distal humeral lateral column anotomical locking plate fixation in the treatment of adult cubitus varus deformity combined with flexion restriction. Methods The clinical data of 6 adult patients with cubitus varus deformity and flexion restriction treated with dual-planar osteotomy and internal fixation between April 2012 and September 2014 were reviewed. There were 3 males and 3 females with an average age of 22.2 years (range, 18-35 years). All the patients had history of elbow injury in childhood, the age being injured was 6.5 years on average (range, 2-13 years). There was no nerve injury, elbow strength weak, or unstable complications before admission. The preoperative elbow flexion was (107.50±5.24)°, elbow extension was (–12.17±3.48)°; the carring angle was (–19.50±4.46)°, the contralateral elbow carrying angle was (11.50±2.67)°; the length of humerus was (0.42±0.38) cm shorter than the unaffected humerus. The postoperative carrying angles, elbow flexion and extension, and humerus length were recorded. The modified Laupattarakasem criteria in which the comparison of bilateral elbow range of motion excluded was used to evaluate the results. Results Primary healing of incision was got in all patients and there was no early postoperative complications. All the patients were followed up 19-27 months (mean, 20.8 months). During the follow-up, there was no complication such as loosening and breakage of the internal fixators and all fractures were healed within 3 months after operation. At last follow-up, the elbow flexion was (124.17±5.85)°, the elbow extension was (0.83±2.04)°, the carrying angle was (12.00±4.19)°, and the humerus shortening was (1.88±0.45) cm, all showing significant difference when compared with preoperative ones (t=–6.742, P=0.001; t=–11.068, P=0.000; t=–20.400, P=0.000; t=–13.914, P=0.000). According to the modified Laupattarakasem criteria, 1 case was excellent, 4 were good, and 1 was fair with an excellent and good rate of 83.3%. Conclusion Normal carrying angle can be restored and elbow flexion can be increased by coronal closing wedge and sagittal trapezoid dual-planar osteotomy, single lateral anatomical locking plate fixation is available for early mobilization.
ObjectiveTo compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3 (AO/OTA) distal humeral fractures and investigate the details of operation.MethodsBetween April 2010 and September 2016, 36 type C3 (AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group (group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group (group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age, dominant side, interval between injury and surgery, causes of injury between 2 groups (P>0.05). Patients were followed up, the postoperative range of motion of elbow joint, strength, pain, and stability in 2 groups were documented and compared; the elbow joint function was evaluated according to Mayo elbow performance score (MEPS).ResultsThe operation time of group A [(115.0±10.4) minutes] was less than that of group B [(121.0±12.3) minutes], but there was no significant difference (t=–1.580, P=0.123). All patients in 2 groups got over 1 year follow-up and there was no significant difference of the follow-up time between 2 groups (t=–0.843, P=0.405). There was 1 case of heterotopic ossification in each group; 1 case of incision infection in group A and 1 case of incision superficial infection in group B, and were cured after 2 weeks of intravenous antibiotics administration. There was no other operative complications in the 2 groups. At 3 months after operation, all the distal humerus healed. At last follow-up, the elbow flexion extension range of groups A and B were (102.0±12.6)° and (99.5±10.1)° respectively, showing no significant difference (t=–0.681, P=0.501). The MEPS scores of groups A and B were 82.9±7.3 and 81.3±7.2 respectively, showing no significant difference (t=0.670, P=0.507); and the evaluation grade also showed no significant difference between 2 groups (Z=–0.442, P=0.659).ConclusionBy paratricipital approach and proper traction of the olecranon, the distal humeral articular surface can be exposed in the operation of type C3 distal humeral fractures, followed with same stable fixation after reduction, the effectiveness is equal to by chevron olecranon V osteotomy approach.