Retrospective study.
Level-1 trauma center.
One hundred twenty-seven patients were analyzed, with a mean follow-up of 5 (3-7) years.
Radiological parameters studied were neck-shaft angle (NSA), greater tuberosity (GT) to articular surface (AS) distance, medial hinge reduction, and presence (or absence) of calcar screw. Functional outcome evaluated by DASH and Constant-Murley (C-M) score.
The mean age is 53.8 years. All patients had a union in 14 (12-18) weeks. The mean NSA is 135° (112-155°). One hundred and thirteen patients with an NSA of >120° had a good functional outcome. Fourteen patients with NSA ≤120° had shoulder abduction <90°. The mean GT to AS distance is 7.2 mm (-2 to 16). The superior displacement of GT above AS is associated with abduction of <90° (16 patients). The mean medial gap is 3 mm (0-17). In 14 patients with a medial gap of >4 mm and without calcar screw, varus collapse is observed. All patients had a good outcome on DASH score and 122 patients had good to excellent outcome on C-M score. Five patients with poor outcome on C-M score had NSA <120° and displacement of GT above AS.
Radiographic indicators for poor outcome are varus angulation with NSA <120°, superior displacement of GT above AS, the presence of medial gap >4 mm, and absence of calcar specific screw. This \"terrible triad\" of proximal humerus fracture should be avoided during operative fixation.
回顾性研究。
一级创伤中心。
分析了一百二十七名患者,平均随访5(3-7)年。
研究的放射学参数是颈轴角(NSA),大结节(GT)到关节面(AS)的距离,内侧铰链复位,以及是否存在(或不存在)Calcar螺丝。通过DASH和Constant-Murley(C-M)评分评估功能结果。
平均年龄为53.8岁。所有患者均在14(12-18)周内愈合。平均NSA为135°(112-155°)。NSA>120°的113名患者具有良好的功能结果。14例NSA≤120°的患者肩关节外展<90°。平均GT到AS距离为7.2mm(-2到16)。GT高于AS的上位移与<90°的外展有关(16例)。平均内侧间隙为3mm(0-17)。在14例内侧间隙>4毫米且无Calcar螺钉的患者中,观察到内翻塌陷。所有患者在DASH评分上都有良好的预后,而在C-M评分上有122例患者的预后良好。5例C-M评分结果不佳的患者NSA<120°,GT位移高于AS。
不良结局的影像学指标是NSA<120°的内翻角度,GT高于AS的优越位移,内侧间隙的存在>4毫米,并且没有calcar特定的螺钉。手术固定时应避免肱骨近端骨折的“可怕三联征”。