Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA,
Curr Rev Musculoskelet Med. 2012 Sep;5(3):192-8. doi: 10.1007/s12178-012-9130-2.
Proximal humeral fractures are extremely common injuries, and are one of the true osteoporotic fractures. Most fractures can be effectively treated nonoperatively, as the rich vascularity and broad cancellous surfaces impart a high propensity for healing. Additionally, many fracture patterns result in adequate bone contact and minimal displacement with acceptable alignment. Open reduction and internal fixation of displaced fractures can improve outcomes, depending on the pre-injury functional status of the patient. If operative treatment is selected, unique treatment challenges must be overcome, including obtaining and maintaining reduction of small bone fragments with strong muscle forces, often in osteoporotic bone. Many options are feasible, including plates, nails, sutures, and other novel devices. Locking plates are the most common device used, but technical detail is critical to minimize the risk of implant failure, loss of reduction, and reoperation.
肱骨近端骨折极为常见，是真正的骨质疏松性骨折之一。大多数骨折可以通过非手术方法有效治疗，因为丰富的血管和广泛的松质骨表面赋予了很高的愈合倾向。此外，许多骨折模式导致足够的骨接触和最小的移位，具有可接受的对线。对于移位骨折，切开复位内固定可以改善结果，具体取决于患者受伤前的功能状态。如果选择手术治疗，必须克服独特的治疗挑战，包括在强大的肌肉力作用下获得和维持小骨碎片的复位，通常在骨质疏松的骨骼中。有许多可行的选择，包括钢板、钉子、缝线和其他新型装置。锁定钢板是最常用的装置，但技术细节至关重要，以最大限度地降低植入物失败、复位丢失和再次手术的风险。
