Pradeep E, Kumar K V Arun, Kumar R Manoj, Mohideen Sheik, Haemanath P, Janeson J Daniel Jey
Department of Orthopaedics and Traumatology, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India.
J Orthop Case Rep. 2024 Dec;14(12):263-269. doi: 10.13107/jocr.2024.v14.i12.5092.
Proximal humerus fractures are prevalent, especially among the elderly, and pose significant challenges in treatment, particularly for displaced fractures. Despite the availability of various surgical techniques, outcomes remain inconsistent, often due to poor anatomical reduction and fixation. This study examines the correlation between specific radiographic parameters and functional outcomes, aiming to identify key predictors of recovery. By focusing on these parameters, we aim to refine surgical approaches and improve follow-up strategies, ultimately enhancing patient outcomes.
A retrospective study involved 40 patients aged 18-75 with proximal humerus fractures, treated with open reduction and plate fixation at Chettinad Hospital between April 2022 and April 2024. All surgeries were performed through anterior deltopectoral approach. Radiographic parameters were evaluated postoperatively, with patients followed for a period of 1 year. Functional outcomes were correlated with radiological parameters using follow-up radiographs and Constant-Murley (C-M) scores.
In this study of 40 patients with proximal humerus fractures, the mean age was 53.24 years, and the majority (60%) were male. The fractures predominantly affected the right side (62.5%), with road traffic accidents and falls being the leading causes. Neer's classification identified 10 patients with two-part fractures, 21 with three-part fractures, and 9 with four-part fractures. The average neck-shaft angle (NSA) was 138.62° ± 11.09°. Four patients with an NSA of ≤120° had fair to good functional outcomes, while those with an NSA >130° and a well-positioned greater tuberosity (GT) generally had better outcomes. The average distance between the GT and the acromion surface (AS) was 6 mm ± 1.4 mm, influencing shoulder abduction and functional results. Patients with an alpha/beta ratio below 1.40 mm, indicating lower bone density, had a higher incidence of screw cut-out. The mean C-M score at 6 months was 80.72, with 87.5% of patients achieving abduction above 90°. Complications occurred in 8 patients (20%), including varus collapse (10%), abduction <90° (12.5%), infection (2.5%), and screw cut-out (5%). Larger head diameters and heights were associated with better functional scores.
Radiographic parameters such as the NSA, GT to AS distance, head diameter, head height, and alpha/beta ratio are crucial predictors of functional outcomes in proximal humerus fractures treated with PHILOS plates. Accurate reduction and medial column stabilization are a key to minimizing complications and improving patient recovery. Despite generally positive outcomes, challenges such as screw cut-out and varus collapse persist, highlighting the need for meticulous surgical technique and thorough post-operative management.
肱骨近端骨折很常见，尤其是在老年人中，并且在治疗方面带来重大挑战，特别是对于移位骨折。尽管有各种手术技术可用，但结果仍然不一致，这通常是由于解剖复位和固定不佳所致。本研究探讨特定影像学参数与功能结果之间的相关性，旨在确定恢复的关键预测因素。通过关注这些参数，我们旨在优化手术方法并改进随访策略，最终改善患者的治疗结果。
一项回顾性研究纳入了40例年龄在18 - 75岁之间的肱骨近端骨折患者，这些患者于2022年4月至2024年4月在切蒂纳德医院接受切开复位钢板固定治疗。所有手术均通过前外侧三角肌胸大肌入路进行。术后评估影像学参数，对患者进行为期1年的随访。使用随访X线片和Constant - Murley（C - M）评分将功能结果与放射学参数相关联。
在这项对40例肱骨近端骨折患者的研究中，平均年龄为53.24岁，大多数（60%）为男性。骨折主要累及右侧（62.5%），交通事故和跌倒为主要原因。Neer分类法确定10例为两部分骨折，21例为三部分骨折，9例为四部分骨折。平均颈干角（NSA）为138.62°±11.09°。4例NSA≤120°的患者功能结果为尚可至良好，而NSA>130°且大结节（GT）位置良好的患者通常有更好的结果。GT与肩峰表面（AS）之间的平均距离为6 mm±1.4 mm，影响肩关节外展和功能结果。α/β比值低于1.40 mm（表明骨密度较低）的患者螺钉穿出的发生率较高。6个月时的平均C - M评分为80.72，87.5%的患者外展超过90°。8例患者（20%）出现并发症，包括内翻塌陷（10%）、外展<90°（12.5%）、感染（2.5%）和螺钉穿出（5%）。较大的股骨头直径和高度与更好的功能评分相关。
NSA、GT至AS距离、股骨头直径、股骨头高度和α/β比值等影像学参数是使用PHILOS钢板治疗的肱骨近端骨折功能结果的关键预测因素。精确复位和内侧柱稳定是将并发症降至最低并改善患者恢复的关键。尽管总体结果良好，但螺钉穿出和内翻塌陷等挑战仍然存在，这突出了需要精细的手术技术和全面的术后管理。
