Department of Orthopaedics, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Eur J Orthop Surg Traumatol. 2024 Nov 16;35(1):6. doi: 10.1007/s00590-024-04120-4.
To investigate whether the outcomes, including union rates, complications, reoperations, blood loss, operative time, and range of motion, differed following intramedullary nailing (IMN) or open reduction internal fixation (ORIF) of two- and three-part proximal humerus fractures with or without ipsilateral shaft fractures and head-split patterns.
This was a retrospective multicenter study at three community centers and one level 1 trauma center. Inclusion criteria were two- and three-part proximal humerus fracture treated with either IMN or ORIF from 2015 to 2022 with at least three months of postoperative follow-up.
228 patients. No significant differences in preoperative subject characteristics were observed. IMN was significantly more common with ipsilateral shaft fractures (p = 0.011). The number of fracture parts was significantly associated with treatment (p < 0.001). IMN had significantly less blood loss in two-part fractures (p = 0.016) and concomitant shaft fractures (p = 0.029), but operative time was not significantly less in any group. Union rates, complications, reoperation, postoperative humeral neck shaft angle, and postoperative range of motion were not significantly different.
IMN and ORIF result in similar outcomes for proximal humerus fractures. Both treatments result in high union rates, the potential for near anatomic postoperative humeral neck shaft angles, and sufficient postoperative range of motion. IMN has lower blood loss than ORIF. IMN is a viable option for two-part proximal humerus fractures and may be effective in select three-part fractures as well. Concomitant humeral shaft fractures can be treated with either IMN or ORIF. Head-split patterns should be treated with ORIF.
研究在伴有或不伴有同侧骨干骨折和头部分离模式的两部分和三部分肱骨近端骨折中，经髓内钉（IMN）或切开复位内固定（ORIF）治疗的结果（包括愈合率、并发症、再次手术、失血量、手术时间和活动范围）是否不同。
这是一项在三个社区中心和一个 1 级创伤中心进行的回顾性多中心研究。纳入标准为 2015 年至 2022 年期间采用 IMN 或 ORIF 治疗的两部分和三部分肱骨近端骨折，术后随访至少三个月。
共纳入 228 例患者。术前患者特征无显著差异。伴有同侧骨干骨折时，IMN 更为常见（p=0.011）。骨折部位数量与治疗方法显著相关（p<0.001）。在两部分骨折（p=0.016）和伴有骨干骨折（p=0.029）中，IMN 的失血量明显较少，但在任何组中手术时间均无明显减少。愈合率、并发症、再次手术、术后肱骨干颈角和术后活动范围无显著差异。
IMN 和 ORIF 治疗肱骨近端骨折的结果相似。两种治疗方法均能获得较高的愈合率，潜在的术后肱骨干颈角接近解剖学，且术后活动范围充足。IMN 的失血量少于 ORIF。IMN 是两部分肱骨近端骨折的可行选择，在某些三部分骨折中也可能有效。伴有骨干骨折可采用 IMN 或 ORIF 治疗。头部分离模式应采用 ORIF 治疗。
