Neer Shoulder Research Articles

Demographic and academic characteristics of orthopaedic shoulder and elbow division chiefs in the United States

Division Chiefs (DCs) and department leadership play an integral role within the service, and in the department as a whole. The goal of this study was to assess the demographics and academic characteristics of the leadership in orthopedic shoulder and elbow services across academic centers in the United States and comment on the diversity within these leadership positions. Academic medical centers were identified using the FRIEDA database. DCs were identified using the hospitals' respective websites where data such as sex, race/ethnicity, academic rank, fellowship institution, and time since graduating fellowship. Scopus database was used to determine individual h-indices. Of 198 academic programs identified, 49 were found to have a DC of the orthopedic shoulder and elbow division. An additional 26 programs were noted to have a shoulder and elbow division, but were not found to have a DC of the division. These DCs were mostly White (n=43, 87.8%), with only 6 identified DCs with a different ethnicity. Forty-five of the DCs (91.8%) were male and 4 were female (8.2%). The average time out of fellowship was 20.7 years and the average h-index was 18.9. More than 20% of the DCs trained at Columbia's Neer shoulder and elbow Fellowship. Six DCs were current or past president of ASES and 5 DCs completed the ASES traveling fellowship. There is a paucity of available research on demographic and leadership characteristics in academic orthopedic shoulder and elbow. Shoulder and elbow DC had average h-index of 18.9 and 20% trained at one fellowship. There also opportunities for increased gender/racial/ethnic diversity among the leadership of shoulder and elbow divisions.

Modified medial minimally invasive double-plating osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus

The optimal surgical approach and placement of plates for the treatment of distal third diaphyseal fracture of the humerus are the subjects of debate. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of modified medial minimally invasive plate osteosynthesis (MIPO) techniques using a double technique for the treatment of distal third diaphyseal fracture of the humerus. A total of 30 patients with a distal third diaphyseal fracture of the humerus were selected from our hospital. Patients were seen between January 2017 and October 2022. They were treated with a modified medial approach combined with MIPO using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complications, the mean fracture length (FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow was evaluated using Neer’s assessment of the shoulder and Mayo’s assessment of the elbow. The FL was 56.1 ± 7.2 mm and the DCL was 38.3 ± 5.3 mm. The mean operative time was 84.8 ± 13.4 min (range 60–110 min). The mean blood loss during surgical treatment was 46.5 ± 10.2 ml (range 30–60 ml). Bone healing was observed in all patients from 10 to 16 weeks (average 12.1 ± 1.7) postoperatively, and one case with poor surgical wound healing was recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.1 ± 4.8°), with a maximum flexibility straightness ranging from 0° to 5° (average 2.2 ± 1.3°). The Mayo elbow joint function score was 80–100 (average 91.4 ± 5.0). The Neer shoulder joint function score ranged from 85 to 100 (average 92.5 ± 3.9). The modified medial approach was beneficial it did not cause any iatrogenic radial nerve or ulnar nerve injuries. The anterior and the medial side plates are fixed perpendicular to the distal humerus and provide excellent stability at the same time producing better shoulder and elbow joint function.

Comparative study of ultrasonic-guided betamethasone local injection and extracorporeal shock wave therapy in post-stroke hemiplegic shoulder pain: a randomized clinical trial.

This study aimed to compare the efficacy and safety of ultrasound-guided local injection (UGLI) of betamethasone around the shoulder and extracorporeal shock wave therapy (ESWT) in patients with hemiplegic shoulder pain. Forty-two patients with hemiplegic shoulder pain were randomly divided into the UGLI group (N = 21) and the ESWT group (N = 21). In the UGLI group, betamethasone was injected at the pain point around the shoulder under ultrasonic localization. In the ESWT group, an extracorporeal shock wave was performed at the pain points around the shoulder for 20 min of time, once a week, for 4 consecutive weeks. Both groups received rehabilitation training. The visual analog scale (VAS) evaluation was performed at baseline, 1 h, 1 week, and 1 month after treatment. Furthermore, Neer shoulder joint function scores, upper limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), Hamilton Depression Scale (HAMD), the MOS-item short-form health survey (SF-36) scores, and serum expression level of cytokine were evaluated at baseline and 1 month after treatment. After 1-h treatment, the UGLI group showed a greater effect on the degree of pain than the ESWT group (P = 0.017). After 4 consecutive weeks of intervention, the UGLI group showed a significant improvement in the serum level of cytokine expression compared with the ESWT group (P < 0.05). The range of motion (ROM) of the hemiplegic shoulder (P < 0.05) has no difference between the two groups (P > 0.05). The ultrasonic-guided betamethasone local injection and extracorporeal shock wave both can improve hemiplegic shoulder pain. However, the UGLI can induce a more cytokine expression level.

Clinical efficacy of intra-articular infusion of cocktail combined with tranexamic acid in the treatment of middle-age and older patients with frozen shoulder following arthroscopic capsular release.

To investigate the clinical efficacy of arthroscopic capsular release and postoperative intra-articular infusion of cocktail combined with tranexamic acid (TXA) in the treatment of patients with frozen shoulder. A total of 85 middle-aged and older patients with frozen shoulder who underwent arthroscopic capsular release and received intra-articular infusion of TXA alone (n = 28), cocktail alone (n = 26), and cocktail plus TXA (n = 31) after surgery were retrospective analyzed. The drainage volume within 24 h after surgery, postoperative length of hospital stay, postoperative complications, visual analog scale (VAS), Neer shoulder assessment scale, ASES score, and range of motion (ROM) of the shoulder joint at 1 day, 1 week, 1 month, and 3 months after surgery in all three groups were recorded and compared. Postoperative length of hospital stay was significantly shorter in the cocktail + TXA and cocktail groups than that in the TXA group. Postoperative drainage volume was significantly higher in the cocktail group compared with TXA + cocktail group (P < 0.05). At 1 day and 1 week after surgery, pain was more pronounced in the TXA group, which was significantly relieved in the cocktail and the cocktail + TXA groups (P < 0.05). Pain was significantly relieved in all the three groups at 1 and 3 months after surgery. Significant functional improvement of the shoulder was achieved in all three groups at 1 week after surgery, the improvement was apparent in the cocktail + TXA groups (P < 0.05), followed by the cocktail group. At 1 month after surgery, patients in the cocktail + TXA groups obtained excellent functional recovery of the shoulder joint. At 3 months after surgery, patients in all the three groups both obtained good recovery of the shoulder joint function, and the recovery was apparent in the cocktail + TXA groups (P < 0.05). Arthroscopic capsular release and postoperative intra-articular infusion of cocktail combined with TXA has good safety and efficacy in the treatment of middle-age and older patients with frozen shoulder, which can reduce postoperative pain and intra-articular bleeding, promote early postoperative functional exercises and accelerate early postoperative recovery.

Review of pediatric functional outcomes measures used to evaluate surgical management in pediatric patients with an upper extremity fracture.

For two decades, many scores, questionnaires, and rating systems have been used to evaluate the functional outcome of children with an upper extremity fracture (UEF). However, only a few of these were created specifically for children, and many assess only elbow function. In the absence of any published review on this topic, we set out to identify and categorize different scores used to evaluate the clinical and functional outcomes of surgically treated pediatric UEFs. A literature search was performed, and 38 studies were identified. The scores used more often were the shortened version of the Disability of the Arm, Shoulder and Hand questionnaire and the Mayo Elbow Performance Score/Index. In a lower number of studies, authors used other scoring systems, including the Mayo Wrist Score, the Patient-Rated Wrist Evaluation, the Patient-Rated Elbow Evaluation, the Métaizeau functional scoring system, the Oxford Elbow Score, the Price and Flynn criteria, the Hardacre Functional Score, the Neer Shoulder Score, the Constant-Murley Shoulder Score, the Modified Orthopedic Trauma Association Score, the Medical Outcomes Study Short Form-36, and the Pediatric Outcomes Data Collection Instrument. Some specific pediatric scoring systems to evaluate the functional outcome of children with a UEF have been suggested, but a single tool that is valid and reliable for skeletally immature patients of all ages is not yet available. Further studies are needed to identify specific pediatric measurements to increase validity, responsiveness, sensitivity, and interpretability of upper limb functional outcome scores in common clinical practice.

Treatment of proximal humeral fractures in elderly patients with intramedullary nail and locking plate

Objective: To compare the effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures in the elderly. Methods: A total of 37 elderly patients with proximal humeral fractures were selected from April 2016 to June 2018 in Tianjin Hospital, including 13 males and 24 females, aged (66±5) years. The patients were divided into observation group (17 cases) and control group (20 cases) according to the random number table, and were treated with multiloc intramedullary nail and locking plate respectively. The operation time, blood loss, healing time of fractures, visual analogue scale of pain, Neer shoulder function score were recored and compared between the two groups. The data were compared with t test between the two groups. Results: The operation time of the observation group was shorter than that of the control group ((72±7) min vs (89±9) min, t=6.365, P<0.05); the intraoperative bleeding volume was lower than that of the control group ((56±6) ml vs (74±8) ml, t=7.923, P<0.05). The superior rate of shoulder function was 94.1%(16/17) in the observation group and 90.0%(18/20) in the control group (χ(2)=0.209, P>0.05). The VAS score of the observation group was lower than that of the control group on the first day after operation (t=4.706, P<0.05); the Neer shoulder function score of the observation group was higher than that of the control group on the sixth month after operation (81±8 vs 76±8, t=2.156, P<0.05). Six months after the operation, the valgus angle (19.21°±2.88°) of the observation group was larger than that of the control group (16.32°±2.63°, t=3.189, P<0.05), the humeral head varus angle (3.57°±0.47°), the humeral neck stem angle (139°±10°) was smaller than that of the others (5.24°±1.26°), (146°±13°) (t=5.159, 2.258, both P<0.05). There was no significant difference in shoulder function score and complication rate 12 months after operation between the two groups (both P>0.05). Conclusion: Both intramedullary nailing and locking plate can achieve better results in the treatment of proximal humeral fractures in the elderly, but the operation time of intramedullary nailing is shorter, the pain after operation is lighter and the recovery is faster.

Early efficacy evaluation of the treatment of complex proximal humeral fractures in the elderly with reverse shoulder arthroplasty

Objective To evaluate the short-term efficacy of one-stage reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly. Methods Data of 43 elderly patients with complex proximal humeral fractures who were treated by reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively analyzed. There were 12 males and 31 females with an average age of 72 years (range, 66-78 years). All fractures were fresh and close which caused by trauma. The average time from injury to operation was 8.0 days (range, 6-11 days). According to Neer classification, 21 cases (48.8%, 21/43) were three-part fractures, 22 cases (51.2%, 22/43) four-part fractures. Visual analogue scale (VAS), Neer shoulder replacement evaluation system and Constant-Murley score were used to evaluate the postoperative results. Results All operations were successfully completed. The average operation time was 141.3 minutes (range, 120-170 minutes. The mean blood loss was 407 ml (range, 250-700 ml) and intraoperative blood transfusion was 446.5 ml (range, 400-800 ml). All patients were followed up for 10.9 months (range, 6 to 16 months). All patients were discharged within 7 days after operation, and no wounds related complications occurred. The bigger and lesser tuberosities of all patients healed completely within 8 weeks. At the latest follow-up, no loosening or dislocation of prosthesis occurred, and the forward elevation was 133.0° (range, 100°-165°); external rotation was 29.5° (range, 20°-35°); internal rotation was 46.7° (range, 30°-60°). VAS score was 0.8 (range, 0-3). The Neer score was 87 (range, 73-98), with 20 cases (46.5%, 20/43) excellent, 16 cases (37.2%, 16/43) good, and 7 cases (16.3%, 7/43) fair. Constant-Murley score was 88.7 (range, 70-98). A 71-year-old patient had symptoms of axillary nerve injury after operation and recovered completely 6 weeks after the operation, which did not affect the functional rehabilitation exercise or the stability of the prosthesis. During the follow-up, no other complications such as infection, acromial stress fracture and scapular notching were found in all patients. Conclusion The short-term effect of one-stage reverse shoulder arthroplasty for the treatment of complex proximal humeral fractures in the elderly is satisfactory. Key words: Aged; Humeral fractures; Arthroplasty, replacement

Clinical comparative study of metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture

Objective To investigate the difference of clinical efficacy between metaphyseal locking intramedullary nail and locking plate in the treatment of humeral surgical neck fracture. Methods 64 patients with Neer II humeral surgical neck fracture who were treated in our hospital from January 2010 to December 2015 were selected. According to the operation plan, the patients were divided into epiphyseal locking intramedullary nail fixation group (observation group, n=42) and locking plate fixation group (control group, n=22). The differences of clinical data (sex, age, time from injury to operation, number of injured cases, follow-up time), clinical indicators (neck-trunk angle, last neck-trunk angle, number of complications, amount of operative bleeding, amount of operative blood transfusion, operation time, fracture healing time): Neer shoulder function score and Constant shoulder score were compared between the two groups. Results There was no significant difference in gender, age, time from injury to operation, number of cases of injury and follow-up time between the two groups, and the subjects were comparable (P>0.05). There was no significant difference in the neck-trunk angle, the last neck-trunk angle and the number of complications between the two groups (P>0.05); the observation group had longer operation time, less operation bleeding volume and blood transfusion volume, shorter fracture healing time (P 0.05). The Constant score, external rotation, abduction and flexion in the observation group were significantly higher than those in the control group (P<0.05). Conclusions The use of metaphyseal locking intramedullary nail in the treatment of humeral surgical neck fracture has a definite clinical effect and a low incidence of complications, which is worthy of clinical application. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, intramedullary; Bone nails; Bone plates

Efficacy of open reduction and locking plate fixation via subacromial anterolateral approach for proximal humerus fracture

Objective To investigate the clinical efficacy of subacromial anterolateral small incision approach with open reduction and internal fixation with proximal humeral locking system (PHILOS) for proximal humeral fractures. Methods A retrospective case-control study was conducted to analyze the complete medical records of 76 patients with proximal humeral fractures admitted to the Department of Traumatic Surgery, Fujian Provincial Hospital from April, 2013 to December, 2017. There were 22 males and 54 females, aged from 25 to 89 years [(60.4±16.4)years]. All patients had closed fractures. According to Neer classification, there were 12 patients of type II, 46 patients of type Ⅲ, and 18 patients of type IV. The duration from injury to operation ranged from 1 to 10 days [(4.4±1.9)days]. All patients received treatment of open reduction fixation with PHILOS. Forty patients received subacromial anterolateral small incision approach with percutaneous interactive reduction and internal fixation of humerus head and humerus shaft, including four patients of Neer type II, 26 patients of type III, and 10 patients of type IV (minimally invasive group). Thirty-six patients received the deltopectoral approach with reduction and internal fixation, including eight patients of type II, 20 patients of type III, and 8 patients of type IV (conventional group). The total length of incision, the operation time, intraoperative blood loss, hospitalization time, review of the neck angle with X-ray 1 week after surgery, and the fracture healing after 6 months, the ipsilateral Neer shoulder joint function score at 6 months after surgery and complications were compared. Results All patients were followed up for 3-12 months [(9.2±1.7)months], and there were six patients lost to the follow-up including four of the minimally invasive group and two of the conventional group. In the minimally invasive group and the conventional group, the total length of incision was 6.0(6.0, 6.8)cm and 11.5(10.0, 15.0)cm ( P 0.05), the intraoperative blood loss was 100(80, 150)ml and 175(100, 200)ml (P 0.05), the neck-shaft angle was (134.7±2.5)° and (134.6±2.6)°(P>0.05). A total of 70 patients obtained good bone healing. At 6 months after operation, the Neer shoulder function score of the affected side in the minimally invasive group was excellent in 30 patients, good in four patients, and fair in two patients, with the excellent and good rate of 96%, and for conventional group the score was excellent in 20 patients, good in eight patients, and fair in six patients, with the excellent and good rate of 84%(P<0.05). There was no complication in the minimally invasive group, but axillary nerve injury was found in one patient in the conventional group. Conclusion For the proximal humerus fracture, compared with the traditional deltopectoral approach, the subacromial anterior lateral small incision approach with percutaneous humeral head and humeral shaft reduction and interal fixation has the advantages of smaller incision, less bleeding and better functional recovery, which is a minimally invasive and effective treatment. Key words: Humeral fractures; Acromion; locking plate

Surgical treatment of avulsion fracture around joints of extremities using hook plate fixation

PurposeThis study proposed to access the clinical outcome of avulsion fractures around joints of extremities using the hook plate.MethodsA total of 60 patients with avulsion fractures of joints admitted in our hospital between January 2011 and June 2016 were performed the surgery of hook plate fixation. Functional recovery was evaluated using the Lysholm knee score, Kaikkonen ankle injury score, Mayo elbow and wrist function score, and Neer shoulder function score.ResultsAll the patients were healed within 3 months after surgery with stage I healing incision without vascular or nerve injuries. The average follow-up period was 18.1 months. At the last follow-up, no instability of joints, looseness of internal fixation or traumatic arthritis was observed. Mild joint fibrosis occurred in 5 cases. A total of 57 patients were well recovered with the excellent and good rate of 95%. Three patients with humeral avulsion fracture of the greater tuberosity had shoulder joint adhesion and peri humeral inflammation at the last follow-up due to the poor cooperation for early rehabilitation exercise. In the last follow-ups, the functional score of the affected limb was markedly greater than that in the 3-month follow-ups (p < 0.05).ConclusionHook plate fixation has the therapeutic effect on treating avulsion fractures around joints of extremities with the advantages of reliable fixation, early rehabilitation after operation, high recovery rates of joint function, wide indications, and convenient uses.

Treatment experience of proximal humerus degloving fracture

To summarize a new type of proximal humerus fracture-proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer's shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.

Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children

To study clinical effects and safety of traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children. From October 2012 to May 2016, 65 patients with proximal humeral fractures were treated with traditional manipulative reduction and percutaneous elastic intramedullary nail fixation. There were 52 boys and 13 girls, ranging in age from 7 to 14 years old, with an average age of 11.2 years old. Twenty-three patients had injuries on the left side, and 42 patients had injuries on the right side. There were 13 cases of oblique fracture, 49 cases of transverse fracture, and 3 cases of comminuted fracture. All the patients had closed, obviously displaced fractures, without vascular and nerve injuries. The duration from injury to treatment ranged from 20 minutes to 5 days, with a mean of 3 days. The fracture healing and complications were observed after operation, and the curative effect was evaluated by Neer shoulder function score. The operation time ranged from 30 to 40 minutes, with a mean of 35 minutes; intraoperative blood loss ranged from 5 to 10 ml, with a mean of 6.5 ml. All the patients were followed up, and the duration ranged from 12 to 28 months, with an average of 18 months. All the fractures healed. According to the Neer evaluation system, 59 patients got an excellent result, 5 good and 1 fair. Four patients had a small amount of secretions on the tail of the needle; 2 patients had skin irritation; 1 patient had partial withdrawal of the nail, and the skin in all the patients healed after taking out the nail. No patients had nonunion fractures due to the broken nails and loosen screws, and no vascular or nerve injuries occurred. Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children has the advantages of less trauma, quicker recovery, less complications and simple operation.

Effect of locking plate fixation for proximal humeral fractures in elderly patients

Objective To investigate the clinical effect of locking plate fixation in treatment of proximal humeral fractures in the elderly. Methods This retrospective case control study enrolled 96 patients with closed proximal humeral fractures admitted from October 2013 and October 2015. There were 52 males and 44 females, with age of (68.2±1.4)years (range, 62-74 years). According to the Neer classification of proximal humeral fractures, two-part fractures were noted in 27 patients, three-part fractures in 57, and four-part fractures in 12. According to the surgical methods, the patients were assigned to locking plate fixation (observation group) and anatomic plate fixation (control group), with 48 cases each. Operation time, intraoperative blood loss, hospitalization time, fracture healing time, varus angle of the humeral head, visual analogue score (VAS), Neer shoulder score for shoulder function and related complications were observed. Results All patients were followed up for 13-24 months (mean, 18.5 months). Better results were observed in observation group than control group in aspects of operation time [(51.2±14.8)minutes vs. (73.2±27.3)minutes], intraoperative bleeding[(158.3±32.9)ml vs. (270.9±34.8)ml], hospitalization time [(8.2±2.9)days vs. (13.1±2.2)days], fracture healing time [( 93.7±18.4)days vs. (122.9±18.9)days], varus angle of the humeral head [(2.2±1.8)° vs. (4.2±1.3)°], VAS[(2.0±0.7)points vs. (5.1±1.2)points], excellence rate of Neer score (98% vs. 90%) and postoperative complication incidence (10% vs. 21%) (P<0.05). Conclusion Compared with the anatomical plate, locking plate fixation has advantages of shorter operation time, less intraoperative bleeding, earlier bone healing, better shoulder movement and less postoperative complications in treatment of proximal humeral fractures. Key words: Humeral fractures; Aged; Fracture fixation, internal; Locking plate

Curative effect of invasive percutaneous plate osteosynthesis technique combined with locking plate for segmental fractures of the humeral shaft

Eleven patients with segmental fractures of the humeral shaft were treated with invasive percutaneous plate osteosynthesis (IPPO) technique combined with locking plate from June 2012 to November 2015. The patients were followed up for 6-18 months with an average of 11 months. All fractures were healed. There were no axillary nerve injury, wound infection, radial nerve palsy, internal fixation loosening, delayed union, nonunion and humeral head necrosis among all patients. The Constant-Murley function score was 86.5±2.2 at the last follow-up. The Neer shoulder function scores were excellent in 7 cases, good in 3 cases and fair in 1 case. The patients obtained good shoulder function. The results suggest that IPPO technique combined with locking plate to treat segmental fractures of the humeral shaft has the advantages of less trauma, early functional exercise and early functional recovery. Key words: Humeral fractures; Fracture fixation, internal; Bone plates

Clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures

To explore the clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures. A total of 284 hospitalized patients of proximal humerus fractures over 60 years of age cases from October 2009 to February 2012 were randomly divided into two groups of locking proximal humeral plate (LPHP) and PHILOS (n = 142 each). And the clinical efficacies of two groups were compared. For PHILOS and LPHP groups, the fracture healing periods were (11.64 ± 3.81) and (14.95 ± 3.95) weeks. And there was statistical significance (P < 0.05). At 3 months post-surgery, the incidence of pain was 72.41% and 64.81%. And there was statistical significance (P < 0.05). At 2 years,Neer shoulder function score had inter-group statistically insignificant difference (P > 0.05). Both PHILOS and LPHP are effective in the treatment of senile proximal humeral fractures.However, the former is conducive to fracture healing and has shorter healing time and lowered postoperative pain.

Clinical efficacy and prognosis of artificial half shoulder replacement for proximal humerus fractures

Objective To explore the clinical value of artificial half shoulder replacement for proximal humerus fractures.Methods 41 patients with proximal humerus fractures were selected from our hospital from March,2008 to March,2010 and were randomly divided into a control group (n=21) and a study group (n=20).The control group were treated with fixed plate,and the study group with artificial half shoulder replacement.The clinical efficacies,operative times,postoperative bleeding volumes,and complications in both groups were compared and analyzed.Results Comparing with the control group,the study group were better in the Neer shoulder pain scores,functional usage,range of motion,and total scores and had markedly higher excellent clinical efficacy (90.48％),obviously shorter operative time,smaller postoperative bleeding volume,and lower complication incidence 6 months after the operation,with statistical differences (P ＜ 0.05).Conclusions Artificial half shoulder replacement can increase the clinical efficacy and improve the prognosis of patients with proximal humerus fractures.It is suitable for clinical treatment application. Key words: Artificial half shoulder replacement; Proximal humerus fractures; Clinical efficacy; Prognosis

Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children

The aim of the study was to evaluate the clinical outcome of closed/open reduction and titanium elastic nails (TENs) in children with severely displaced proximal humeral fractures. A retrospective study was performed on 37 children suffering from proximal humeral fracture between April 2009 and July 2012. All these patients were treated by closed or open reduction with TEN fixation. The healing process was assessed by radiographic and clinical follow-up for up to 36months. Radiographic assessment was performed on the scheduled follow-ups to examine fracture healing, remodelling, bone growth and residual deformity. The clinical outcomes were evaluated using the Neer shoulder score and patients' satisfaction report at the final follow-up. Complications related to the treatment were also recorded. All patients had a mean follow-up period of 24months (12-36) after surgery. All fractures were healed, radiologically, at a median time of eightweeks (seven to tenweeks). There were no major complications related to the treatment. Two patients complained about skin irritation around the sides of the prominent distal ends of the nails. Implant removal took place at an average of 5.8months post-operatively as an outpatient procedure. There were no observed complications in association with the removal of the hardware. At the final follow-up, the mean Neer shoulder score was 96.65 (range 83-100). Thirty patients were very satisfied with their surgical outcomes and the remaining seven were satisfied. Function of the affected arm returned to normal at the end of the follow-up period in all cases. Combining closed or open reduction with TEN fixation is recommended for treating severely displaced proximal humeral fractures in children. Our data showed evidence of satisfactory outcomes with a low complication rate and a fast return to normal mobility of the affected arms.

Management of proximal humeral Neer 3-part and 4-part fracture dislocations with anatomic reconstruction locking plate

Objective To analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus. Methods The study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.Conclusions Although the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients. Key words: Shoulder fractures; Fracture fixation, internal; Shoulder dislocation

Prospective Randomized Comparative Study of Antegrade and Retrograde Locked Nailing for Middle Humeral Shaft Fracture

Humeral shaft fractures can be effectively treated by either antegrade or retrograde locked intramedullary nailing, but these two methods have not been adequately compared. The present study compared the effectiveness and potential risks of these two approaches on middle humeral shaft fractures using the same locked nails. In this prospective comparative study, 92 fractures in 92 patients with middle humeral shaft fractures were randomly allocated to receive either antegrade or retrograde locked nailing by sealed-envelope technique. The clinical outcomes of fracture healing, time to healing, complications, elbow and shoulder functional recovery, and time for functional recovery were compared. Retrograde nailing required significantly longer time than antegrade nailing (64.8 vs. 51.3 minutes; p < 0.01) Except for three patients lost to follow-up, the average follow-up time was 18.6 months for 44 fractures in the antegrade group and 19.8 months for 45 fractures in the retrograde group. The fracture healed in 42 fractures (95%) in the antegrade group versus 42 fractures (93%) in the retrograde group, and this difference was not significant. After exclusion of two patients with brachial plexus injury and three with head injury, functional recovery was compared between 41 patients with antegrade and 43 with retrograde nailing. For shoulder joints, the difference in the average Neer shoulder score between the two groups was statistically significant (90.8 vs. 93.5; p = 0.03). However, if four elderly patients were excluded, the average score in the antegrade group was 91.9, and the difference became insignificant (p = 0.1). Still, the antegrade group needed significantly longer time for shoulder functional recovery (16.4 vs. 8.3 weeks; p < 0.01). For elbow joints, the average postoperative Mayo elbow performance score (96.3 vs. 94.8; p = 0.16) did not differ significantly between these two approaches, but the retrograde approach needed significantly longer time for elbow functional recovery (3.9 vs. 8.8 weeks; p < 0.01). All patients, except those with associated injuries, resumed their pretrauma occupations or activities. With proper patient selection, antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. It is recommended that retrograde nailing be used in patients with a wide medullary canal or preexisting shoulder problems and antegrade nailing be used in patients with young age or a small medullary canal. In critically ill patients, antegrade nailing is preferred because of shorter operation time.

Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children

To demonstrate the effectiveness of intramedullary fixation of severely displaced proximal humeral physeal fractures in skeletally immature children using the elastic stable intramedullary nail (ESIN). Retrospective recruitment of 14 patients aged 10-15-years old with severely displaced proximal humeral physeal fractures between 1999 and 2004 in a single regional specialist paediatric orthopaedic hospital. The fractures were graded using the Neer classification; severe displacement constituted Neer II-IV or displacement >1 cm and angulation >45 degrees . Patients were followed up and assessed using the Disabilities of the Arm, Shoulder and Hand score (DASH) and the Neer Shoulder score. Radiographs were assessed for deformity. Subjective satisfaction was assessed. Fourteen patients with mean follow-up of 30 months (12-66 m) from surgery. All fractures were radiologically united at a median time of eight weeks (7-10 weeks). At follow-up, Neer Shoulder mean score was 96.79 (range 83-100) and DASH mean score 2.26 (0-7.5). Subjectively 71% were very satisfied and 29% were satisfied. We commend stabilisation using ESIN in the management of the displaced proximal humeral physeal fracture in older children, once reduction of the fracture has been achieved by either closed or open means. ESIN is safe and allows early return to pre-injury function.