Surgical Treatment of Humerus Fracture-Dislocations: Medium-Term Results

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Abstract

Background. Fracture-dislocation of the proximal humerus is a severe injury that equally affects both young and old people. Such injuries are often accompanied by the high risk of neurocirculatory and other complications, which defines their great medical and social importance. The purposes of this study were: 1) to compare the mid-term results of the surgical treatment of the patients with dislocation-fractures of the proximal humerus when they were managed according to the standard algorithm or the new one developed by the authors of this study; 2) to evaluate the effectiveness of the proposed protocol in relation to the patients with neurological complications in order to elaborate a universal approach to the optimal treatment tactics. Patients and Methods. The treatment results of 73 patients with proximal humerus fracture-dislocation undergone the surgery from 2012 to 2018. The patients were divided into 2 groups, which were managed according to the traditional (control group) or the new algorithms (main group), differing in the time of the surgery, a set of diagnostic methods, and an approach to the prevention and treatment of complications. The patients’ examination included taking patients’ anamnesis, their physical examination, X-rays and multispiral computed tomography of the injured shoulder, electromyoneurography, ultrasound of the upper limb blood vessels, patients’ questioning. Results. A year after the surgery, a statistically significant difference in the functional results was revealed in the patients of the main and control groups by the Constant Shoulder Score (p = 0.0063). In the control group, there was a statistically significant difference of the functional results by Constant Shoulder Score between the patients with and without neurological complications (p = 0.003). There was no statistically significant difference among such patients in the main group (p = 0.387). Conclusion. The main group patients, including those with neurological complications, achieved higher functional results in comparison with the control group. Thus, the authors’ treatment algorithm showed its effectiveness. The surgery within 6 hours from the moment of admission of the patients with humerus fracture-dislocation, as well as the earliest possible diagnosis of neurological injury and treatment of complications significantly improved the prognosis and outcome the main group patients.

About the authors

K. A. Egiazaryan

Pirogov Russian National Research Medical University

Email: egkar@mail.ru
ORCID iD: 0000-0002-6680-9334

Karen A. Egiazaryan — Dr. Sci. (Med.), Professor, Head of Traumatology, Orthopedics and Military Field Surgery Chair

Moscow

Russian Federation

A. P. Ratyev

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

Author for correspondence.
Email: anratiev@gmail.com
ORCID iD: 0000-0002-6559-4263

Andrei P. Ratyev — Dr. Sci. (Med.), Professor of Chair of traumatology, Orthopedics and Military Surgery, Pirogov Russian National Research Medical University; Orthopedic Surgeon, City Clinical Hospital No.1

Moscow

Russian Federation

D. S. Ershov

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

Email: Ershov0808@gmail.com
ORCID iD: 0000-0001-7005-2752

Dmitrii S. Ershov — Cand. Sci. (Med.), Associate Professor of Chair of Traumatology, Orthopedics and Military Surgery, Pirogov Russian National Research Medical University; Orthopedic Surgeon, City Clinical Hospital No.1

Moscow

Russian Federation

E. A. Kuruch

Pirogov Russian National Research Medical University; Podolsk City Clinical Hospital

Email: Kuruch@bk.ru
ORCID iD: 0000-0002-8522-8623

Evgenii A. Kuruch — PhD Student of Chair of Traumatology, Orthopedics and Military Surgery, Pirogov Russian National Research Medical University, Moscow; Orthopedic Surgeon, Podolsk City Clinical Hospital

Moscow; Podolsk

Russian Federation

V. N. Kuznetsov

Podolsk City Clinical Hospital

Email: Vadim556677@yandex.ru
ORCID iD: 0000-0002-7429-0704

Vadim N. Kuznetsov — Cand. Sci. (Med.), Chief of Trauma and Orthopedics Unit

Podolsk

Russian Federation

N. V. Ovcharenko

Pirogov Russian National Research Medical University

Email: nina2009_94@mail.ru
ORCID iD: 0000-0003-4447-0445

Nina V. Ovcharenko — PhD Student

Moscow

Russian Federation

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