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Abstract：
The purpose of this study is to analyze the radiological and functional outcome of complex proximal humerus fractures treated by open reduction and plate fixation, and how radiological parameters correlate with functional outcome.
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.
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.
摘要：
本研究的目的是分析切开复位钢板内固定治疗复杂肱骨近端骨折的放射学和功能结果,以及放射学参数如何与功能结果相关。
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”。
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”。
