Internal fixation of proximal humeral fractures with a Polarus humeral nail

Background  Proximal humeral fractures occur frequently. Displaced or unstable fractures require open reduction and internal fixation. Our objective was to investigate the clinical and radiographic results of the internal fixation using Polarus humeral nails for fractures of the proximal humerus. Materials and methods  From January 2001 to April 2006, 54 shoulders of 54 patients (44 females, 10 males) underwent the intramedullary fixation using Polarus humeral nail. Mean age of the patients was 66-year-old (39–89) at the time of the surgery. Fracture-type by Neer classification was 2-part (29 shoulders), 3-part (22 shoulders) and 4-part (3 shoulders). The clinical and radiological outcomes were evaluated. Results  All the shoulders after osteosynthesis obtained bone-union. There was no osteonecrosis of the humeral head. Functional outcome measured by JOA score averaged 81 points. Totally 43 patients (79%) had satisfactory to excellent results. Varus deformity was seen in 4 shoulders (8%) and the deformity of the greater tuberosity in 4 (8%). Conclusion  The Polarus intramedullary humeral nail is effective for the treatment of proximal humeral fractures.     

Internal fixation of proximal humerus fractures with the polarus intramedullary nail

The optimal treatment method for displaced proximal humeral fractures continues to be under debate. There are a variety of fixation techniques, none of which has been proven to be more effective. We retrospectively studied 24 patients with displaced proximal humerus fractures, treated with the Polarus intramedullary nail. All patients were followed radiographically and clinically for one year. Clinical outcome was assessed with the Constant score. All fractures went on to clinical and radiographic union. Mean time to union was 9.2 weeks (range: 9-16). Only one patient with a 3-part fracture had an asymptomatic malunion and one patient had iatrogenic radial nerve palsy, which spontaneously recovered. In total, 83.3% of the patients had an excellent or good clinical outcome. The Polarus nail appeared in this study as an effective device to treat proximal humeral fractures, with good overall functional results and a low complication rate.     

Fixation of proximal humeral fractures with the Polarus nail

Thirty patients with fractures of the proximal humerus were treated by internal fixation with an intramedullary locked nail. Fourteen of these patients were more than 60 years of age; 23 patients had 2-part fractures (surgical neck fractures) and were operated on within an average of 3 days after injury. At follow-up, 20 (80%) of 25 patients showed satisfactory to excellent functional outcomes, as measured by Constant score. All but 1 fracture progressed to clinical and radiologic union. The good functional results indicate that the Polarus nail is a satisfactory mechanical device that can be used in the treatment of displaced proximal humeral fractures in both the young and the elderly with osteopenic bone.     

The Polarus intramedullary nail for proximal humeral fractures: outcome in 28 patients followed for 1 year

Background One of the new treatment options for proximal humeral fractures is the minimally invasive intramedullary nail. In this study, we reviewed the early clinical results after 1 year.

Patients and methods 35 patients with proximal humeral fractures were treated using the Polarus nail. In 14 cases the initial treatment was operative; the other 21 patients were initially treated nonoperatively. 19 patients had a 2-part fracture, 5 had a 3-part fracture and 2 had a 4-part fracture. In 9 patients the fracture extended metaphyseally. The functional outcome was assessed by the Constant score.

Results 28 patients were available for 1-year followup. 17 patients showed excellent functional outcome (with an average Constant score of 81%). 6 patients required revision surgery, 1 because of nonunion and 1 because of an avascular necrosis. 4 others were reoperated because of inadequate position of the osteosynthesis or migration of the screws.

Interpretation The Polarus nail is of value for (displaced) 2-, 3-, and even 4-part proximal humeral fractures and enables early postoperative mobilization with a limited amount of pain.     

The Polarus intramedullary nail for proximal humeral fractures Outcome in 28 patients followed for 1 year

Background?One of the new treatment options for proximal humeral fractures is the minimally invasive intramedullary nail. In this study, we reviewed the early clinical results after 1 year.

Patients?and methods 35 patients with proximal humeral fractures were treated using the Polarus nail. In 14 cases the initial treatment was operative; the other 21 patients were initially treated nonoperatively. 19 patients had a 2-part fracture, 5 had a 3-part fracture and 2 had a 4-part fracture. In 9 patients the fracture extended metaphyseally. The functional outcome was assessed by the Constant score.

Results?28 patients were available for 1-year followup. 17 patients showed excellent functional outcome (with an average Constant score of 81%). 6 patients required revision surgery, 1 because of nonunion and 1 because of an avascular necrosis. 4 others were reoperated because of inadequate position of the osteosynthesis or migration of the screws.

Interpretation?The Polarus nail is of value for (displaced) 2-, 3-, and even 4-part proximal humeral fractures and enables early postoperative mobilization with a limited amount of pain.     

A preliminary clinical experience with Polarus nail for proximal humeral fractures. A pilot study on ten patients

The Polarus nail has recently been popularised to fix proximal humeral fractures. In the current pilot study we reviewed the early results obtained using this nail. Ten patients with proximal humeral fracture (four pathological, 5 traumatic and one non-union) were fixed using a Polarus nail. The fractures were classified according to Neer (7 two-parts and 3 three-part fractures). The mean followup was 22 months (6–39) months. The following criteria were assessed: pain, range of shoulder movement and function. Seven patients were satisfied with their operation, their fractures healed in a mean period of 3 months (2–4 months). No postoperative neurovascular complications were encountered; the re-operation rate, was however 30%. Conclusion: in the authors' brief pilot study in 10 patients, and despite the heterogenous fracture types, we came in to conclusion that the indications for using Polarus nail is limited due to the high complications rate associated with the procedure when used for displaced three or four part surgical neck fracture of humerus.     

The treatment of established non-union of the proximal humerus using the Polarus locking intramedullary nail

Introduction:

Non-union following fracture of the proximal humerus is not uncommon, particularly in the elderly. This can be associated with significant morbidity due to pain, instability and functional impairment. The Polarus device (Acumed) is a locked, antegrade intramedullary nail designed to stabilize displaced 2-, 3- and 4-part fractures of the proximal humerus. We report our experience with the Polarus nail for the treatment of established non-union of the proximal humerus.

Materials and Methods:

A total of 7 Polarus nails were inserted for the treatment of non-union of the proximal humerus between June 2000 and July 2007. Each fracture site was opened, debrided, stabilized with a Polarus nail and then grafted with autologous cancellous iliac crest bone. The time between injury and surgery ranged from 6 to 102 months. One patient had undergone previous fixation of her fracture using Rush intramedullary rods. All patients were females, and mean age at surgery was 63.6 years (range, 49-78 years). A retrospective review of notes and radiographs was carried out. Patients were reviewed at varying intervals postoperatively (range, 13-68 months) and assessed using the Constant shoulder-scoring system.

Results:

All un-united fractures progressed to union. There were no wound complications and no postoperative nerve palsies. Functional outcome was good, even in those cases with a long interval between injury and surgery. The mean Constant score was 63 (range, 54-81). Migration of a single proximal locking screw was seen in 2 patients, and these screws required removal at 5 and 12 months, respectively, postoperatively.

Conclusion:

In our experience, a locked proximal humeral nail used in conjunction with autologous bone grafting is an excellent device for the treatment of proximal humerus non-unions.     

Multiloc髓内钉治疗肱骨近端骨折的临床疗效分析

目的探讨Multiloc髓内钉治疗肱骨近端骨折的临床疗效。 方法回顾性分析2015年1月至2017年7月在首都医科大学附属北京朝阳医院骨科采用Multiloc髓内钉治疗并获得完整随访资料的33例肱骨近端骨折患者，年龄44~83岁，平均（68.7±15.7）岁；其中Neer分型二部分骨折22例，三部分骨折11例。分别记录手术时间、术中出血量、骨折愈合情况及手术并发症，采用视觉模拟评分（visual analogue scale，VAS）及Constant-Murley评分评价患者术后肩关节功能情况。 结果手术均顺利完成，平均手术时间为93.2 min（70~150 min），术中平均出血量为108.2 ml（30~200 ml）。随访时间最短13个月，最长40个月，平均随访时间为（22.4±7.3）个月。末次随访平均肩关节疼痛评分0.47分（0~2分）。骨折平均愈合时间为（15.7±2.9）周，肩关节活动平均活动范围：前屈140.2°，外展135.9°，内旋36.0°，外旋54.4°。术后平均Constant评分为（85.9±10.8）分，其中优11例、良17例、一般3例，优良率为90.9%。末次随访时无一例发生切口感染、骨折不愈合及肩袖损伤等并发症。 结论Multiloc髓内钉治疗肱骨近端骨折具有手术创伤小、并发症少、内固定物牢固、关节功能恢复优良，对肱骨近端Neer分型二部分和三部分骨折有满意的治疗效果。     

长PHILOS钢板结合MIPO技术治疗肱骨近端伴肱骨干骨折临床研究

目的总结应用长型肱骨近端内固定锁定钢板(PHILOS),经微创钢板内固定(MIPO)技术,即肩峰下前外侧经三角肌入路治疗肱骨近端伴肱骨干复杂骨折的临床疗效。方法 2007年3月至2009年12月,应用长型PHILOS结合MIPO技术治疗肱骨近端伴肱骨干复杂骨折18例。其中男11例,女7例;年龄28～69岁,平均58.5岁。均为新鲜闭合性骨折,受伤至手术时间5～10 d。肱骨近端骨折中Neer分型2部分骨折2例,3部分骨折12例,4部分骨折4例;肱骨干骨折中AO分型A1型3例,A2型1例,B1型5例,B2型2例,B3型3例,C1型2例,C3型2例。术后肩关节功能评价采用Neer评分,肘关节功能评价采用美国特种外科医院(HSS)评分。结果 18例患者均获随访,随访时间11～31个月,平均14.6个月。术后出现桡神经麻痹症状1例,12周内自行恢复;出现肩关节慢性轻度疼痛2例,予以对症治疗后逐渐缓解。术后12个月18例全部达骨性愈合,无退钉或内固定松动等并发症发生。按Neer评分,肩关节功能优7例,良9例,中2例,优良率为88.9%;按HSS评分,肘关节功能优16例,良2例,优良率为100%。结论长型PHILOS结合MIPO技术,具有血运破坏少、固定可靠、并发症少、满意率高等优点,是治疗肱骨近端伴肱骨干骨折的一种新方法。     

The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail

Twenty-three patients with acute displaced three- and four-part fractures of the proximal humerus, including seven patients with associated shaft involvement, were treated with the Polarus intramedullary interlocking nail using a closed technique.At the 1-year follow up, the median Neer scores were 89 and 60 for the three- and four-part fractures, respectively.Three patients (13%), all of whom were in the four-part group, continued to have significant pain at final review.We found the implant to be extremely satisfactory and particularly useful in the treatment of combined neck and shaft fractures of the humerus.     

MultiLoc髓内钉技术在肱骨近端骨折中的应用和体会

目的 探讨MultiLoc髓内钉治疗肱骨近端Neer分型Ⅱ、Ⅲ、Ⅳ部分骨折中的技术应用以及临床疗效.方法 回顾性分析2017年12月至2019年12月手术治疗的肱骨近端骨折患者共70例,具备完整随访资料者61例,其中男24例、女37例;年龄23～81岁,平均年龄(58.02±13.44)岁;Neer分型:Ⅱ部分骨折17...     

锁定钢板治疗Neer 3、4部分肱骨近端骨折的病例对照研究

目的：比较运用锁定钢板治疗Neer 3、4部分肱骨近端骨折的疗效。方法：自2009年1月至2011年6月,采用锁定钢板治疗64例Neer 3、4部分肱骨近端骨折。3部分骨折组39例,男16例,女23例;平均年龄（55.12±12.52）岁。4部分骨折组25例,男9例,女16例;平均年龄（57.92±13.14）岁。随访根据美国肩肘外科医师评分（American Shoulder and Elbow Surgeons score,ASES）评估患者肩关节功能,采用视觉模拟评分法（visual analogue scale,VAS）进行疼痛评分,并评价相关并发症。结果：术后患者切口均I期愈合。64例均获随访,时间12～30个月,平均16.5个月。末次随访时,ASES评分3部分骨折（76.14±14.10）分,4部分骨折（65.93±11.82）分;VAS评分分别为2.12±1.63和3.90±2.21,以上指标两组比较差异均有统计学意义（P〈0.05）.并发症发生率分别为20.51%和36.00%,差异无统计学意义。结论：锁定钢板治疗肱骨近端3部分骨折的疗效优于4部分骨折,术中需争取解剖复位、稳定固定、选择合适长度的螺钉及钢板位置,术后合理功能锻炼以获得良好的疗效。     

应用肱骨近端锁定钢板治疗老年肱骨近端粉碎性骨折

目的探讨肱骨近端锁定钢板治疗老年肱骨近端粉碎性骨折的疗效.方法应用肱骨近端锁定钢板治疗老年肱骨近端粉碎性骨折18例,其中Neer分类三部骨折15例,四部骨折3例.结果骨折临床愈合6～8周.术后10～12周,以Neer评分法评估其功能,6例为优,8例为良,2例为可,2例为差.结论肱骨近端锁定钢板治疗老年肱骨近端粉碎性骨折,短期效果较好,但后期效果还需长期随访.     

Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation – introduction of a new treatment concept

The treatment of three- or 4-part proximal humerus fractures is still a matter of scientific discussion. The following study presents the results of a combined procedure using limited invasive fixation techniques for reconstruction of the humerus head and retrograde intramedullary wiring with elastic nails for the treatment of displaced three- or 4-part fractures. A prospective study of 24 patients with 3-part and 4-part fractures was performed from September 1995 to December 1998. Combined biologic fixation for reconstruction of the humerus head, including intramedullary wiring, was utilized. Fracture reduction was performed in an open soft-tissue-preserving technique through a limited lateral approach. Fixation of the head fragments was performed using screw and/or cerclage wire fixation. The reconstructed humerus head was stabilized to the shaft with intramedullary wires, with retrograde insertion 2 cm above the olecranon fossa. Supportive fixation of the head fragments was achieved using fully threaded cancellous screws. At the 1-year postoperative follow-up, 40% of the 18 patients had excellent results using the Neer and Constant score. Forty-five percent had satisfactory and 15% unsatisfactory results. The initial results of this study reveal that a combination of limited internal fixation of the humerus head and retrograde elastic intramedullary wiring provide stable fixation with limited soft-tissue destruction. This approach has been shown to be especially useful for the combined treatment of three- or four-part fractures of the humeral head.     

锁定加压接骨板治疗肱骨近端复杂骨折

目的 探讨肱骨近端锁定加压接骨板治疗肱骨近端复杂骨折的临床疗效及相关手术技巧.方法 采用肱骨近端锁定钢板治疗肱骨近端复杂骨折49例,根据Neer分型:三部分骨折32例,四部分骨折17例.结果 术后有47例获得12～36个月随访,平均20个月.术后骨折全部愈合,无严重并发症.按Neer肩关节功能评分标准:优17例;满意26例,优良率达91.5％.结论 肱骨近端锁定加压接骨板是治疗肱骨近端复杂骨折有效方法,术中注意保护肱骨内侧软组织链完整和肱骨内侧柱有效支撑是手术成功的关键.     

Transitory percutaneous pinning in fractures of the proximal humerus

We report 31 patients with displaced fractures of the proximal humerus treated by transitory percutaneous pinning. The Neer fracture classification was used; there were 7 two-part, 20 three-part, and 4 four-part fractures. The Constant score was used for evaluation of the results; the mean score was 80 points. The high mean age of our patients (68 years) diminished the score because of the 25 points attributed to the strength. Avascular necrosis was observed in 5 cases: 2 three-part and 3 four-part fractures. Transitory percutaneous pinning is a good technique for the management of displaced 3-part fractures of the proximal humerus even in the older population, keeping in mind that the shoulder will tolerate a moderate residual deformity without changing the functional outcome significantly. Transitory percutaneous pinning, on the other hand, is not a satisfactory method for the management of 4-part fractures.     

复杂肱骨近端骨折人工肱骨头置换术中肩袖重建的长期疗效观察

目的探讨Neer 3、4部分肱骨近端骨折人工肱骨头置换术中肩袖重建的远期临床效果。方法回顾性分析自2001-01—2012-12采用人工肱骨头置换术治疗的25例Neer 3、4部分肱骨近端骨折。术前测量健侧大结节最低点至肱骨头最高点的距离,术中尽量解剖复位肱骨大、小结节,合理控制假体高度及后倾角度,尽可能修复重建损伤肩袖,术后分阶段康复锻炼。结果本组22例获得有效随访,随访时间平均120(49~190)个月。末次随访时ASES评分为80~92(86.28±3.36)分,肩关节内旋至T10水平,患肢主动前屈上举125°~135°,外旋36°~42°。1例合并臂丛神经损伤者术后肩关节功能恢复满意。结论对于骨折端无法良好复位、肱骨头缺血性坏死可能性大的复杂肱骨近端骨折,人工肱骨头置换同时进行精细的肩袖重建可以获得无痛和良好运动范围的肩关节。     

Surgical anatomy of multipart fractures of the proximal humerus

The gross fracture anatomy was recorded in a cohort of 22 consecutive patients who underwent open surgery for 3-part and 4-part fractures of the proximal humerus and was compared with preoperative radiographs in a blind manner. It was noted that 8 of the 22 fractures did not correspond to any category of the Neer or AO/Orthopaedic Trauma Association/Jakob classification. These fractures had 3 displaced segments in terms of surgical anatomy, but the humeral head was free of soft tissue. In addition, the soft-tissue attachments to the head were closely related to the articular surface orientation on radiographs (medially oriented or not), rather than to the number of displaced segments or to the grouping of the AO/Orthopaedic Trauma Association/Jakob classification. Thus, in our study population, the current classification systems were inaccurate for realizing the fracture anatomy, particularly humeral head status. They would be accurate if the articular surface orientation was taken into account.     

The treatment of dislocated humeral head fractures with a new proximal intramedullary nail system

A new proximal humerus nail (Sirus) for the treatment of proximal humerus fractures has become available. This paper presents the clinical and radiological outcome of the first collective study of 36 patients. Evaluation was performed prospectively. An antero-acromial approach was used for all patients. Three fixed-angle screws were inserted in a locking technique. Thirty-six fractures were fixed with the Sirus nail. These were dislocated 2- and 3-part fractures as described by Neer (J Bone Joint Surg 52:1077-1089). Outcomes were evaluated using the Constant score. Of the 36 patients evaluated 23 had sustained a 2-part fracture and 13 a 3-part fracture. The average age at surgery was 71.2 years (range, 30-93). In 75% of the cases, good to very good outcomes were achieved. Outcomes were satisfactory in 13.8% of the cases. Twenty-five fractures were treated in a closed technique. Average operating time was 41 minutes (range, 19-106) with a fluoroscopy time of 0.6 minutes (range, 0.4-2.6). Secondary fragment dislocation occurred in two cases. After 12.1 months the average Constant score was 79.2 (range, 46-100). Initial clinical experience with the Sirus nail indicates that the procedure is straightforward and has a low complication rate. Functional outcomes are predominantly good to very good. Large fragments of the greater tuberosity and 4-part fractures are beyond the scope of this application.     

老年复杂肱骨近端骨折的治疗选择：保守治疗，切开复位还是肱骨头置换？系统评价及Meta分析

目的对已发表的随机对照试验进行Meta分析,以期得到证据等级水平更高的关于老年复杂肱骨近端骨折治疗的临床指南。 方法通过检索Pubmed、EMBASE和Cochrane General Register of Controlled Trials,搜索符合纳入标准并报道功能评分和并发症的随机对照试验,对文献进行证据等级评价并提取功能评分及并发症数据,采用Revman 5.0软件进行Meta分析。 结果本研究共纳入4篇包含215例患者的随机对照试验,其中2篇（105例患者）比较了肱骨近端Neer 4部分骨折保守治疗和肱骨头置换的Constant功能总体评分、分组评分及并发症情况。Meta分析结果显示对于Neer 4部分骨折,与肱骨头置换相比,保守治疗短期Constant总体评分（WMD =5.69, 95% CI: 0.34~11.03, P=0.04）更高,术后1年肱骨头置换可明显改善疼痛评分（WMD =-2.75, 95% CI: -4.45~-1.04, P=0.002）,但总体功能评分与保守治疗无明显差别（WMD =-2.46 , 95% CI: -8.88~-3.96, P=0.14）。另外2篇文献（110例患者）比较了Neer 3、4部分骨折保守治疗和锁定钢板治疗的Constant功能评分和并发症情况,Meta分析显示对于两者在改善功能评分和并发症方面无明显差别。其中1篇文献研究显示对于Neer 3部分骨折,锁定钢板可能改善患者总体功能评分。 结论对于Neer 4部分骨折短期内保守治疗功能评分更高,肱骨头置换长期可改善疼痛,但无法改善总体功能评分。锁定钢板对于Neer 3部分骨折患者可能改善总体功能评分。