Fixation Techniques for Intraarticular Proximal Humeral Fractures
Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization...
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| Format: | Article |
| Language: | Russian |
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Vreden Russian Research Institute of Traumatology and Orthopedics
2023-06-01
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| Series: | Travmatologiâ i Ortopediâ Rossii |
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| Online Access: | https://journal.rniito.org/jour/article/viewFile/2370/pdf |
| _version_ | 1797792440710594560 |
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| author | Yuri A. Afanasiev |
| author_facet | Yuri A. Afanasiev |
| author_sort | Yuri A. Afanasiev |
| collection | DOAJ |
| description | Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization as a result of trauma. Current osteosynthesis techniques for intraarticular fractures of the proximal humerus (PH) do not reduce the risk of avascular osteonecrosis of the humeral head (AONHH) and do not reduce the risk of nonunion. To prevent ischemic changes in the humeral head, osteosynthesis with reparative osteogenesis stimulation is recommended.
Aim of the study to specify indications for various fixation techniques of intraarticular fractures of the proximal humerus.
Methods. The study enrolled 48 patients with AO/ASIF type 11C1 and 11C2 intraarticular PH fractures requiring surgical treatment. All patients were allocated into 2 groups. Retrospective (control) group included 25 patients who were treated using locking plate osteosynthesis or intramedullary locking osteosynthesis with proximal humeral nails. Prospective (main) group included 23 patients who were additionally treated with a vascularized musculoskeletal graft from the coracoid process of the scapula transplanted to the fracture area.
Results. Functional treatment results of patients who underwent surgery using vascularized musculoskeletal grafts from the coracoid processes of the scapula (71.50% were excellent and 14.3% were good) were better than those of the control group (35.28% were excellent and 17.64% were good). Consolidation of the fracture in the control group occurred in 92% of cases (23 patients); the remaining 8% (2) of patients had pseudoarthrosis of the anatomical or surgical neck of the humerus developed within 6 months after the surgery. In the main group, the fractures consolidated in all patients.
Conclusion. Fractures with no damage to the bicipital groove should be considered an indication for performing plate osteosynthesis without vascularized musculoskeletal grafting. Locking osteosynthesis in case of intraarticular PH fractures makes it much more difficult to reduce the humeral head and the tubercular area. Locking osteosynthesis decreases the rigidity of fixation of fragments, which may contribute to their secondary displacement. |
| first_indexed | 2024-03-13T02:33:07Z |
| format | Article |
| id | doaj.art-5e570b1ed2b940248a01f9aedcf55f23 |
| institution | Directory Open Access Journal |
| issn | 2311-2905 2542-0933 |
| language | Russian |
| last_indexed | 2024-03-13T02:33:07Z |
| publishDate | 2023-06-01 |
| publisher | Vreden Russian Research Institute of Traumatology and Orthopedics |
| record_format | Article |
| series | Travmatologiâ i Ortopediâ Rossii |
| spelling | doaj.art-5e570b1ed2b940248a01f9aedcf55f232023-06-29T11:50:20ZrusVreden Russian Research Institute of Traumatology and OrthopedicsTravmatologiâ i Ortopediâ Rossii2311-29052542-09332023-06-01292384510.17816/2311-2905-23701262Fixation Techniques for Intraarticular Proximal Humeral FracturesYuri A. Afanasiev0https://orcid.org/0000-0003-1134-1524City Clinical Hospital No 1Background. The most severe type of injuries of the proximal epiphysis of the humerus are intraarticular fractures. One of the main complication is the development of avascular osteonecrosis, which is caused by the peculiarities of blood supply of the humeral head and its compromised vascularization as a result of trauma. Current osteosynthesis techniques for intraarticular fractures of the proximal humerus (PH) do not reduce the risk of avascular osteonecrosis of the humeral head (AONHH) and do not reduce the risk of nonunion. To prevent ischemic changes in the humeral head, osteosynthesis with reparative osteogenesis stimulation is recommended. Aim of the study to specify indications for various fixation techniques of intraarticular fractures of the proximal humerus. Methods. The study enrolled 48 patients with AO/ASIF type 11C1 and 11C2 intraarticular PH fractures requiring surgical treatment. All patients were allocated into 2 groups. Retrospective (control) group included 25 patients who were treated using locking plate osteosynthesis or intramedullary locking osteosynthesis with proximal humeral nails. Prospective (main) group included 23 patients who were additionally treated with a vascularized musculoskeletal graft from the coracoid process of the scapula transplanted to the fracture area. Results. Functional treatment results of patients who underwent surgery using vascularized musculoskeletal grafts from the coracoid processes of the scapula (71.50% were excellent and 14.3% were good) were better than those of the control group (35.28% were excellent and 17.64% were good). Consolidation of the fracture in the control group occurred in 92% of cases (23 patients); the remaining 8% (2) of patients had pseudoarthrosis of the anatomical or surgical neck of the humerus developed within 6 months after the surgery. In the main group, the fractures consolidated in all patients. Conclusion. Fractures with no damage to the bicipital groove should be considered an indication for performing plate osteosynthesis without vascularized musculoskeletal grafting. Locking osteosynthesis in case of intraarticular PH fractures makes it much more difficult to reduce the humeral head and the tubercular area. Locking osteosynthesis decreases the rigidity of fixation of fragments, which may contribute to their secondary displacement.https://journal.rniito.org/jour/article/viewFile/2370/pdfproximal humerus fractureplate osteosynthesisstimulation of reparative osteogenesisvascularized musculoskeletal grafthumeral osteonecrosis |
| spellingShingle | Yuri A. Afanasiev Fixation Techniques for Intraarticular Proximal Humeral Fractures Travmatologiâ i Ortopediâ Rossii proximal humerus fracture plate osteosynthesis stimulation of reparative osteogenesis vascularized musculoskeletal graft humeral osteonecrosis |
| title | Fixation Techniques for Intraarticular Proximal Humeral Fractures |
| title_full | Fixation Techniques for Intraarticular Proximal Humeral Fractures |
| title_fullStr | Fixation Techniques for Intraarticular Proximal Humeral Fractures |
| title_full_unstemmed | Fixation Techniques for Intraarticular Proximal Humeral Fractures |
| title_short | Fixation Techniques for Intraarticular Proximal Humeral Fractures |
| title_sort | fixation techniques for intraarticular proximal humeral fractures |
| topic | proximal humerus fracture plate osteosynthesis stimulation of reparative osteogenesis vascularized musculoskeletal graft humeral osteonecrosis |
| url | https://journal.rniito.org/jour/article/viewFile/2370/pdf |
| work_keys_str_mv | AT yuriaafanasiev fixationtechniquesforintraarticularproximalhumeralfractures |