Sacré-Coeur hospital of Montreal, 5400, boulevard Gouin-Ouest, Montreal, Quebec, Canada.
Orthop Traumatol Surg Res. 2009 Feb;95(1):56-62. doi: 10.1016/j.otsr.2008.09.003. Epub 2009 Feb 20.
There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus.
Locked and minimally-invasive plating is a promising treatment option.
The aim of this prospective, multicentric study is to describe a recently introduced surgical technique for proximal humeral fractures and to evaluate the radiographic and clinical outcomes of this operation. Closed and minimally-invasive reduction is first performed. A proximal humerus specific locking plate featuring multiple-angle screws is secondly implanted. Proper identification and protection of the axillary nerve with the index finger during plate insertion on the lateral humeral side is highly advisable. If it can't be palpated, a classic delto-pectoral approach should be preferred. Thirty-four patients were included in this study with a 1-year minimal postoperative follow-up. Twenty-two patients presented a two-part surgical neck fracture according to the Neer classification and 12 patients had a three-part valgus-impacted fracture. DASH (Disabilities of the Arm, Shoulder and Hand) and Constant scoring systems were used for functional evaluation.
Specifically, no axillary nerve injury and no loss of reduction were observed. The median Constant score and the mean DASH score were 82 and 26 respectively at 1-year follow-up. The age-adjusted functional scores values were satisfactory. Two of the patients (6%) required surgical revision for intra-articular screw penetration.
Our study suggests that percutaneous plating with angular screw fixation of proximal humeral fractures is a safe and effective method, which produces good functional and radiologic outcomes. These minimally-invasive techniques allowing a better preservation of soft-tissues help promote early functional recovery. This more friendly approach combined to upgraded implants and instruments will also improve early and long-term outcomes of these fractures.
目前对于不稳定型肱骨近端骨折，尚无公认的最佳手术治疗推荐。
锁定和微创接骨板固定是一种有前途的治疗选择。
本前瞻性、多中心研究旨在描述一种新引入的肱骨近端骨折手术技术，并评估该手术的影像学和临床结果。首先进行闭合和微创复位，然后植入一种带有多角度螺钉的专用肱骨近端锁定板。强烈建议在将外侧肱骨侧的钢板插入时，用食指正确识别和保护腋神经。如果无法触诊，应首选经典的三角肌胸大肌入路。本研究共纳入 34 例患者，术后随访至少 1 年。22 例患者根据 Neer 分类为二部分外科颈骨折，12 例患者为三部分外展型骨折。采用 DASH（上肢、肩和手功能障碍）和 Constant 评分系统进行功能评估。
具体来说，未观察到腋神经损伤和复位丢失。1 年随访时，Constant 评分中位数和 DASH 评分均值分别为 82 分和 26 分。年龄调整后的功能评分值令人满意。2 例患者（6%）因关节内螺钉穿透需要手术翻修。
我们的研究表明，经皮接骨板固定术治疗肱骨近端骨折是一种安全有效的方法，可获得良好的功能和影像学结果。这些微创技术可更好地保护软组织，有助于促进早期功能恢复。这种更友好的方法结合改进的植入物和器械，也将改善这些骨折的早期和长期结果。
