From the Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA (Omid), Midwest Orthopaedics at Rush, Chicago, IL (Trasolini), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Stone), and Rothman Orthopaedic Institute, Philadelphia, PA (Namdari).
J Am Acad Orthop Surg. 2021 Jun 1;29(11):e523-e535. doi: 10.5435/JAAOS-D-20-00558.
Proximal humerus fractures are common, particularly in elderly patients and those with osteopenia or osteoporosis. Although nonsurgical management results in satisfactory outcomes for most patients, surgical treatment is indicated in select cases. Despite an increasing trend toward arthroplasty, open reduction and internal fixation of proximal humerus fractures can still provide excellent clinical outcomes. Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy. In particular, understanding reliable regions of biomechanically superior bone can help prevent failure of fixation. Biomechanical studies have shown that locked plating of proximal humerus fractures provides stable fixation. Cadaveric and finite element models underscore the importance of screw placement in the posteromedial metaphysis. When medial column support is challenging to obtain, or when bone quality is poor, augmentation with bone autograft, allograft, and/or synthetic composites can improve the biomechanics of internal fixation constructs. The purpose of this review is to outline the anatomic, biologic, and biomechanical principles of plate fixation for proximal humerus fractures to provide evidence-based recommendations for optimizing fixation and preventing fixation failure.
肱骨近端骨折很常见，特别是在老年患者和骨质疏松或骨量减少的患者中。尽管大多数患者采用非手术治疗可获得满意的结果，但在某些情况下需要手术治疗。尽管关节成形术的趋势不断增加，但肱骨近端骨折的切开复位内固定仍然可以提供出色的临床结果。肱骨近端内固定的正确技术需要了解骨骼和神经血管解剖结构。特别是，了解生物力学上优势骨的可靠区域有助于防止固定失败。生物力学研究表明，肱骨近端骨折的锁定钢板固定可提供稳定的固定。尸体和有限元模型强调了在后内侧干骺端放置螺钉的重要性。当难以获得内侧柱支撑或骨质量较差时，使用骨自体移植物、同种异体移植物和/或合成复合材料进行增强可以改善内固定结构的生物力学性能。本文综述了肱骨近端骨折钢板固定的解剖学、生物学和生物力学原则，为优化固定和防止固定失败提供了循证建议。
