Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS.

There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61-74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11-34) months. The fractures united in an average of 7.2 (6-14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

[Arthroscopic surgery for the treatment of stiff elbow].

OBJECTIVE: To investigate the clinical results of arthroscopic surgery for the treatment of stiff elbow. METHODS: From October 2010 to December 2012, 27 patients with stiff elbow were treated with arthroscopic debridement and joint capsular releasing. There were 18 males and 9 females, ranging in age from 24 to 54 years old, with an average of 35.7 years old. Analgesia and rehabilitation were necessary after operation. Mayo criteria system was used to evaluate therapeutic effects. RESULTS: All the patients were followed up, and the duration ranged from 12 to 18 months, with a mean of 13.5 months. The mean maximum flexion angle of patients improved from preoperative (61.5 ± 30.1) degrees to postoperative (102.5 ± 20.1) degrees; and the mean maximum extension angle improved from preoperative (34.8 ± 12.1) degrees to postoperative (16.3 ± 16.1) degrees; the average total range of motion improved from preoperative (34.2 ± 21.0) degrees to postoperative (84.9 ± 9.2) degrees. According to the Mayo criteria system, the average score increased from preoperative 60.5 ± 13.4 to postoperative 88.7 ± 6.3; ten patients got an excellent result, 13 good and 4 fair. CONCLUSION: Arthroscopic surgery to treat elbow stiffness has such advantages as minimal invasion, less blood loss, fast recovery, and clear visualization, which is effective to improve elbow joint functions with less complications.

[Operative treatment of Dubberley type 3B capitulum-trochlea fractures].

OBJECTIVE: To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. METHODS: Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum- trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9 days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. RESULTS: All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). CONCLUSION: For Dubbelley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional

[Operative treatment of anterior olecranon fracture-dislocation].

OBJECTIVE: To investigate the method and effectiveness of operative treatment of anterior olecranon fracture-dislocation. METHODS: Between January 2007 and December 2010, 10 cases of anterior olecranon fracture-dislocation were treated. There were 6 males and 4 females with an average age of 46.1 years (range, 27-68 years). The injury was caused by traffic accident in 7 cases, falling from height in 2 cases, and falling in 1 case. Nine cases were fresh fracture and 1 case was old fracture. There were 9 cases of ulnar olecranon comminuted fracture and 1 case of simple oblique fracture. Associated fractures were Regan-Morrey type III coronoid process fractures in 5 cases, Mason type II radial head fracture in 1 case, and Mason type III radial head fracture in 1 case. Open reduction and internal fixation were performed in all cases: reconstruction plates were used in 4 cases, tension band and reconstruction plates in 5 cases, and tension band and one-third tubular plate in 1 case; bone graft was performed in 2 cases. RESULTS: All incisions healed by first intention. The patients were followed up 12-26 months (mean, 19.8 months). The X-ray films showed that fractures healing was achieved at 12-24 weeks (mean, 16.4 weeks). No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the elbow function score was 69-100 (mean, 89.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 4 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 80%. The Disability of Arm-Shoulder-Hand (DASH) score was 0-22 (mean, 9). The visual analogue score (VAS) was 0-3 (mean, 0.5). CONCLUSION: For anterior olecranon fracture-dislocation, an early and stable anatomic reconstruction of the trochlear notch of the ulna with plates and early active mobilization are given, the good functional results can be obtained.

[Treatment of humerus shaft fractures using minimally invasive percutaneous plate osteosynthesis through anterior approach].

OBJECTIVE: To discuss the method and effects of treatment of minimally invasive percutaneous plate osteosynthesis (MIPO) through anterior approach for the treatment of humerus shaft fractures. METHODS: 2006.1 to 2007.10,15 patients with humerus shaft fractures were treated with MIPO through anterior approach. There were 11 males and 4 females, ranging in age from 16 to 59 years, with an average of 35 years old. The duration of the disease was 7.5 days on average (5 to 10 days). Six patients had Type A fractures, 8 Type B, and 1 Type C according to AO classification. The AO LC-DCP with diameter of 4.5 mm was chosen in the operation. The patients were physically examined preoperatively and postoperatively, the range of motion of shoulder and elbow joint was observed, and the joint function was included. RESULTS: All the patients were followed up for a period ranging from 5 to 18 months,averaged 10 months. In terms of Gill ipsilateral total shoulder and elbow arthroplasties, 12 patients got an excellent result (> or = 80 scores), 3 good (between the scores of 66 and 79). The Gill score increased from preoperative (59.33 +/- 8.21) to postoperative (84.67 +/- 5.81). Fractures were healed after 2 to 3 months after operation, and patients resumed daily life without the complications of nervous lesion, incision infection, internal fixation failure and nonunion of fracture etc. CONCLUSION: It is feasible for the treatment of humerus shaft fracture using MIPO through anterior approach,to avoid radial nerve injury and to prompt fracture union.