Tactics of surgical treatment of fractures of the proximal humerus



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BACKGROUND: Based on the analysis of the literature data, there is no single treatment tactic, the existence of clear objective indications for osteosynthesis of the humerus or endoprosthetics of the shoulder joint in fractures.

AIM: Development of an algorithm of diagnostic measures for the purpose of a differentiated approach to surgical treatment in the surgical treatment of fractures of the humerus.

MATERIALS AND METHODS: The present study is a pilot, single-center, retrospective, observational cohort study with a consecutive sample, comparing quantitative and qualitative data between two patient groups. The results of treatment of 50 patients with fractures of the proximal metaepiphysis of the humerus, operated in the period from 2019 to 2022, were studied. All patients underwent multispiral computed tomography of the shoulder joint. According to CT data, Hounsfield units of humerus fragments were calculated. Prognostically, with indicators of Hounsfield units below 65, which corresponds to a pronounced decrease in bone density of fragments and regional / systemic osteoporosis, osteosynthesis may be unpromising, the risks of instability of the metal structure, secondary displacement of fragments, non-fusion of the fracture zone are increased. With satisfactory bone density indices, methods of osteosynthesis of humerus fractures were used. Reversible shoulder joint replacement was performed in patients with unpromising fractures for reconstruction. Functional, clinical and radiological results of surgical treatment of both groups of patients were evaluated. Functional and clinical results were assessed using the questionnaire The Disabilities of the Arm, Shoulder and Hand (DASH).

RESULTS: According to the results of observation of the treatment results of a group of patients with prospective follow-up, such adverse outcomes of osteosynthesis as non-fusion of fragments and their aseptic necrosis were not observed. There were no purulent-inflammatory complications. Fracture consolidation was achieved, and excellent functional results were obtained in all patients who underwent osteosynthesis and shoulder joint replacement.

CONCLUSIONS: The measurement of Hounsfield units of fragments is an objective quantitative criterion for assessing bone density and predicting prospects for osteosynthesis of fractures.

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作者简介

Gurgen Kesyan

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: kesyan.gurgen@yandex.ru
ORCID iD: 0000-0003-1933-1822
SPIN 代码: 8960-7440

MD, PhD, Dr. Sci. (Med.), traumatologist-orthopedist

俄罗斯联邦, 10, Priorova str., 127299, Moscow

Grigoriy Karapetyan

N.N. Priorov National Medical Research Center of Traumatology and Orthopedics

Email: dr.karapetian@mail.ru
ORCID iD: 0000-0002-3172-0161
SPIN 代码: 6025-2377

MD, PhD, Cand. Sci. (Med.), traumatologist-orthopedist

俄罗斯联邦, 10 Priorova str., 127299, Moscow

Artuom Shuyskiy

National Medical Research Center of Traumatology and Orthopedics of N.N. Priorov

编辑信件的主要联系方式.
Email: shuj-artyom@mail.ru
ORCID iD: 0000-0002-9028-3969
SPIN 代码: 6125-1792

no title, post-graduate student, Department of Adult Orthopedics

俄罗斯联邦, Россия, 127299, Москва, ул. Приорова, д. 10

参考

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