Surgical treatment of proximal humerus fractures

Panov A.A., Kopysova V.A., Khalaman A.G., Petrushin E.G.

Abstract


Surgical repair of unstable proximal humerus fractures involves accurate reduction of the humerus tubercles, reconstruction of rotator cuff muscles and tendons, stable bone fixation to be performed shortly after injury to ensure functional recovery of the shoulder joint.
Objective
To evaluate the efficacy of surgical treatment with fixation shape memory constructs and through porous titanium nickelide implants used for patients with proximal humerus fractures and a different injury-to-surgery interval.
Material and methods
Surgical treatment with titanium nickelide constructs was performed for 71 patients with proximal humerus fractures. Thirty (42.3 %) patients had comminuted intra- and juxta-articular fractures, 26 (36.6 %) cases were unifocal and metadiaphysial injuries and 15 (21.1 %) had greater tuberosity fractures. 21 (29.6 %) patients had associated rotator cuff tears. An injury-tosurgery interval was 1 to 10 days in 52 (73.2 %) patients and 11 to 30 days in 19 (26.8 %) cases.
Results
Consolidation of realigned bone was achieved in all the patients at 4-to-6-month follow-up. Shoulder joint function recovered in 50 (96.2 %) patients who were surgically treated in the first 10 days of injury and in 14 (73.7 %) out of 19 patients who had procedure performed between 11 and 30 days post injury. There were statistically significant differences in the groups (χ2 = 8.391, p = 0.015).
Conclusions
Accurate bone reduction and shoulder ligament repair performed early after the injury provided restored function to the shoulder joint in 96.2 % of the cases. Preoperative delays showed reduction in favourable outcomes of the surgical intervention by 21.1 %.

Keywords


proximal humerus, fracture, osteosynthesis, shape memory construct, implant, titanium nickelide, injury-to-surgery interval, results

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