Kantharaju H, Gawhale Sangeet K, Prasanna Kumar G S, Sahare Balu, Shah Nadir
Department of Orthopaedics, Government Medical College, Nagpur, India.
Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India.
Indian J Orthop. 2021 Mar 15;55(3):702-707. doi: 10.1007/s43465-020-00275-4. eCollection 2021 Jun.
Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome.
We retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant-Murley score.
Two-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6 months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 ( = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle.
High fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.
肱骨近端骨折约占所有骨折的4%，占肱骨骨折的26%。正确复位、稳定内固定及早期开始物理治疗有助于获得良好的功能预后。本研究的目的是评估肱骨近端骨折的内翻固定/畸形愈合及其与功能预后的关系。
我们回顾性评估了2015年至2017年在三级医院接受手术治疗的32例肱骨近端骨折患者。根据颈干角将患者分为三组，即外翻组、正常组和内翻组，以观察颈干角对疗效的影响。采用Constant-Murley评分评估患者的功能预后。
两部分骨折的功能预后较好（Constant评分=75.15），三部分骨折的功能预后中等（Constant评分=68.81），四部分骨折的功能预后较差（Constant评分=52.66）。随访6个月后，13例患者的颈干角小于126°。颈干角正常的患者功能预后明显更好，平均Constant评分为76.63，而内翻畸形患者的平均Constant评分为60（P=0.001）。10例患者没有内侧支撑，其中8例患者的颈干角小于126°，2例患者的颈干角正常。
骨折粉碎严重、内侧连续性恢复不当导致肱骨头内翻畸形，进而导致功能预后不良。样本量小是本研究的局限性。
