Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.
Int Orthop. 2024 Dec;48(12):3207-3216. doi: 10.1007/s00264-024-06324-z. Epub 2024 Sep 30.
Proximal humerus fractures account for 4-5% of all fractures in adults and affect females more than males. With the advent of special locking plates, the treatment trend has shifted more towards a surgical approach. These methods have produced good results but very high complications rates have been reported in the literature. This study was undertaken to analyse the radiological parameters which reflect towards a favourable long term functional outcome in order to advance the surgical fixation skills for managing fractures of the proximal part of the humerus.
83 study participants with proximal humerus fracture fixed using proximal humerus locking plates were retrospectively analysed. The radiological parameters studied were neck shaft angle, head shaft angle, head diameter, head height, greater tuberosity to articular surface distance and reduction of the medial hinge with or without placement of calcar screw. The functional parameters assessed were the Constant Murley Score and range of movements of the shoulder joint. The patients were not followed further for the purpose of the study.
The mean Constant Murley Score for the participants was 80.75 ± 8.09 (range 60-90). The participants with good to excellent CM Score had a significantly higher neck shaft angle (107.47 ± 9.74 v/s 124.16 ± 10.68) and (-0.28 ± 0.85 v/s 2.37 ± 2.28), head shaft angle (23.09 ± 4.82 v/s 31.76 ± 7.76), head diameter (40.08 ± 8.63 v/s 45.15 ± 4.73), head height (18.77 ± 1.96 v/s 20.69 ± 2.76) and greater tuberosity to articular surface distance (-0.28±0.85 v/s 2.37±2.28) as compared to the patients with satisfactory and worse CM Score. The patients with a higher neck shaft angle and a maintained subacromial space had a better range of shoulder abduction. A higher rate of valgus collapse was seen with an inadequate medial hinge reduction.
The radiological parameters which can predict towards a good functional outcome are a higher neck shaft angle and head shaft angle, a larger head diameter and head height, a superior position of the greater tuberosity in relation to the articular surface and a good medial hinge reduction.
肱骨近端骨折占成人所有骨折的 4-5%，女性发病率高于男性。随着特殊锁定钢板的出现，治疗趋势更多地转向手术治疗。这些方法取得了良好的效果，但文献报道的并发症发生率非常高。本研究旨在分析反映长期功能预后良好的影像学参数，以提高治疗肱骨近端骨折的手术固定技术。
回顾性分析 83 例采用肱骨近端锁定钢板固定的肱骨近端骨折患者。研究的影像学参数包括颈干角、头干角、头直径、头高、大结节到关节面的距离以及内侧铰链的复位情况，有无放置 calcar 螺钉。评估的功能参数包括 Constant-Murley 评分和肩关节活动范围。患者未进一步随访。
参与者的平均 Constant-Murley 评分为 80.75±8.09（范围 60-90）。Constant-Murley 评分良好至优秀的患者颈干角（107.47±9.74 与 124.16±10.68）和（-0.28±0.85 与 2.37±2.28）、头干角（23.09±4.82 与 31.76±7.76）、头直径（40.08±8.63 与 45.15±4.73）、头高（18.77±1.96 与 20.69±2.76）和大结节到关节面的距离（-0.28±0.85 与 2.37±2.28）明显更高。与 Constant-Murley 评分满意和较差的患者相比，这些患者的肩关节外展范围更好。维持肩峰下间隙的颈干角较高，有更好的肩关节外展范围。内侧铰链复位不良时，更易发生内翻塌陷。
可预测良好功能预后的影像学参数包括较高的颈干角和头干角、较大的头直径和头高、大结节相对于关节面的较好位置以及良好的内侧铰链复位。
