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Abstract：
Background: The morphology of proximal humeral fractures (PHFs) is complex, and the fixation and selection of implants need to be guided by the fracture type and classification, which requires an accurate understanding of the fracture line. This study had three purposes. 1) Define and analyze the fracture lines and morphological features of all types PHFs by three-dimensional (3D) mapping technology. 2) Determine the osteotomy position of the biomechanical model of the PHFs according to the fracture heat map. 3) Based on the analysis of the pathological morphology and distribution of a large number of consecutive cases of PHFs, propose a novel classification of PHFs. Methods: We retrospectively collected 220 cases of PHFs and generated a 3D fracture map and heat map based on computed tomography (CT) imaging. Through analysis of the fracture morphology of the 220 PHFs, a novel classification was proposed. The primary criterion for staging was the continuity between the humeral head and the greater tuberosity and lesser tuberosity, and the secondary criterion was the relationship between the humeral head segment and the humeral shaft. Results: The fracture line was primarily found around the metaphyseal zone of region of the surgical neck, with the most extensive distribution being below the larger tuberosity and on the posterior medial side of the epiphysis. We suggest that the osteotomy gap should be immediately (approximately 5-10 mm) below the lower edge of the articular surface. The most common type of fracture was type I3 (33 cases, 15.0%), followed by type IV3 fracture (23 cases, 10.4%), and type III2 fracture (22 cases, 10.0%). Interobserver and intraobserver reliability analysis for the fracture classification revealed a k value (95% confidence interval) of 0.639 (0.57-0.71) and 0.841, P < 0.01, respectively. Conclusion: In this study, the fracture line and morphological characteristics of PHFs were clarified in detail by 3D mapping technique. In addition, a new classification method was proposed by analysis of the morphological characteristics of 220 PHFs, A two-part fracture model for PHFs is also proposed.
摘要：
背景：肱骨近端骨折（PHFs）的形态复杂，植入物的固定和选择需要以骨折类型和分类为指导，这就需要准确理解断裂线.本研究有三个目的。1）通过三维（3D）映射技术定义和分析所有类型PHF的断裂线和形态特征。2)根据骨折热图确定PHFs生物力学模型的截骨位置。3)在对大量连续PHFs病例的病理形态和分布进行分析的基础上,提出了一种新的PHFs分类。方法：我们回顾性收集了220例PHFs，并根据计算机断层扫描（CT）成像生成了3D骨折图和热图。通过对220个PHFs的断口形貌分析,提出了一种新的分类方法。分期的主要标准是肱骨头与大结节和小结节之间的连续性，次要标准是肱骨头段与肱骨干之间的关系。结果：骨折线主要出现在手术颈干meta端区周围，最广泛的分布在较大的结节下方和骨phy的后内侧。我们建议截骨间隙应位于关节面下边缘下方（约5-10mm）。最常见的骨折类型为I3型（33例，15.0%），其次是IV3型骨折（23例，10.4%），和III2型骨折（22例，10.0%）。对骨折分类的观察者间和观察者间可靠性分析显示，k值（95％置信区间）分别为0.639（0.57-0.71）和0.841，P<0.01。结论：在这项研究中，通过3D作图技术详细阐明了PHFs的断裂线和形态特征。此外,通过分析220个PHFs的形态特征，提出了一种新的分类方法，还提出了PHF的两部分断裂模型。
