Department of Orthopaedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Orthop Surg. 2023 Aug;15(8):2187-2192. doi: 10.1111/os.13445. Epub 2022 Sep 2.
Proximal humeral fractures with increasing incidence are common over the past decades. Among them, the complicated and displaced ones, especially combined with the proximal third humeral shaft fractures, need to be treated surgically. Humeral intramedullary nail and locking plate are the most frequently used options. However, few studies address the application of nail-plate combination for management.
A 49-year-old man struck by a car was referred to our emergency trauma center. The X-ray and three-dimensional computed tomography (CT) showed a complex proximal humeral fracture with proximal third shaft fracture. No evidence of other associated injuries and neurovascular symptom of the injured left upper limb was shown by physical examination. Nail-plate fixation was performed to restore the anatomic integrity of proximal humerus. The injured arm was maintained in a broad arm sling for 14 days after surgery. The active as well as positive movements under the instruction were encouraged as long as the pain could be tolerated from postoperative day 2. One year after the surgery, the fracture was healed, and the patient regained normal shoulder motion. The good clinical outcomes were obtained by application of nail-plate fixation to treat complex proximal third humeral shaft fractures. Thus, this surgical intervention could be performed as an alternative.
近几十年来，肱骨近端骨折的发病率不断上升，较为常见。其中，复杂移位骨折，尤其是合并肱骨近端三分之一骨干骨折者，需要手术治疗。髓内钉和锁定钢板是最常用的选择。然而，很少有研究涉及钉板联合应用的管理。
一位 49 岁男性被汽车撞伤，被转至我院急诊创伤中心。X 射线和三维 CT 显示复杂的肱骨近端骨折合并肱骨近端三分之一骨干骨折。体格检查未发现其他相关损伤和受伤左上肢的神经血管症状。采用钉板固定恢复肱骨近端的解剖完整性。术后，受伤的手臂用宽臂吊带固定 14 天。术后第 2 天开始，只要疼痛可以耐受，就鼓励主动和积极的运动。术后 1 年，骨折愈合，患者恢复正常肩部活动。钉板固定治疗复杂的肱骨近端三分之一骨干骨折取得了良好的临床效果。因此，这种手术干预可以作为一种替代方法。
