Kasha Srinivas, Yalamanchili Ranjith Kumar, Rohit G P R K, Lokayah Suresh Krishna, Kulkarni Varun
Department of Orthopaedics, Krishna Institute of Medical Sciences, Secunderabad, Telanagana, India.
All India Institute of Medical Sciences, Bibinagar, Telangana, India.
JSES Rev Rep Tech. 2024 Nov 18;5(1):22-29. doi: 10.1016/j.xrrt.2024.10.002. eCollection 2025 Feb.
Proximal humerus fractures present a treatment challenge due to varied fracture configurations and a lack of consensus on optimal management. Locking plate designs offer promising solutions, yet technical guidelines for successful outcomes remain elusive. Complications are common, with fixation-related failures often attributed to varus collapse. Addressing this, we review a novel intraoperative technique of medialization of the humerus shaft to provide medial buttress support to the humerus head.
This retrospective study included acute 3-part and 4-part proximal humerus fractures treated with open reduction and proximal humerus locking plate fixation from February 2013 to August 2021, which were restored by creating medial buttress by the described technique. Central Column Diaphyseal angle was measured on the 20° external rotation anteroposterior X-ray radiograph, by measuring the intersection angle of the axis of the proximal part of the humerus and the line perpendicular to the anatomical neck. The functional outcome was measured with the Constant score that assesses pain and shoulder function during daily activities, range of motion, and shoulder strength at each follow-up.
Seventy-six patients with acute 3- and 4-part proximal humerus fractures were treated using this technique and followed for an average of 16 months. Results showed successful union in 76% of cases within 12 weeks, with no nonunions or implant failures requiring revision surgery at a minimum of 24 months follow-up. Functional outcomes were favorable in 70% of patients. However, avascular necrosis of the humeral head occurred in 12% of cases.
Despite limitations, this technique offers a biomechanically sound approach to enhance fixation stability, potentially improving the outcomes in proximal humerus fractures without the need for any additional fibular grafting procedures.
由于近端肱骨骨折的骨折形态多样且在最佳治疗方法上缺乏共识，因此对其治疗构成挑战。锁定钢板设计提供了有前景的解决方案，但关于成功治疗结果的技术指南仍不明确。并发症很常见，与固定相关的失败通常归因于内翻塌陷。针对这一问题，我们回顾了一种肱骨骨干内移的新型术中技术，以向肱骨头提供内侧支撑。
这项回顾性研究纳入了2013年2月至2021年8月期间采用切开复位和近端肱骨锁定钢板固定治疗的急性三部分和四部分近端肱骨骨折，这些骨折通过所述技术建立内侧支撑来复位。在20°外旋前后位X线片上测量中央柱骨干角，即通过测量肱骨近端轴线与垂直于解剖颈的线的相交角度。在每次随访时，使用Constant评分评估功能结果，该评分评估日常活动中的疼痛和肩部功能、活动范围以及肩部力量。
76例急性三部分和四部分近端肱骨骨折患者采用该技术治疗，平均随访16个月。结果显示，76%的病例在12周内成功愈合，在至少24个月的随访中，没有出现骨不连或需要翻修手术的植入物失败情况。70%的患者功能结果良好。然而，12%的病例出现了肱骨头缺血性坏死。
尽管存在局限性，但该技术提供了一种生物力学上合理的方法来增强固定稳定性，有可能改善近端肱骨骨折的治疗结果，而无需任何额外的腓骨移植手术。
