University of Fribourg Medical School, Switzerland; Department of Orthopaedics and Traumatology, Fribourg Cantonal Hospital, Switzerland; Lugano Regional Hospital, Switzerland.
University of Fribourg Medical School, Switzerland; Department of Orthopaedics and Traumatology, Fribourg Cantonal Hospital, Switzerland.
Injury. 2021 Aug;52(8):2292-2299. doi: 10.1016/j.injury.2021.05.005. Epub 2021 May 18.
Several surgical techniques of osteosynthesis have been described for treatment of proximal humeral fractures. There is evidence that the quality of reduction improves the clinical outcome and decreases the number of complications. Reduction of the medial calcar is tricky when standard manoeuvres are performed. We have therefore augmented our standard surgical technique with a low-profile medial hinge plate which aims at better reconstructing the medial metaphysis without extensile soft tissue dissection in combination with proximal humerus locked plating.
Evaluate the radiological and clinical outcome after application of an augmented fixation with a low-profile medial hinge plate. We questioned: (i) The quality of reduction, (ii) The rate of complications, (iii) The clinical function in terms of the Oxford Shoulder Score (OSS).
A retrospective single-centre case series. Between 2016 and 2019, patients who had undergone open reduction and osteosynthesis by an anatomical locking plate associated with a 2.0 mm locking compression plate used as a hinge to support the medial metaphysis. Thirty-four patients, with an average age of 64 years had a clinical and/or radiological average follow-up of 36 months.
The preoperative imaging identified three fractures in two parts, 19 fractures in three parts and 12 fractures in four parts. Seven cases with fracture-dislocation were identified, one head-split fracture, and 14 cases with a metaphyseal head extension of less than 8 mm. After comparing head-shaft displacement, cranialisation of the greater tuberosity as well as head-shaft alignment in the preoperative and postoperative radiographs, overall anatomical or near-anatomical fracture reduction was achieved in 27 of the patients. Only two cases presented postoperative complications. The two cases were complicated with nonunion without screw perforation requiring surgical intervention by re-osteosynthesis. The clinical outcome assessed by the OSS showed an average of 45/48. The age of the group with anatomical or near anatomical reduction and the group with at least one parameter of malreduction was significantly different, 65 and 74 years respectively (p<0.05). No significant differences were found when comparing the sex, surgical time, time to operation or the number of fracture parts.
The technique described provides a surgical treatment option with lower complication rates and a quality of reduction consistent with the current literature as well as a satisfactory clinical outcome.
已经有几种外科接骨术技术被描述用于治疗肱骨近端骨折。有证据表明，复位质量的提高可以改善临床结果并减少并发症的数量。当进行标准手法时，内侧骨块的复位很棘手。因此，我们在标准手术技术的基础上增加了一个低切迹内侧铰链板，该板的目的是在不进行广泛软组织松解的情况下更好地重建内侧干骺端，同时结合肱骨近端锁定钢板。
评估应用低切迹内侧铰链板增强固定的放射学和临床结果。我们提出了以下三个问题：（i）复位质量，（ii）并发症发生率，（iii）根据牛津肩评分（OSS）评估的临床功能。
回顾性单中心病例系列研究。在 2016 年至 2019 年期间，对接受切开复位和解剖锁定钢板内固定的患者进行了研究，同时使用 2.0 毫米锁定加压钢板作为铰链以支撑内侧干骺端。34 名患者，平均年龄为 64 岁，平均临床和/或放射学随访时间为 36 个月。
术前影像学检查发现三部分骨折 3 例，三部分骨折 19 例，四部分骨折 12 例。7 例为骨折脱位，1 例为头劈裂骨折，14 例头干骺端延伸不足 8 毫米。比较头干位移、大结节的颅化以及术前和术后 X 线片中的头干对线后，27 例患者达到了总体解剖或近乎解剖复位。仅 2 例出现术后并发症。2 例患者出现术后并发症，无螺钉穿透，需要通过再次骨固定手术干预。通过 OSS 评估的临床结果显示平均得分为 45/48。解剖或近乎解剖复位组和至少有一个参数复位不良组的年龄差异有统计学意义，分别为 65 岁和 74 岁（p<0.05）。性别、手术时间、手术至开始时间或骨折部位数量的比较无统计学差异。
所描述的技术提供了一种具有较低并发症发生率和与当前文献一致的复位质量的手术治疗选择，同时具有令人满意的临床结果。
