Liu Jichao, Zhang Ziyan, Ding Jie, Zhang Jian, Sheng Qian, Piao Chengdong
Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
Department of Stomatology, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China.
Front Bioeng Biotechnol. 2024 Jul 19;12:1366089. doi: 10.3389/fbioe.2024.1366089. eCollection 2024.
The morphology of proximal humeral fractures (PHFs) is complex, and the fixation and selection of implants need to be guided by the fracture type and classification, which requires an accurate understanding of the fracture line. This study had three purposes. 1) Define and analyze the fracture lines and morphological features of all types PHFs by three-dimensional (3D) mapping technology. 2) Determine the osteotomy position of the biomechanical model of the PHFs according to the fracture heat map. 3) Based on the analysis of the pathological morphology and distribution of a large number of consecutive cases of PHFs, propose a novel classification of PHFs. We retrospectively collected 220 cases of PHFs and generated a 3D fracture map and heat map based on computed tomography (CT) imaging. Through analysis of the fracture morphology of the 220 PHFs, a novel classification was proposed. The primary criterion for staging was the continuity between the humeral head and the greater tuberosity and lesser tuberosity, and the secondary criterion was the relationship between the humeral head segment and the humeral shaft. The fracture line was primarily found around the metaphyseal zone of region of the surgical neck, with the most extensive distribution being below the larger tuberosity and on the posterior medial side of the epiphysis. We suggest that the osteotomy gap should be immediately (approximately 5-10 mm) below the lower edge of the articular surface. The most common type of fracture was type I3 (33 cases, 15.0%), followed by type IV3 fracture (23 cases, 10.4%), and type III2 fracture (22 cases, 10.0%). Interobserver and intraobserver reliability analysis for the fracture classification revealed a k value (95% confidence interval) of 0.639 (0.57-0.71) and 0.841, < 0.01, respectively. In this study, the fracture line and morphological characteristics of PHFs were clarified in detail by 3D mapping technique. In addition, a new classification method was proposed by analysis of the morphological characteristics of 220 PHFs, A two-part fracture model for PHFs is also proposed.
肱骨近端骨折（PHFs）的形态复杂，植入物的固定和选择需要依据骨折类型和分类来指导，这就需要准确了解骨折线。本研究有三个目的。1）通过三维（3D）映射技术定义并分析所有类型PHFs的骨折线及形态特征。2）根据骨折热图确定PHFs生物力学模型的截骨位置。3）基于对大量连续PHFs病例的病理形态和分布分析，提出一种新的PHFs分类方法。我们回顾性收集了220例PHFs病例，并基于计算机断层扫描（CT）成像生成了3D骨折图和热图。通过对220例PHFs骨折形态的分析，提出了一种新的分类方法。分期的主要标准是肱骨头与大结节和小结节之间的连续性，次要标准是肱骨头段与肱骨干之间的关系。骨折线主要出现在手术颈区域的干骺端周围，分布最广泛的是在大结节下方和骨骺的后内侧。我们建议截骨间隙应紧邻（约5 - 10毫米）关节面下缘下方。最常见的骨折类型是I3型（33例，15.0%），其次是IV3型骨折（23例，10.4%）和III2型骨折（22例，10.0%）。骨折分类的观察者间和观察者内可靠性分析显示，k值（95%置信区间）分别为0.639（0.57 - 0.71）和0.841，<0.01。在本研究中，通过3D映射技术详细阐明了PHFs的骨折线和形态特征。此外，通过对220例PHFs形态特征的分析提出了一种新的分类方法，还提出了一种PHFs的两部分骨折模型。
