Arthroplasty, Replacement ; Fracture Fixation, Internal ; methods ; Humans ; Shoulder Fractures ; therapy ; Shoulder Joint ; surgery

Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in children is a rare injury. The injury often occurs as a consequence of high velocity trauma. Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture- dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.
Child, Preschool ; Female ; Fracture Fixation, Internal ; Humans ; Shoulder Dislocation ; complications ; therapy ; Shoulder Fractures ; complications ; surgery

OBJECTIVETo study the effect of the treatment for comminuted fractures of proximal humerus with open reduction and internal fixation, and the influence of the different internal fixation.

METHODSFrom January 2003 to June 2007, 423 cases of comminuted fractures of proximal humerus were treated with open reduction and internal fixation. Among them, 139 patients included 51 males and 88 females were treated with the Kirschner needle with an average age of 55.8 years old ranging from 35 to 72 years, and the average course was 7 days (from 3 to 20 days); 103 patients included 48 males and 55 females were treated with the cloverleaf plate with an average age of 56.7 years old (from 22 to 76 years), and the average course was 8.5 days (from 3 to 23 days); 181 patients included 85 males and 96 females were treated with the locking plate with an average age of 57.1 years old (from 29 to 77 years), and the average course was 7.9 days (from 3 to 21 days). The pain, daily activities, orbit, and the strength of the shoulder were evaluated with the Constant's scale.

RESULTSThe wound of all the cases was primary healing. All patients were followed-up for over 12 months, the sings and symptoms of all the patients were improved very well. There was significant difference between, before and after operation on Constant's scoring. While there was not significant difference among the different internal fixation.

CONCLUSIONOpen reduction and internal fixation is effective for comminuted fractures of proximal humerus. There is no significant difference on therapeutic efficacy in different internal fixation.

Adult ; Aged ; Female ; Fracture Fixation, Internal ; adverse effects ; Fractures, Comminuted ; physiopathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Shoulder Fractures ; physiopathology ; surgery ; therapy ; Treatment Outcome

OBJECTIVETo observe clinical therapeutic effects of electroacupuncture, radiation of infrared rays plus passive exercise on movement disorders of shoulder joint after operation of fracture of surgical neck of humerous.

METHODSSixty cases were randomly divided into an acupuncture plus exercise group (n = 32) and an exercise therapy group (n = 28). The acupuncture plus exercise group were treated with electroacupuncture and infrared ray radiation at rigid soft tissue on the affected side, with adjuvant points, Xuehai (SP 10), Sanyinjiao (SP 6) and Yang-lingquan (GB 34) selected for acupuncture treatment and after the needles were withdrawn passive exercise of the shoulder joints were made. The exercise therapy group were treated by active exercise after passive exercise of shoulder joint. Therapeutic effects were observed after treatment for one month, and shoulder pain scores VAS and scores of activity of shoulder joint before and after treatment were observed.

RESULTSThe total effective rate of 84.4% in the acupuncture plus exercise group was better than 64.3% in the exercise group. Before and after treatment, the VAS scores were 5.8 +/- 0.5 and 3.1 +/- 0.3 in the acupuncture plus exercise group, and 5.7 +/- 0.5, 4.3 +/- 0.4 in the exercise therapy group, respectively, with significant decreases after treatment in the two groups (both P < 0.001), the acupuncture plus exercise group being more significantly decreased than the exercise therapy group (P < 0.001). Before and after treatment, the total scores of activity of shoulder joint were 103.38 +/- 11.10 and 193.61 +/- 10.21 in the acupuncture plus exercise group, and 103.01 +/- 10.01 and 133.45 +/- 9.81 in the exercise therapy group, respectively, with significant increases after treatment in the two groups (both P < 0. 01), the acupuncture plus exercise group being better than the exercise therapy group (P < 0.001).

CONCLUSIONElectroacupuncture, radiation of infrared rays plus passive exercise has obvious therapeutic effect on movement disorders of shoulder joint after operation of fracture of surgical neck of humerous.

Adult ; Combined Modality Therapy ; Electroacupuncture ; Exercise Therapy ; Female ; Humans ; Infrared Rays ; therapeutic use ; Male ; Middle Aged ; Motor Activity ; Neck ; physiopathology ; surgery ; Postoperative Complications ; physiopathology ; therapy ; Radiotherapy ; Shoulder Fractures ; complications ; physiopathology ; surgery ; Shoulder Joint ; physiopathology

BACKGROUND: This study examined the clinical outcomes of indirect reduction maneuver and minimally invasive approach for treating displaced proximal humerus fractures in patients older than 60. METHODS: Thirty-two patients (11 male and 21 female) who had undergone treatment for displaced proximal humerus fracture were evaluated. The mean age of the patients was 72.4 years (range, 60 to 92 years). All cases were followed up for at least 12 months. All patients were interviewed and evaluated on the visual analog scale, with gender-specific constant score correction for age, standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support, and bone mineral density. Statistical analysis was performed with a multiple regression analysis. RESULTS: The average visual analog scale score was 2.4, and the average gender-specific constant score correction for age was 80.6 points. Final functional outcomes were 8 excellent, 15 good, 7 fair, and 2 poor. The average NSA was 122.8degrees; and the radiological results were 20 good, 11 fair, and 1 poor. There was significant difference of the gender-specific constant score for age between the group of NSA more than 110degrees and the group of NSA less than 110degrees (p = 0.00). There were 26 cases with and 6 cases without medial support, with significant difference between the gender-specific constant score correction for age of these groups (p = 0.01). Complications occurred in 4 patients (12.5%). CONCLUSIONS: The indirect reduction maneuver and minimally invasive approach were safe and reliable options for the treatment of displaced proximal humerus fractures in the elderly patients. An inadequate reduction (i.e., less than 110degrees NSA) or lack of medial support (e.g., no cortical or screw support) were significant factors contributing to poor functional outcomes.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Manipulation, Orthopedic ; Middle Aged ; Range of Motion, Articular ; Shoulder Fractures/*surgery/therapy ; Surgical Procedures, Minimally Invasive

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
Aged ; Comparative Effectiveness Research ; Fracture Healing ; Fractures, Multiple ; complications ; therapy ; Fractures, Ununited ; epidemiology ; Humans ; Humerus ; injuries ; surgery ; Orthopedic Procedures ; adverse effects ; methods ; statistics & numerical data ; Osteoarthritis ; epidemiology ; Osteonecrosis ; epidemiology ; Randomized Controlled Trials as Topic ; Reoperation ; statistics & numerical data ; Shoulder Fractures ; complications ; therapy ; Treatment Outcome

OBJECTIVETo evaluate the treatment effect of three and four-part fractures of proximal humerus in elder patients using indirect reduction combined with locking proximal humeral plate (LPHP) fixation.

METHODSFrom November 2004 to May 2008, 24 cases of proximal humeral three and four-part fracture were treated with percutaneous plate fixation using LPHP included 6 males and 18 females with an average age of 70 years old ranging from 55 to 88 years. The surgery was performed through antrolateral transdeoltoid approach. After extra articular capsule indirect reduction, the plate was inserted through the incision, and then an incision was made distal to previous incision to expose distal plate. The proximal fragments were fixed with 4 to 6 screws, and distal fragments were fixed with 3 screws. Shoulder exercises were performed at the 2nd to 3rd day after operation. Two weeks after operation, active shoulder exercise was done, which was gradually intensified 3 weeks after operation. The functional outcomes of the shoulder were assessed according to Constant score.

RESULTSAll the fractures united clinically and radiologically. The mean healing time was 10.5 weeks (8 to 21 weeks). The mean Constant score was 81.6 points (49 to 92 points). A total of 20 patients had excellent or satisfactory result, with only one scored as poor.

CONCLUSIONThe technique of extra articular capsule indirect reduction combined LPHP internal fixation has the advantages of stable, easy to operate, less vascular damage and so on. It can effectively treat the proximal humerus three-and four-part fractures, especially to elder patients.

Aged ; Aged, 80 and over ; Bone Plates ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recovery of Function ; Shoulder Fractures ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Skin ; Tomography, X-Ray Computed ; Treatment Outcome