Primary Joint Replacement in Proximal Humeral Fractures

Abstract The surgical treatment of proximal humeral fractures constitutes a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined ischemia-predicting criteria in the elderly. Good functional results are received by a soft-tissue preserving surgical technique, a secure tuberosity attachment and accurate soft tissue balancing of the rotator cuff, a correct restoration of height, retrotorsion and offset, and an appropriate aftertreatment. Multicenter studies observed an averaged Constant Murlay Score of 56 to 73.5 points. 79% of the patients had no or only mild pain in the follow up, ROM was acceptable (41.9% Anteversion >90°, 34.7% Abduction >90°). Generally, subjective evaluations are much better than objective results. The incidence of complications after primary humeral head replacement is still relatively high, whereas the 10-year-survival-rate of shoulder hemiarthroplasties was found to be 100%, currently.     

Plating in Proximal Humeral Fractures

Abstract Improved imaging, updated knowledge regarding humeral head perfusion and adapted fixation techniques with implants having better purchase also in osteopenic bone, have influenced the treatment of proximal humeral fractures in recent years. Demographic evolution and a more active population even among the older age groups will increase the incidence of this fracture, which is already the third most frequent fracture after hip and distal radius fractures in elderly patients. Long-term morbidity related to the treatment of these fractures like avascular humeral head necrosis, non-union, malunion, shoulder stiffness, persistent pain and functional disability are the challenging factors to be overcome. Plate osteosynthesis with angular stable implants have shown to address some of these problems and to broaden the spectrum of indication towards anatomic fracture stabilization even for severely displaced three- and four-part fractures instead of replacing the humeral head with an endoprosthesis, as long as a stable fixation is possible. Open access surgery is often needed for anatomic reconstruction of complex and displaced fractures. This calls for immediate postoperative mobilization with active-assisted ROM exercise to prevent subdeltoidal adhesions. Even though plating of proximal humeral fractures with angular stable implants has shown promising first clinical results, there still remain elevated complication rates especially in the elderly osteoporotic patient population. Recent clinical reports using angular stable plates provided only data with a low level of evidence to help in decision-making. The comparison with historical series using non-angular stable plates in respect to the long-term morbidity should help to better evaluate the value of locked plates inserted with less-extensive soft-tissue exposure.     

锁定钢板治疗肱骨近端骨折的临床效果

目的 探究对肱骨近端骨折（PHF）患者实施锁定钢板治疗的临床效果。方法 选取2019年5月-2022年3月我院收治的60例PHF患者为研究对象,采用随机数字表法分为对照组和应用组,各30例。对照组实施常规手术治疗,应用组实施锁定钢板治疗,比较两组手术时间、术中出血量、住院时间、临床疗效、疼痛程度及并发症发生情况。结果 应用组手术时间、术中出血量、住院时间均优于对照组,差异有统计学意义（P＜0.05）;应用组治疗总有效率为93.33%,高于对照组的76.67%,差异有统计学意义（P＜0.05）;应用组术后1、3、6个月的VAS评分均低于对照组,差异有统计学意义（P＜0.05）;应用组并发症发生率为6.67%,低于对照组的20.00%,差异有统计学意义（P＜0.05）。结论 锁定钢板疗法在PHF患者中的应用效果确切,可有效缩短手术时间及住院时间,减少术中出血量,同时可有效改善患者的疼痛状况,且并发症发生风险较小,安全性较高。     

Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture

ObjectiveTo investigate the outcomes of humeral head replacement in the treatment of patients with comminuted proximal humeral fracture.MethodsBetween February 2013 and September 2016, 56 patients underwent humeral head replacement in our hospital. Of them, 18 cases were diagnosed as comminuted proximal humeral fracture before the operation. The mean age of the patients was 69.5 years old (ranging from 61 to 79 years old). Of them, there were six males and 12 females. All the patients in this group had fresh fractures. They were all treated by artificial humeral head replacements. After the prosthesis was fixed by bone cement reliably, the greater or lesser trochanter and prosthesis handle were sutured and fixed firmly. The interval time from injury to operation ranged from 1 to 5 days. The Constant Functional Score, operation time, blood loss, nerve injury, joint dislocation rate, and infection rate were recorded at the final follow‐up. The clinical data of these patients were retrospectively studied. All of the data were recorded in average form.ResultsIn this study, the mean duration of follow‐up was 4 years, ranging from 3 to 6 years. The operation time ranged from 75 to 120 min, with the average of 82 min. The blood loss ranged from 100 to 400 mL, with the average of 210 mL. The mean score of Constant Functional Score was 83.5 ± 3.1. Of them, 14 cases achieved excellent and good (scores of more than 80), and four cases achieved moderate and poor (scores of less than 80). No patient suffered from joint dislocation, unstable joint, or infection after the operation. There were two patients with axillary nerve injury before the operation. However, the function could be recovered within 3–6 weeks after the surgery.ConclusionThe artificial humeral head replacement could be applied for the treatment of patients with comminuted proximal humeral fracture. During the surgery process, the stable structure of shoulder joint could be completely restructured, and the rehabilitation plan should be adjusted reasonably and timely after the operation.     

Proximal Humeral Fractures: Nailing

Abstract Treating proximal humeral fractures surgically has always been a challenge for the orthopaedic trauma surgeon. The challenge was and is due to numerous factors such as the specific anatomy of the proximal humerus, problems of an adequate approach and exposure of the fracture and different fracture fragments, possible iatrogenic injuries to the rotator cuff on approach and the detrimental effects of the former on the latter’s gliding and contracting ability after surgery. Furthermore, the very different fracture patterns that can occur at the proximal humerus, the shear number of fragments which can be of extremely bad bone quality, the necessity for anatomic reduction of these fragments with an implant that will allow for a stable osteosynthesis and at the meantime will not impinge in the subacromial area and lastly, the intention of the physician-in-charge to commence with physical therapy as soon as possible post OP. All of these added to the fact that not one fixation technique with one certain implant could be recommended as a treatment or implant of choice in dealing with these difficult fractures. Most of the supposedly applicable surgical techniques and implants had major setbacks such as being limited to only very expert hands, necessitating a long-standing postoperative immobilisation, resulting in secondary loosening of implants, secondary loosening of reduction or impaired bone healing and, despite all efforts, finally led to poor function at the shoulder. With the advent of angular stable implants such as angular stable, anatomically contoured plates designed for proximal humeral fractures only and special angular stable nails for the same or similar indications the treatment options and the quality of treatment in this area was much improved. Our experience with angular stable nails of two different manufacturers in now more than 320 implantations reveals that indications for the surgical treatment of such fractures can be extended constantly, that the number of complications will simultaneously decline, the necessity for primary joint arthroplasty even in multiple fragment fractures is minimal and that long-term results are, comparing the published results in the literature with those of our institution, equal if not superior to other treatment options.     

超声引导下闭合复位联合外固定架治疗青少年及儿童肱骨近端骨折

目的 探讨超声引导下闭合复位联合外固定架治疗青少年及儿童肱骨近端骨折的临床疗效.方法 回顾性分析2019年1月至2020年12月我院收治的38例移位明显的肱骨近端骨折病人的临床资料,其中男25例,女13例,年龄为6～17岁,平均年龄为10.3岁.手术方式均采用超声引导下骨折闭合复位联合外固定架.全程使用超声进行监控,术...     

肱骨近端骨折的外科治疗

目的探讨肱骨近端骨折的外科治疗及术后康复对疗效的影响。方法2000年10月至2003年12月，对收治的103例肱骨近端骨折患根据Neer分型及骨折的移位程度分别进行非手术治疗55例，手术治疗48例。术后早期行外展固定及功能锻炼。结果经过6～36个月(平均20．4个月)的随访，骨折均愈合。根据Neer评分标准，手术组和非手术组的优良率分别为93．8％和81．8％。结论肱骨近端骨折移位较小的，一般可采用非手术治疗。对于移位严重的NeerⅡ型和Ⅲ、Ⅳ型骨折。早期采用开放复位T形和三叶形钢板内固定，术后早期行外展固定及适当的功能锻炼可获得满意的疗效。治疗的关键是准确的复位、可靠的固定和适当的功能锻炼。     

Dual Locking Plate Osteosynthesis for 3- or 4-Part Proximal Humeral Fractures Combined with Multiple Fractures of the Greater Tuberosity

BackgroundThis retrospective study was conducted to evaluate the efficacy of dual locking plate osteosynthesis for treating 3- or 4-part proximal humeral fractures combined with multiple fractures of the greater tuberosity.MethodsFrom January 2012 to December 2018, 19 skeletally mature patients, who suffered 3- or 4-part proximal humeral fractures combined with multiple fractures of the greater tuberosity, were treated with open reduction and internal fixation using a dual locking plate technique through a delto-pectoral approach. Indexes for evaluation included fracture healing, quality of reduction, and incidence of complications (infections, screw perforation into the glenohumeral joint, subacromial impingement, hardware failure, avascular necrosis, and loss of reduction). Shoulder function was evaluated using Constant–Murley scoring.ResultsThe patients were assessed at a mean time of 25.3 months after surgery. Union of fractures was radiographically confirmed for all 19 patients. The mean Constant–Murley patient score was 85.2 points, and complications were identified in two patients during follow-up evaluations.ConclusionsThe method of using dual locking plate osteosynthesis through a delto-pectoral approach resulted in a satisfactory union rate, excellent fracture reduction, low complication rate and good shoulder function for patients with complex proximal humeral fractures. The method is effective for treating 3- or 4-part proximal humeral fractures combined with multiple fractures of the greater tuberosity.     

髓内钉与锁定钢板治疗肱骨近端骨折临床疗效的Meta 分析

目的:系统评价髓内钉与锁定钢板治疗肱骨近端骨折的临床疗效。方法:使用计算机检索Pubmed,Embase,Cochrane Library,万方,知网,VIP 数据库,检索从建库到2019 年12 月的所有关于髓内钉与锁定钢板治疗肱骨近端骨折的随机对照试验。由2 名评价者对独立纳入的文献进行数据提取后,用RevMan5.3 软件进行Meta 分析。结果:按照规定的文献检索方式,最终纳入7 篇RCT 研究,研究中共纳入患者412 例,分析结果显示:在手术时间、术中出血量、骨折愈合时间方面髓内钉组优于锁定钢板组,两者之间差异具有统计学意义;在术后6 个月Constant-Murley 评分方面,两者之间差异无统计学意义。结论:治疗肱骨近端骨折髓内钉与锁定钢板均可取得良好疗效,但在减少手术时间、术中出血量以及缩短骨折愈合时间方面髓内钉更具优势,但仍需高质量的临床研究进一步验证。     

两种不同钢板治疗不同年龄段肱骨近端C2型骨折的疗效观察

目的比较锁定钢板(Locking proximal humeral plate,LPHP)及普通加压钢板,治疗不同年龄段肱骨近端C2型骨折的临床疗效。方法2004年1月至2009年6月,对152例肱骨近端C2型骨折患者,按年龄分为青少年段(<30周岁)、中年段(30~60周岁)及老年段(>60周岁);每个年龄段再随机分为A、B两组,A组77例患者采用锁定钢板治疗,B组75例患者采用普通钢板治疗。通过骨折愈合率及Neer评分,比较分析各组及每个年龄段的疗效。结果术后随访18~24个月。A组青少年段、中年段的骨折愈合率与B组比较均无统计学差异(P>0.05);A组的老年段骨折愈合率为97.1%,明显高于B组的81.8%(P<0.05)。A、B两组青少年段的Neer疗效评分无显著差异(P>0.05);A组其他两个年龄段的Neer疗效评分明显高于B组(P<0.05)。结论锁定钢板治疗中老年肱骨近端C2型骨折较普通钢板更为安全有效,中老年段肱骨近端C2型骨折患者建议使用锁定钢板治疗。     

Correlation of CT Values and Bone Mineral Density in Elderly Chinese Patients with Proximal Humeral Fractures

ObjectiveTo investigate the correlation between computed tomography (CT) values and bone mineral density (BMD) in elderly Chinese patients with proximal humeral fractures.MethodsThis was a single‐center retrospective study involving 166 elderly patients with proximal humeral fractures between January and June 2015 in our hospital. Following the inclusion and exclusion criteria, 89 patients were finally enrolled in this study. The spiral CT scanning was performed on these patients, and the CT images were obtained by using MIMICS software. The CT values in axial, coronal, and sagittal images of healthy proximal humeri were measured using a circular region of interest (ROI) by Image J. The bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual‐energy X‐ray absorptiometry (DXA). Spearman rank correlation methods were used for analysis of the association between the proximal humerus average CT value (CT_Mean) and the lumbar spine as well as femoral neck BMD in patients with proximal humeral fractures, or osteoporotic patients.ResultsAmong the included 89 patients, there were 26 males and 63 females, 69% and 84% of whom were diagnosed with osteoporosis, respectively. The lumbar spine and femoral neck BMD and the CT_Mean of the proximal humerus were higher in males than females with proximal humeral fractures (P < 0.05). This gender difference was also found in the osteoporotic patient population (P < 0.05). The Spearman rank correlation method showed that the lumbar spine and femoral neck BMD was closely related to the proximal humeral CT_Mean in males (r = 0.877, P = 0.000; r = 0.832, P = 0.000; respectively) and females (r = 0.806, P = 0.000; r = 0.616, P = 0.000; respectively) with proximal humeral fractures, as well as osteoporotic male (r = 0.745, P = 0.000; r = 0.575, P = 0.000; respectively) and female (r = 0.613, P = 0.000; r = 0.629, P = 0.000; respectively) patients.ConclusionsThe CT value of the proximal humerus is a rapid and accurate method by which bone quality can be assessed in elderly patients with proximal humeral fractures. Moreover, the CT value of the proximal humerus is an alternative measurement of BMD that can guide surgeons in selecting the appropriate internal fixation material.     

Fixation of Proximal Humeral Fractures with an Intramedullary Nail: Tipps and Tricks

Abstract Antegrade interlocking nailing has been established as a valid option of treatment in proximal humeral fractures which follows the principles of minimum invasive surgery. The introduction of angular stability into intramedullary nailing has increased the stability of reconstruction even in osteoporotic fractures. The outcome of the surgical procedure essentially depends on the adequate intraoperative management of the specific features and challenges of the corresponding fracture type. The creation of the correct nail entry point is crucial for anatomic reduction and stability of the reconstruction, as well. The knowledge on intraoperative reduction aids and additional tools of enhancing the stability of the reconstruction alleviates a mechanically sound application of antegrade intramedullary nailing in most highly unstable proximal humeral fractures.     

Direct Arthroscopy of the Bicipital Groove: A New Approach to Evaluation and Treatment of Bicipital Groove and Biceps Tendon Pathology

Assessment of the intra-articular and intertubercular regions of the long tendon of the biceps forms an important aspect of routine glenohumeral arthroscopic examination. We describe a new technique of direct visualization of the bicipital groove and tendon by positioning the arthroscope in linear alignment with the bicipital groove. A 4.5-mm cannula is introduced through a superior-medial (Neviaser) portal, into the glenohumeral joint, parallel and adjacent to the superior aspect of the biceps tendon, and is used as a viewing portal. The arm is then positioned in abduction, external rotation, and forward flexion, to align the groove with the arthroscope, thereby attempting to “look down the groove.” The biceps tendon, as well as the structures forming its medial and lateral pulleys, can be evaluated from the glenohumeral and intertubercular aspects. A greater length of the medial and lateral lips and the floor and roof of the bicipital groove can be visualized by advancing the arthroscope deeper within the groove. A fat pad along the lateral wall of the groove serves as an anatomic landmark to limit dissection in this region, thereby preventing damage to the anterolateral ascending branch of the anterior circumflex artery. An extension of this technique, to facilitate instrumentation for arthroscopic biceps tenodesis, is described.     

半肩关节置换治疗高龄肱骨近端四部分骨折的疗效评价

目的 评估半肩关节置换治疗高龄肱骨近端四部分骨折的疗效。方法 回顾性分析2018年1月至2021年12月采用半肩关节置换手术治疗的21例高龄肱骨近端四部分骨折的病人资料,其中男4例,女17例,平均年龄76岁（65~89岁）;均为闭合性新鲜骨折;受伤至手术时间平均为5天（3~8天）。采用疼痛视觉模拟量表（VAS）和Constant-Murley肩关节评分评价手术疗效。结果 21例病人切口均一期愈合。所有病人随访时间超过6个月,其中11例病人随访超过24个月,平均随访时间20个月（6~48个月）。21例病人肱骨大、小结节均愈合。术后6个月,21例病人的VAS评分为（1.24±1.22）分;Constant-Murley评分为（81.10±7.16）分,末次随访时进一步提高为（88.45±4.57）分。进一步研究发现,75岁以上病人术后6个月的VAS评分显著低于75岁以下病人［（0.73±0.90）分 vs. （1.80±1.32）分］,Constant-Murley评分也显著低于75岁以下病人［（78.00±6.83）分 vs. （84.50±6.13）分］,差异均有统计学意义（P＜0.05）。结论 半肩关节置换治疗高龄肱骨近端四部分骨折的疗效优良。     

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Objective

There is currently no consensus on proximal humerus fractures with an initial deformity in the coronal plane who are better off with plates or nails, so we designed this study. To compare the effect of the initial deformity in the coronal plane of proximal humerus fractures on postoperative outcomes, we compare the maintenance of reduction in procedures utilizing plates and nails, and analyzed the subsequent occurrence of complications to explore whether the initial deformity should dictate the fixation approach.

Methods

The clinical data of patients with proximal humerus fractures who were hospitalized and underwent surgical treatment in our hospital from January 2016 to December 2020 were reviewed. Postoperative functional scores (American Shoulder and Elbow Surgeons, ASES; Constant-Murley Score, CMS), Neck-shaft angle (NSA), Quality of fracture reduction, Deltoid Tuberosity Index (DTI), and complications were compared among cases with initial varus, normal, or valgus deformities.

Results

We included 131 patients, 56 males and 75 females, with a mean age of 60.89 ± 5.53 years (range 50–76) and a mean follow-up duration of 16.63 ± 6.78 months (range 12–48). Of these, 29 cases had initial varus displacement, 71 had a normal NSA, and 31 had initial valgus displacement. Seventy-five were treated with a locking plate and 56 with a nail. After open reduction and internal fixation, the NSA was restored to normal (−135°) in all patients in all groups (P > 0.05). There was a significant difference in NSA changes at the last follow-up; 2.93° ± 2.12° in the varus group, 1.77° ± 1.18° in the normal group, and 2.32° ± 1.64° in the valgus group, with the highest change occurring in the varus group. There was no significant difference in the range of motion or functional scores including ASES and CMS among the three groups (P > 0.05). The complication rate of 20.7% in the varus group was significantly higher than the complication rates of 12.7% in the normal and 12.9% in the valgus groups (P < 0.05).

Conclusions

While proximal humerus fractures with initial coronal displacement (varus, normal, and valgus) show similar postoperative functional outcomes, varus fractures have a higher rate of complications. The nail provides better maintenance of reduction than the locking plate, especially in varus fractures.     

Fracture Line Morphology of Greater Tuberosity Fragments of Neer Three- and Four-Part Proximal Humerus Fractures

Objective

In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three- or four-part PHF and analyze the location relationship between the locking plate and the GT fragment.

Methods

Seventy-one three-dimensional computed tomography scans of Neer three- and four-part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3-matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer-simulated scenario.

Results

The fracture line morphology of GT fragments was similar between Neer three- and four-part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior-split, posterior-split, complete-split, anterior -avulsion, and posterior-avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior-split, posterior-split, complete-split, anterior-avulsion, and posterior-avulsion type GT fragments. We defined the posterior-split, anterior-avulsion, and posterior-avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three- and four-part PHFs.

Conclusion

The fracture line morphology of GT fragments of Neer three- and four-part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior-avulsion, posterior-avulsion, and posterior-split type fragments as the risky GT fragments with a high incidence rate in Neer three- and four-part PHFs.     

人工肱骨头置换治疗老年肱骨近端粉碎骨折

目的探讨人工肱骨头置换治疗老年肱骨近端粉碎骨折的疗效。方法对14例肱骨近端粉碎骨折老年患者施行人工肱骨头置换术,并进行疗效评定。患者年龄65～78岁,平均年龄72岁,7例为三部分骨折,2例为肱骨头劈裂骨折,5例为四部分骨折,其中5例伴肩关节半脱位,手术全部采用骨水泥型人工肱骨头假体。结果本组14例术后随访6～24个月,平均15个月,按肩关节Neer评分系统进行评价,优2例,良10例,可2例,优良率85．7％。结论人工肱骨头置换治疗老年肱骨近端粉碎骨折,能有效解除疼痛、重建关节功能,是一种理想的治疗方法。     

Arthroscopical Findings after Antegrade Nailing of a Proximal Humeral Fracture

Abstract Proximal humeral fractures represent up to five percent of all fractures in adults, commonly found in elderly patients. The final functional results after different operative procedures are among other factors dependent on whether or not a rotator cuff lesion is pre-existent, prior to the fracture, and how its surgical therapy is carried out. However, to what extent prior rotator cuff tears in this special patient group contribute to the functional outcome remains widely unclear. In our institution antegrade intramedullary nailing is the treatment of choice for proximal humeral fractures. One critical point of this technique is the unavoidable split of the rotator cuff on the approach to the proximal humerus and the insertion of the nail through the incised cuff. We report on a case of an impingement after antegrade intramedullary nailing of a proximal humeral fracture. Diagnostic glenohumeral arthroscopy revealed neither a residual lesion of the former rotator cuff incision nor a chondral lesion at the former insertion site of the nail. In the same session subacromial decompression and a nettoyage of adhesions were performed. We assume that splitting the rotator cuff for the insertion of an antegrade nail in a proximal humeral fracture is less relevant than previously assumed and described.     

Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

Background

We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle.

Methods

Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al.

Results

The mean neck shaft angles were 133.6° (range, 100° to 116°) at immediate postoperative, 129.8° (range, 99° to 150°) at 3 months postoperative and 128.4° (range, 97° to 145°) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8° as compared to 1.3° in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant.

Conclusions

The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.     

髓内钉治疗老年性肱骨近端骨折的疗效评价

目的探讨髓内钉治疗老年性肱骨近端粉碎性骨折的可行性及临床疗效。方法回顾性分析2015年1月至2016年12月收治的49例老年粉碎性肱骨近端骨折(NeerⅡ~Ⅳ型)患者,按内固定方式分为两组,分别采用肱骨近端锁定钢板(LPHP组)和肱骨近端髓内钉(IPHN组)进行固定。分析两组患者术后肩关节功能恢复情况及影像学资料。结果 IPHN组术后早期(1~3个月)Constant-Murley评分均高于LPHP组,差异具有统计学意义(P<0.05);而远期(术后6个月)随访结果显示,两组Constant-Murley评分和治愈率均无统计学差异(P>0.05)。结论髓内钉可促进老年性肱骨近端粉碎性骨折的早期恢复,但其远期效果无明显优势。