Midterm Treatment Outcomes of Proximal Humerus Fractures by Intramedullary Fixation

Cover Page


Cite item

Abstract

Background. Treatment tactics of proximal humerus fractures remains a matter of dispute due to multiple cases of unsatisfactory outcomes and high rate of postoperative complications.

The aim of the study to evaluate midterm outcomes of intramedullary fixation for treatment the proximal humerus fractures in comparison with plate fixation.

Material and Methods. The authors evaluated treatment outcomes of 175 patients with proximal humerus fractures who underwent surgery in the period from 2012 to 2017. Depending on the fixation method the patients were divided into two groups: the main group consisted of 107 patients who underwent intramedullary fixation by a nail of third generation; a comparison group — consisting of 68 patients who underwent fixation by a locking plate with angular stability.

Results. In one year after intramedullary nail fixation the authors observed the excellent and good outcomes on Constant scale in 83.2% of cases, satisfactory — 12.1%, unsatisfactory — 4.7%. Patients who underwent plate fixation demonstrated the following outcomes: excellent and good — 73.5%, satisfactory — 17.7%, unsatisfactory — in 8.8%. Constant score increase was equal in the main and control groups and varied depending on the fracture type.

Conclusion. Intramedullary nailing is an option for treatment of all fracture types of proximal humerus as well as for the cases of combined humeral neck and diaphysis fractures. Functional recovery parameters were higher in the main group of patients after intramedullary nailing.

About the authors

K. A. Egiazaryan

Pirogov Russian National Research Medical University

Author for correspondence.
Email: dr.grigoriev.gkbl@yandex.ru

Karen A. Egiazaryan - chief, the Chair of Trauma, Orthopedics and Military Surgery 

Moscow

Russian Federation

A P. Ratyev

Pirogov Russian National Research Medical University;
City Clinical Hospital No.1

Email: fake@neicon.ru

Andrei P. Ratyev — Dr. Sci. (Med.), professor. Chair of Trauma, Orthopedics and Military Surgery, Pirogov Russian National Research Medical University; orthopedic surgeon. City Clinical Hospital No.1

Moscow

Russian Federation

D. I. Gordienko

Pirogov Russian National Research Medical University;
City Clinical Hospital No.1

Email: fake@neicon.ru

Dmitrii I. Gordienko — Cand. Sci. (Med.), assistant professor, Chair of Trauma, Orthopedics and Military Surgery, Pirogov Russian National Research Medical University; deputy chief. Trauma and Orthopedics Department, City Clinical Hospital No.1

Moscow

Russian Federation

A. V. Grigoriev

Pirogov Russian National Research Medical University;
City Clinical Hospital No.1

Email: dr.grigoriev.gkbl@yandex.ru

Alexei V. Grigoriev — assistant. Chair of Trauma, Orthopedics and Mihtary Surgery, Pirogov Russian National Research Medical University; chief of Trauma and Orthopedics Unit, City Clinical Hospital No.1

Moscow

Russian Federation

N. V. Ovcharenko

Pirogov Russian National Research Medical University

Email: fake@neicon.ru

Nina V. Ovcharenko — resident. Chair of Trauma, Orthopedics and Military Surgery 

Moscow

 

Russian Federation

References

  1. I. Handoll Н.Н., Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015. 11;(11):CD000434. doi: 10.1002/14651858.CD000434.pub4.
  2. Архипов C.B., Кавалерский Г.М. Хирургическое лечение переломов проксимального отдела плечевой кости. В КП.: Хирургия плечевого сустава. М.: ГРАНАТ; 2015. с. 163-176.
  3. Скорошядов А.В., Васильев А.Ю. Диагаостика и лечение переломов проксимального отдела плечевой кости. Лечебное дело. 2007;(3):79-86.
  4. Court-Brown C.M., Garg A., McQueen M.M. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-371.
  5. Jawa A., Bumikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. 2016;4(1). doi: 10.2106/JBJS.RVW.0.00003.
  6. Rothberg D., Higgins T. Fractures of the proximal humerus. Orthop Clin North Am. 2013;44(1):9-19. doi: 10.1016/j.ocl.2012.08.004.
  7. Gerber C., Werner C.M., Vietme P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86(6):848-855.
  8. Murray I.R., Amin A.K., White T.O., Robinson C.M. Proximal humeral fractures: current concepts in classification,treatmentandoutcomes./5o«e/ointSurg5r. 2011;93(1):1-11. doi: 10.1302/0301-620X.93B1.25702.
  9. Russo R., Cautiero F., Della Rotonda G. The classification of complex 4-part humeral fractures revisited: the missing fifth fragment and indications for surgery. Musculoskelet Surg. 2012;96 Suppl l:S13-9. doi: 10.1007/S12306-012-0195-2.
  10. Neer C.S. 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077-1089.
  11. Kettler M., Biberthaler P., Braunstein V., Zeiler C., Kroetz M., Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures]. Unfallchirurg. 2006;109(12):1032-1040. (In German).
  12. Коган П.Г., Воронцова T.H., Шубняков И.И., Воронкевич И.А., Ласунский С.А. Эволюция лечения переломов проксимального отдела плечевой кости (обзор литературы). Травматология и ортопедия России. 2013;(3):154-161.
  13. Conboy V.B., Morris R.W., Kiss ]., Carr A.J. An evaluation of the Constant-Murley shoulder assessment .J Bone Joint Surg Br. 1996;78(2):229-232.
  14. Hirschmarm M.T., Wind B., Amsler F., Gross T. Reliability of shoulder abduction strength measure for the Constant-Murley score. Clin Orthop Relat Res. 2010;468(6):1565-1571. doi: 10.1007/S11999-009-1007-3.
  15. Lekic N., Montero N.M., Takemoto R.C., Davidovitch R.I., Egol K.A. Treatment of two-part proximalhumerus fractures: intramedullary nail compared to locked plating. HSS J. 20128(2):86-91. doi: 10.1007/S11420-012-9274-Z.
  16. Sun Q., Ge W., Li G., Wu J., Lu G., Cai M., Li S. Locking plates versus intramedullary nails in management of displaced proximal humeral fractures: a systematic review and meta-analysis. Int Orthop. 2018;42(3):641- 650. doi: 10.1007/S00264-017-3683-Z.
  17. Загородний H.B., Бондаренко П.В., Семенистый А.Ю., Семенистый А.А., Логвинов А.Н. Результаты оперативного лечения 2-фрагментарных переломов проксимального отдела плечевой кости проксимальным плечевым гвоздем и блокированной пластиной. Врач-аспирант. 2015;3.2(70):222-229.
  18. Helfen T., Siebenbiirger G., Mayer M., Bocker W., Ockert B., Haasters F. Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®. BMC Musculoskelet Disord. 2016;17(1):448. doi: 10.1186/sl2891-016-1302-6.
  19. Haasters F., Prali W.C., Himmler M., Polzer H., Schieker M., Mutschler W. [Prevalence and management of osteoporosis in trauma surgery. Implementation of national guidelines during inpatient fracture treatment]. Unfallchirurg. 2015;118(2):138-145. doi: 10.1007/S00113-013-2500-4. (In German).
  20. Sproul R.C., Iyengar J.J., Devcic Z., Feeley B.T. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408-413. doi: 10.1016/j.injury.2010.11.058.
  21. Мурылев В., Имамкулиев A., Елизаров П., Коршев О., Кутузов А. Хирургическое лечение внесуставных переломов проксимального отдела плеча. Врач. 2014;(11):10-13.
  22. Osterhoff G., Ossendorf C., Warmer G.A., Simmen H.P., Wemer C.M. The calcar screw in angular stable plate fixation of proximal humeral fractures — a case study. J Orthop Surg Res. 2011;24(6):50. doi: 10.1186/1749-799X-6-50.
  23. Carbone S., Tangari M., Gumina S., Postacchini R., Campi A., Postacchini F. Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning. Int Orthop. 2012;36(6):1267-1273. doi: 10.1007/S00264-011-1474-5.
  24. Sun J.C., Li Y.L., Ning G.Z., Wu O., Feng S.O. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate. Eur J Orthop Surg Traumatol. 2013;23(6):699-704. doi: 10.1007/S00590-012-1040-X.
  25. Yu Z., Zheng L., Yan X., Li X., Zhao J., Ma B. Closed reduction and percutaneous armulated screw fixation in the treatment of comminuted proximal humeral fractures. Adv Clin Exp Med 2017;26(2):287-293. doi: 10.17219/acem/28898.
  26. Rothstock S., Plecko M., Kloub M., Schiuma D., Windolf M., Gueorguiev B. Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. ClinBiomech (Bristol, Avon). 2012;27(7):686-691. doi: 10.1016/j.cUnbiomech.2012.03.003.
  27. Young A.A., Hughes J.S. Locked intramedullary nailing for treatment of displaced proximal humerus fractures. Orthop Clin North Am. 2008;39(4):417-428. doi: 10.1016/j.ocl.2008.05.001.
  28. Hessmarm M.H., Nijs S., Mitthneier T., Kloub M., Segers M.J.M., Winkelbach V., Blauth M. Internal fixation of fractures of the proximal humerus with the MultiLoc nail. Oper Orthop TraumatoL 2012;24(4-5):426-239. doi: 10.1007/S00064-011-0085-Z.
  29. Cuny С., Goetzmann Т., Dedome D., Gross J.B., Irrazi M., Berrichi A. et al. Antegrade nailing evolution for proximal humeral fractures, the Telegraph IV®: a study of 67 patients. Eur J Orthop Surg Traumatol. 2015;25: 287-295. doi: 10.1007/s00590-014-1493-1.
  30. Cuny C., Goetzmarm T., Irrazi M.B., Berrichi A., Dedome D., Mainard D. Development of the telegraph nail for proximal humeral fractures. Injury Int J Care Injured. 2012;43:1-10.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies