Department of Traumatology, Hospital Universitari I Politècnic la Fe, València, Spain, Avinguda Fernando Abril Martorell n106, 46022, València, Spain.
Department of Traumatology, Hospital Universitari I Politècnic la Fe, València, Spain, Avinguda Fernando Abril Martorell n106, 46022, València, Spain.
Injury. 2022 Oct;53(10):3332-3338. doi: 10.1016/j.injury.2022.07.049. Epub 2022 Aug 1.
Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results.
retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained..
No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28).
Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results.
肱骨近端合并干骺端骨折的发生率较低，治疗决策较为困难，因此对骨科医生来说是一个挑战。这些骨折可以采用髓内钉或 MIPO 技术进行治疗，具体采用哪种方法取决于不同的优势和并发症。本研究的目的是比较肱骨近端合并干骺端骨折采用顺行髓内钉和 MIPO 技术治疗的效果，以评估两种方法在功能、临床和影像学结果方面是否存在显著差异。
回顾性、分析性和单中心研究，纳入了 2014 年至 2020 年期间在我院接受 MIPO 技术治疗的 29 例肱骨近端合并干骺端骨折患者和采用顺行髓内钉（IMN）治疗的 33 例患者。收集患者的人口统计学、功能、影像学和临床资料。
两组患者在骨折机制（p=0.34）、骨折类型（p=0.13）或 Maresca 分型（p=0.32）方面无显著差异。髓内钉组的手术时间明显短于 MIPO 组（p=0.014）。两组患者在输血需求方面无显著差异（p=0.32）。MIPO 组的平均愈合时间为 21 周，与髓内钉组的 21 周相比无显著差异（p=0.88）。MIPO 组和髓内钉组在 CONSANT 测试的 1 年随访结果方面无显著差异（p=0.79），在桡神经麻痹方面也无显著差异（p=0.28）。
肱骨近端合并干骺端骨折较为少见，治疗较为复杂，目前对于这种损伤的理想治疗方法尚未达成共识，因此对骨科医生来说是一个挑战。MIPO 技术联合 Philos 钢板和髓内钉都是治疗这些骨折的有效方法，在骨折愈合时间和功能结果方面无显著差异。
