Treatment of proximal humerus fractures combined with avulsion fractures of the greater tuberosity

The proximal humerus fracture series combined with greater tuberosity avulsion surgical neck fracture (proximal) refers to the fracture 2-3 cm below the anatomical neck of the humerus, also known as diaphragm shoulder fracture. The surgical neck of the humerus is located at the junction of the lower border of the humerus tuberosity and the humerus shaft. There is more cancellous bone, thin cortical bone, and no muscle attachment. It is the connection between the humerus shaft and the upper end of the humerus. , prone to fractures, is one of the predisposing sites of systemic fractures.

Cureus | A Novel Technique of Proximal Humerus Fixation

Studies have shown that the main cause of this fracture is osteoporosis. The study also found that there are two trabecular bone systems at the upper end of the humerus that maintain the integrity and strength of the humerus. One is through the medial bundle of the lower part of the humeral head, and the other is vertically descended through the greater tuberosity of the humerus and through the trabecular bone system on the lateral surface of the humeral head. Both of these trabecular systems are related to the static load capacity of the humerus, and weakening of these two trabecular systems through the surgical neck of the humerus is a common cause of fractures. Close to the medial side of the surgical neck of the humerus, the axillary nerve enters the deltoid muscle, and the brachial plexus and axillary artery and vein pass through the axilla. When the fracture end is severely displaced, neurovascular damage may occur.

Treat

Conservative treatment

Closed restoration and external fixation are mainly divided into two types of fixation methods: plaster and splint, and they are also widely used in clinical practice. Among them, the clinical treatment effect of shoulder splint external fixation and U-shaped plaster external fixation is the most ideal, and it needs to be carried out gradually in the later stage. functional exercise.

Proximal Humerus Fracture • Easy Explained - OrthoFixar 2022

Operation treatment

Surgical treatment methods mainly include closed needle internal fixation, closed interlocking intramedullary needle plus cannulated nail internal fixation, open reduction plate internal fixation, and modified Kirschner wire tension band internal fixation. The main surgical methods include:

Intramedullary nailing treatment

Intramedullary nailing in the treatment of humeral surgical neck fractures causes less trauma, can preserve the blood supply to the fracture ends, and can achieve a high rate of excellent and good results. Severely displaced fractures should be treated with interlocking intramedullary nailing, especially when combined with humeral shaft fractures. For the modified interlocking intramedullary nail, the helical-blade interlocking nail is mainly used at the proximal end to effectively complete the angular stabilization. Compared with the ordinary interlocking intramedullary nail, it can increase the release effect of the intraosseous fixation and reduce the strain on the trabecular bone. The use of intramedullary nailing for the treatment of proximal humeral fractures mainly includes two methods: single-needle fixation and multi-needle fixation.

Internal fixation with steel plate

The disadvantage of locking proximal humerus plate (LPHP) treatment is that there is extensive surgical exposure, which will lead to soft tissue damage around the fracture, which will destroy the blood supply, cause the fracture to fail to heal, and increase avascular necrosis of the humeral head. The advantage is that the stability of fracture fixation is good. The plate is an angular stability plate designed according to the anatomical shape of the proximal humerus of the patient, which can firmly fix the proximal humerus, and the osteoporotic fractures can obtain significant results.

Closed reduction and percutaneous needle fixation

This method of treatment can prevent excessive peeling of soft tissue, promote fracture healing, reduce the probability of avascular necrosis of the humeral head, and can achieve significant results with early shoulder functional exercise. Selecting the hollow compression screw for treatment can achieve ideal results. It can not only effectively fix the fracture section, strengthen the fracture stability, but also have a certain compressive stress on the fracture section, which can promote the close contact of the fracture section and shorten the fracture. Healing time and reducing the chance of complications.

Shoulder replacement surgery

Artificial joint replacement is mainly suitable for patients with comminuted fractures combined with osteoporosis, compression fractures with cumulative damage to the articular surface exceeding 2/5, and non-reconstructive humeral splits. Humerus replacement surgery can relieve pain symptoms, but there are restrictions on shoulder movement after the surgery is completed.

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