• Journal of Acupuncture Research
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• 제36권1호
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• pp.50-54
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• 2019

The purpose of this case study is to examine the effects of Korean traditional medicine in the postoperative treatment of proximal humeral fracture. The patient with postoperative pain following proximal humeral fracture surgery was treated with Korean traditional medicine including acupuncture cupping therapy and herbal medicine in hospital for 67 days. The effects of the treatment were evaluated using the Numerical Rate Scale (NRS), Range Of Motion (ROM), and Shoulder Pain and Disability Index (SPADI). As a result of treatment, the NRS score was reduced from 7 to 3, the ROM was improved (on average by 21%), SPADI was reduced from 93 to 25.9. This study proposes that Korean traditional medicine may be effective in postoperative treatment for proximal humeral fracture.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.282-287
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• 2022

Background: Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity. Methods: A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. Results: There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only. Conclusions: Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.10-17
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• 2014

Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

• Clinics in Shoulder and Elbow
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• 제3권1호
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• pp.20-25
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• 2000

Purpose : To evaluate functional results and study factors influencing results after humeral hemiarthroplasty for comminuted fractures of the proximal humerus. Materials and Methods: We reviewed 12 patients with average follow-up period of 23 months(12 to 42). The proximal humeral fractures consisted of one anatomical neck fracture, five three-part and six four-part fractures or fracture-dislocations. Constant score and Compito et al' evaluation system were used for clinical assessment. Statistical analysis was done with the Wilcoxon test. Results: Six cases of anatomical neck, three-part fractures or fracture-dislocations showed 61 points on the average Constant score and three unsatisfactory results on the Compito et al' evaluation; Six of four-part fractures or fracture-dislocations showed 51 points and three unsatisfactory results. There were 59(two unsatisfactory) for five non-associated dislocation and 53(four unsatistactory) for seven associated dislocation; 66(one unsatisfactory) for three under 60 years and 41(five unsatisfactory) for nine over 60 years; 67(two unsatisfactory) for seven tuberosity union and 41(four unsatisfactory) for five tuberosity non-union or resorption; 58(four unsatisfactory) for ten early operation within two weeks and 43(all unsatisfactory) for two delayed operation; and 18(unsatisfactory) for one case of a accompanied rotator cuff tear. Conclusion: We concluded that tuberosity union was important factor influencing the results. Also, we thought that age, timing of operation and accompanied rotator cuff tear could be influenced to results.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.149-160
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• 2003

Purpose: to determine the results after open intramedullary nailing and tension band suture technique in proximal humerus fracture for improving the stability and decreasing the complications. Materials and Method: Authors reviewed 27 patients treated by open intramedullary nailing and tension band suture technique. Mean follow-up period was 39 months (24-59months). Surgical neck fracture were 6 cases, surgical neck fracture with shaft fracture were 3 cases, three part fracture with greater tuberosity fracture were 17 cases, four part fracture was 1 case and fracture and dislocation were 2 cases Results: We got the bony union in 26 cases. Average pain scale was 1 point (0-6), Neer score was 86 point(45-99) and ASES score was 85 point(40-100). We separate all cases in two groups based on age (65 years), L-spine t-score (-2.5) and Neer classification (2 and 3 part). There is no significance in pain scale, Neer score and ASES score between each group. Conclusion: As a method of surgical treatment on severe proximal humeral fractures, we recommend intramedullary nailing and tension band suture technique and it may have particular advantages in early exercise and satisfactory functional outcome.

• Clinics in Shoulder and Elbow
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• 제17권3호
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• pp.120-126
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• 2014

Background: To compare the treatment of the proximal humerus fracture using a Polarus nail or Philos plate, we aimed to analyze the functional recovery and the factors affecting the selection between the two types of surgery. Methods: The study included 107 patients with proximal humerus fracture who underwent surgery at our institution. Of these patients, 67 underwent surgery with Polarus nails (G1) and 40 with Philos plates (G2). In G1, the cases of two- and three-part fractures were 60 and 7 cases, in G2, the cases of two-, three-, and four-part fractures were 28, 10, and 2 cases, respectively. The average age was 61 years old, and the average follow-up period was 32.5 months. We compared radiological results, the functional recovery retrospectively. Results: The radiological union time was 6.8 weeks and 8.7 weeks on average in G1 and G2 (p < 0.05). At the one-year follow-up period, these were visual analogue scale (VAS) 1.355, forward flexion (FF) 130.968, external rotation (ER) 50.161, internal rotation (IR) L2 in G1, and VAS 0.781, FF 135.806 ER 51.25, IR L1 in G2, respectively, showing no significant differences between the two groups (p > 0.05). Similar observations were made at the final follow-up. In terms of functional recovery, no significant differences were seen at the one-year or at the final follow-up period (p > 0.05). Conclusions: For the surgical treatment of proximal humeral fracture, the selection of the type of surgery is affected by the fracture pattern. However, both methods give satisfactory outcomes and do not show significant differences in the functional outcome after the surgery.

• Clinics in Shoulder and Elbow
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• 제23권3호
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• pp.136-143
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• 2020

Background: The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive plate osteosynthesis (MIPO), in Neer's classification two-, threepart proximal humeral fractures. Methods: In this retrospective study, 77 patients with two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients, who underwent MIPO at one institution (group A), and 38 patients, who underwent a deltopectoral approach with allo-fibular bone graft (group B) at another institution. The results between the groups were compared. Results: The MIPO technique was significantly less time consuming and caused less bleeding than the deltopectoral approach with allo-fibular bone graft (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4; range, 10-22 weeks) compared to group B (16.4±4.3; range, 12-28) weeks (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores between the two groups, 1 year postoperatively. In radiological evaluation, there was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups. Conclusions: The MIPO technique and deltopectoral approach with allo-fibular bone graft for two-, three-part proximal humeral fractures, show similar clinical and radiological results. However, allogenous fibular grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than MIPO technique.

• 대한정형외과스포츠의학회:학술대회논문집
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• 대한정형외과스포츠의학회 2004년도 The 7th korea-japan joint meeting of orthopaedic sports medicine
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• pp.39-39
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• 2004

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.205-211
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• 1998

저자들은 상완골 근위부의 골절탈구로 일차성 견관절 반치환술로 치료받은 환자 25례중 14례를 대상으로 치료결과를 분석하여 다음과 같은 결론을 얻었다. 1. 전례에서 동통은 소실되거나 완화되었으나 Neer의 평가에 따라 총 14례중 5례에서만 만족할만 한 결과를 믿었으며 나머지 9례에서는 불만족한 결과를 보였다. 2. 수상시 상완곤두의 분쇄상이 심하거나, 수술이 지연되어 골편치 연화가 심한 경우 상완골 길이와 humeral offset의 유지가 힘들었으며, 견관절 반치환술 시팽한 측이 정상측보다 1cm 이상 단축을 보인 경우가 5례였으며 이 경우 능동적 견관절 운동범위가 정상측보다 감소되었다. 3. 견관절 반치환술은 분쇄상 상완골 근위부 골절에서 사용되어지며 동통의 감소와 기능의 호전은 있으나 완전한 회복은 어려우며 수술시 연부조직 손상이 적고 적당한 후염각, 결절의 재건 과 회전근개의 수복은 필수적이다. humeral offset과 길이의 유지는 술 후 능동적 견관절 운동 범위의 향상에 영향을 미치며 아울러 환자의 협조하에 체계적인 재활운동이 필요할 것으로 사료된다.