Department of Orthopedic Surgery and Traumatology, Medical University, 02-005 Warsaw, Poland.
ARS MEDICA Foundation for Medical Education and Promotion of Health, Art and Culture, 04-036 Warsaw, Poland.
Medicina (Kaunas). 2023 Mar 15;59(3):575. doi: 10.3390/medicina59030575.
: Intramedullary nailing (IMN) and angularly stable plating (ASP) are the most popular techniques for the stabilization of comminuted fractures of the proximal humerus, without either one being obviously superior. The aim of the study was to validate the functional outcomes of both stabilization techniques in the COVID-19 pandemic by comparing them with data obtained just before the pandemic, because the limitations of the COVID-19 pandemic are affecting several aspects of social and medical life-being afraid of the transmission of the infection, patients reduce their exposure to healthcare to absolutely essential emergencies. Moreover, working conditions in the operating theater have also become more restrictive. : Investigations were performed on 112 adult patients with Neer's three- and four-fragment fractures stabilized with IMN (64) and ASP (48). Treatment effects were validated six months after surgery based on radiographs for evidence of bone union, humeral neck-shaft angle (NSA) and implant placement. Limb function was assessed with the QuickDash and Constant-Murley scores. Data obtained from patients treated in the COVID-19 pandemic were compared with those obtained before the pandemic. : The healing of all fractures was satisfactory, but complications developed in six cases. Three patients required secondary interventions due to inadequate repositioning: one after IMN and two after ASP. Additionally, one ASP was complicated by the secondary destabilization of a primarily properly stabilized major tubercle, and in two cases by conflict of the protruding implant with the acromion. ASP was noted to provide better functional results during the COVID-19 pandemic according to the Constant-Murley score ( = 0.0048; Student's -test). No significant differences were observed in the pre-COVID-19 pandemic. : Our results suggest that ASP is more beneficial for the stabilization of comminuted fractures of the proximal humerus during the COVID-19 pandemic.
: 交锁髓内钉（IMN）和角度稳定接骨板（ASP）是治疗肱骨近端粉碎性骨折最常用的两种固定技术，没有哪一种技术明显更优。本研究的目的是通过与大流行前获得的数据进行比较，验证这两种固定技术在 COVID-19 大流行期间的功能结果，因为 COVID-19 大流行的限制正在影响社会和医疗生活的多个方面——害怕感染的传播，患者减少了对医疗保健的接触，只保留绝对必要的紧急情况。此外，手术室的工作条件也变得更加严格。 : 对 112 名成人 Neer 三、四部分骨折患者进行了研究，这些患者分别采用 IMN（64 例）和 ASP（48 例）固定。术后 6 个月，根据 X 线片评估骨愈合、肱骨头颈干角（NSA）和植入物位置来验证治疗效果。肢体功能采用 QuickDash 和 Constant-Murley 评分进行评估。将 COVID-19 大流行期间治疗的患者数据与大流行前的数据进行比较。 : 所有骨折均愈合良好，但有 6 例出现并发症。由于复位不良，3 例患者需要二次干预：1 例采用 IMN，2 例采用 ASP。此外，1 例 ASP 继发主要结节的初次稳定后再次失稳，2 例 ASP 中突出的植入物与肩峰发生冲突。根据 Constant-Murley 评分（ = 0.0048；Student's -test），ASP 在 COVID-19 大流行期间提供了更好的功能结果。在 COVID-19 大流行之前，没有观察到显著差异。 : 我们的结果表明，在 COVID-19 大流行期间，ASP 更有利于治疗肱骨近端粉碎性骨折。
