Application of “door-shaft method” in limited open reduction and internal fixation with locking plate for two- and three-part fractures of the proximal humerus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Xiaopeng ^1,2 , TANG Xiaoyu ² , FENG Jian ² , ZOU Yiyuan ² , ZHENG Xinbo ²

1. Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. Department of Upper Limb, No.1 Orthopedics Hospital of Chengdu, Chengdu Qingyang District Medical Center Hospital, Chengdu Sichuan, 610073, P.R.China;

Corresponding?author：

WANG Xiaopeng, Email: flasheyes@163.com

Keywords：

Proximal humeral fracture; door-shaft method; limited open reduction; locking plate; internal fixation

DOI：

10.7507/1002-1892.202103173

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Objective To investigate the effectiveness of limited open reduction via “door-shaft method” and internal fixation with locking plate for two- and three-part fractures of the proximal humerus.Methods The clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via “door-shaft method” and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard.Results The operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36).Conclusion The “door-shaft method” not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness.

Citation： WANG Xiaopeng, TANG Xiaoyu, FENG Jian, ZOU Yiyuan, ZHENG Xinbo. Application of “door-shaft method” in limited open reduction and internal fixation with locking plate for two- and three-part fractures of the proximal humerus. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(7): 818-822. doi: 10.7507/1002-1892.202103173 Copy

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2.	Beeres FJP, Quaile OM, Link BC, et al. Reduction techniques for minimally invasive stabilization of proximal humeral fractures. Oper Orthop Traumatol, 2019, 31(1): 63-80.
3.	Fisher ND, Barger JM, Driesman AS, et al. Fracture severity based on classification does not predict outcome following proximal humerus fracture. Orthopedics, 2017, 40(6): 368-374.
4.	Maroun C, Aliani D, Hass A, et al. Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years. Eur J Orthop Surg Traumatol, 2017, 27(3): 317-321.
5.	Chamseddine AH, El-Hajj OM, Haidar IM, et al. Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures. International Orthopaedics, 2021, 45(1): 253-263.
6.	Buranaphatthana T, Apivatthakakul T, Apivatthakakul V. Anteromedial minimally invasive plate osteosynthesis (MIPO) for distal third humeral shaft fractures–Is it possible?: A cadaveric study. Injury, 2019, 50(6): 1166-1174.
7.	張英澤. 骨折順勢復位固定理論在創傷骨科中的應用. 中華創傷雜志, 2017, 33(7): 577-580.
8.	Kim JY, Lee J, Kim SH. Comparison between MIPO and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures. Clin Shoulder Elb, 2020, 23(3): 136-143.
9.	Gardner MJ, Griffith MH, Dines JS, et al. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res, 2005, (434): 123-129.
10.	Fox O, Lorentzos P, Farhat M, et al. The change in position of the axillary nerve with rotation of the arm. Clin Anat, 2019, 32(2): 268-271.
11.	Simone JP, Streubel PN, Sanchez-Sotelo J, et al. Change in the distance from the axillary nerve to the glenohumeral joint wth shoulder external rotation or abduction position. Hand (N Y), 2017, 12(4): 395-400.
12.	盛寧, 褚光宇, 石文亭, 等. 肱骨近端雙結節鎖定鋼板治療肱骨近端骨折. 中華骨科雜志, 2020, 40(11): 726-733.

1. G?n? U, Atabek M, Teker K, et al. Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures. Acta Orthop Traumatol Turc, 2017, 51(1): 17-22.
2. Beeres FJP, Quaile OM, Link BC, et al. Reduction techniques for minimally invasive stabilization of proximal humeral fractures. Oper Orthop Traumatol, 2019, 31(1): 63-80.
3. Fisher ND, Barger JM, Driesman AS, et al. Fracture severity based on classification does not predict outcome following proximal humerus fracture. Orthopedics, 2017, 40(6): 368-374.
4. Maroun C, Aliani D, Hass A, et al. Shoulder arthroscopy combined to hardware removal in proximal humeral fractures: a series of 58 cases with a mean follow-up of 2 years. Eur J Orthop Surg Traumatol, 2017, 27(3): 317-321.
5. Chamseddine AH, El-Hajj OM, Haidar IM, et al. Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures. International Orthopaedics, 2021, 45(1): 253-263.
6. Buranaphatthana T, Apivatthakakul T, Apivatthakakul V. Anteromedial minimally invasive plate osteosynthesis (MIPO) for distal third humeral shaft fractures–Is it possible?: A cadaveric study. Injury, 2019, 50(6): 1166-1174.
7. 張英澤. 骨折順勢復位固定理論在創傷骨科中的應用. 中華創傷雜志, 2017, 33(7): 577-580.
8. Kim JY, Lee J, Kim SH. Comparison between MIPO and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures. Clin Shoulder Elb, 2020, 23(3): 136-143.
9. Gardner MJ, Griffith MH, Dines JS, et al. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res, 2005, (434): 123-129.
10. Fox O, Lorentzos P, Farhat M, et al. The change in position of the axillary nerve with rotation of the arm. Clin Anat, 2019, 32(2): 268-271.
11. Simone JP, Streubel PN, Sanchez-Sotelo J, et al. Change in the distance from the axillary nerve to the glenohumeral joint wth shoulder external rotation or abduction position. Hand (N Y), 2017, 12(4): 395-400.
12. 盛寧, 褚光宇, 石文亭, 等. 肱骨近端雙結節鎖定鋼板治療肱骨近端骨折. 中華骨科雜志, 2020, 40(11): 726-733.

Chinese Journal of Reparative and Reconstructive Surgery

Application of “door-shaft method” in limited open reduction and internal fixation with locking plate for two- and three-part fractures of the proximal humerus

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