Seo Joong-Bae, Yoo Jae-Sung, Kim Yeon-Jun, Kim Kyu-Beom
Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea.
Department of Orthopaedic Surgery, Asan Chungmu Hospital, Mojongdong 432-2, Asan, Chungnam, Republic of Korea.
BMC Musculoskelet Disord. 2020 Dec 2;21(1):800. doi: 10.1186/s12891-020-03821-1.
Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.
Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).
No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.
When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.
锁定钢板固定是治疗肱骨近端骨折的策略之一。然而，锁定钢板固定后的僵硬是一个临床关注点。标准锁定钢板系统的机械刚度可能会抑制通过骨痂形成促进二期骨愈合所需的骨折块间运动。远皮质锁定（FCL）技术于2005年开发以解决这一局限性。FCL增加了内固定结构的灵活性并促进骨痂形成。我们的研究旨在评估FCL技术应用于肱骨近端骨折治疗时的临床和影像学结果。此外，我们比较了FCL与传统双皮质锁定（BCL）螺钉固定技术的手术结果。
本研究纳入了45例连续接受肱骨近端骨折锁定固定的患者。前27例使用带有BCL螺钉固定的肱骨近端锁定钢板（PHILOS）系统，最后连续18例使用带有FCL螺钉固定的关节周围肱骨近端锁定钢板。使用Constant评分、美国肩肘外科医师（ASES）评分和活动范围评估功能能力。使用Paavolainen测量颈干角（NSA）的方法评估影像学结果。
两组之间的临床结果（ASES评分、Constant评分和活动范围）无显著差异。FCL组12周时的骨愈合率（94.4%）显著高于BCL组（66.7%，p = 0.006）。两种治疗策略之间的NSA无显著差异。两组之间的并发症发生率无显著差异。
与传统的BCL技术相比，FCL技术应用于肱骨近端骨折时显示出令人满意的临床和影像学结果。FCL组术后12周的骨愈合率显著高于BCL组。然而，两组之间的最终骨愈合率无显著差异。
