[Effect of primary neck-shaft angle after operation on the treatment of proximal humerus fracture by locking plate].

OBJECTIVE: To explore the effect of postoperative initial neck stem angle on the treatment of proximal humeral fractures with locking plate. METHODS: From June 2014 to Septembetr 2016, 62 patients with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed, including 29 males and 33 females with an average age of(55.95±9.48) years old ranging from 34 to 74 years old. According to the difference of the initial neck stem angle, the patients were divided into three groups, 15 patients in the varus group had less than 127° postoperative initial neck-shaft angle, 36 patients in the normal group had 127° to 145° postoperative initial neck-shaft angle, 11 patients in the valgus group had more than 145° postoperative initial neck-shaft angle. The operating time, fracture healing time, complications, the visual analogue scale(VAS) and shoulder functional Neer scores among three groups were compared for analysis. RESULTS: All 62 patients were followed up for 17.2 months(ranged 12 to 38 months). Operative time, fracture healing time and VAS were(2.37±0.59) hours, (3.99±0.48) months and(3.67±2.02) points in the varus group;(2.60±0.49) hours, (3.78±0.49) months and(3.22±2.06) points in the normal group;(2.75±0.39) hours, (3.82±0.42) months and (4.09±1.58) points in the valgus group. There was no statistical difference in operating time, fracture healing time and VAS among these groups(P>0.05). The Neer score(87.14±6.48) in the normal group and(84.31±9.05) in the valgus group was significantly better than(75.93±9.77) in the varus group (P<0.05). Among them, 4 cases occurred complications in the varus group;2 cases in the normal group;while no complication occurred in the valgus group. CONCLUSIONS: The internal fixation with locking plates of the proximal humerus fractures with postoperative initial neck-shaft angle more than 127° can reduce complications, improve shoulder function and allow for better postoperative outcome.

[Clinical study thoracolumbar Chance fractures: a report of 21 cases].

OBJECTIVE: To discuss the mechanism, clinical characteristics, diagnosis and treatment of thoracolumbar Chance fractures. METHODS: Among all the 21 patients, 13 patients were male and 8 patients were female, ranging in age from 23 to 57 years, with an average of 32 years. The injury was at the level of T11 in 3 patients, at the level of T12 in 9 patients, at the level of L1 in 8 patients and at the level of L2 in 1 patient. According to Denis classification, 10 patients were type A, 2 type B, 5 type C, and 4 type D. All the patients were treated with pedicle screw internal fixation and posterior lateral fusion at the level of injury. RESULTS: Twenty-one patients had been followed up for an average of 18 months (13 to 28 months). According to ASIA neurologic grading system, 4 cases in grade C or D recovered to grade E postoperatively and one case in grade B was not improved. Postoperative X-ray showed good reduction and fixation in all cases and no looseness or breakage in the fixation system. The results of postoperative back pain and function assessment were mostly satisfactory. CONCLUSION: Thoracolumbar Chance fractures are due to flexion-distraction injuries and regarded as unstable, which are uncommon and usually not present with a neurologic deficit. Reduction and stabilization with posterior pedicle screw internal fixation is suggested in patients with thoracolumbar Chance fractures.