Furuhata Ryogo, Tanji Atsushi, Kamata Yusaku, Matsumura Noboru
Department of Orthopaedic Surgery, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga-shi, Tochigi, 326-0843, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan.
BMC Musculoskelet Disord. 2025 Jul 9;26(1):668. doi: 10.1186/s12891-025-08917-0.
Plate fixation is a widely used surgical procedure for proximal humeral fracture; however, relatively high complication rates have been reported. To prevent the occurrence of proximal screw cut out, pegs with blunt tips have been introduced to replace traditional screws for fixation of the humeral head. However, few reports are available on the effect of using smooth pegs on surgical outcomes. In this study, we aimed to compare the postoperative outcomes of osteosynthesis using anatomical plates using all proximal screws and using all proximal pegs.
We retrospectively identified 48 patients who underwent osteosynthesis using an anatomical locking plate for proximal humeral fractures. We divided the patients into a screw group (25 patients) and a peg group (23 patients) according to the devices used to fix the humeral head. We compared operative outcomes, postoperative shoulder functional scores, and postoperative complication rates between the two groups.
In terms of operative outcomes, the operation time was significantly shorter in the peg group than that in the screw group (94 [83–105] min vs. 114 [98–124] min, < 0.001, = 0.52). No significant differences in adjusted Constant score and American Shoulder and Elbow Surgeon score were observed at 1 year postoperatively between the two groups. However, the incidence of greater tuberosity reduction loss was significantly higher in the peg group than that in the screw group (17.4% vs. 0%, = 0.046, φ = 0.32).
Our study showed that the use of proximal pegs did not significantly affect postoperative shoulder functional outcomes, although it may reduce operative time. In three-part fractures involving the greater tuberosity, the use of proximal screws or plates with sufficient coverage of the greater tuberosity may be desirable to prevent reduction loss of the greater tuberosity.
The online version contains supplementary material available at 10.1186/s12891-025-08917-0.
钢板固定是治疗肱骨近端骨折广泛应用的外科手术；然而，据报道其并发症发生率相对较高。为防止近端螺钉穿出，已引入钝头钉来替代传统螺钉用于肱骨头固定。然而，关于使用光滑钉对手术效果影响的报道较少。在本研究中，我们旨在比较使用全近端螺钉的解剖钢板与使用全近端钉进行骨合成的术后效果。
我们回顾性纳入了48例行解剖锁定钢板治疗肱骨近端骨折的患者。根据固定肱骨头所用器械将患者分为螺钉组（25例）和钉组（23例）。我们比较了两组的手术效果、术后肩部功能评分及术后并发症发生率。
在手术效果方面，钉组的手术时间显著短于螺钉组（94[83 - 105]分钟对114[98 - 124]分钟，<0.001，=0.52）。术后1年两组间调整后的Constant评分和美国肩肘外科医师评分无显著差异。然而，钉组大结节复位丢失的发生率显著高于螺钉组（17.4%对0%，=0.046，φ=0.32）。
我们的研究表明，使用近端钉虽可能缩短手术时间，但对术后肩部功能结果无显著影响。在涉及大结节的三部分骨折中，使用近端螺钉或对大结节有足够覆盖的钢板可能有助于防止大结节复位丢失。
在线版本包含可在10.1186/s12891 - 025 - 08917 - 0获取的补充材料。
