Objective: To assess the short-term efficacy of reverse shoulder arthroplasty in the treatment of complex proximal humeral fractures in the elderly. Methods: Forty-three elderly patients treated operatively for complex proximal humeral fractures with reverse shoulder arthroplasty from July 2017 to January 2019 were retrospectively reviewed. To be specific, 12 males and 31 females were reviewed with an average age of 72.0 years (range, 66-78 years). All fractures were attributed to trauma and treated for 8.0 days on average (range, 6-11 days). As suggested from Neer classification, 21 cases (48.8%, 21/43) were threepart fractures, and 22 (51.2%, 22/43) were four-part fractures. To assess the postoperative efficacy, Visual Analog Scale (VAS), American Society of Shoulder and Elbow Surgery Shoulder Joint Score (ASES), Constant-Murley score and radiological examination were adopted. The Neer three-part fracture group and the Neer four-part fracture group were compared. Results: There was no significant difference in age, gender, operation time, and follow-up period between Neer threepart fracture group and Neer four-part fracture group. All operations were successfully performed, and the average operation time was 120-170 min, with an average of 141.3 min. Besides, the mean blood loss was 407.0 mL (250-700 mL), and the average intraoperative blood transfusion reached 446.5 mL (400-800 mL). All patients received the follow-up for 6 to 16 months, that is for 10.9 months on average. All patients were discharged in 7 days after operation, and no wound-related complications were identified. In 8 weeks, the greater and lesser tuberosities of all patients healed completely. During the last follow-up, no loosening or dislocation of prosthesis was detected, and the forward elevation of 133.0 (100-165), the external rotation of 29.5 (20-35), the internal rotation of 46.7 (30-60), the VAS score of 0.8(0-3), the ASES score of 89.1(78.8-100.0) were achieved. Constant-Murley score reached 88.7 (range, 70-98). There was no significant difference between Neer three-part fracture group and Neer four-part fracture group (P > 0.05). A 71-year-old patient developed the symptoms of axillary nerve injury after operation; he recovered completely at 6 weeks after the operation, which had not adversely affected the functional rehabilitation exercise or the stability of the prosthesis. At the follow-up, no other complications (e.g., infection, acromial stress fracture, and scapular notching) were identified in all patients. Conclusion: The short-term efficacy of one-stage reverse shoulder arthroplasty to treat complex proximal humeral fractures in the elderly is satisfactory.

ObjectiveCalcar comminution has been considered to be the main cause of the failure of internal fixation and fracture nonunion in proximal humerus surgery. Anatomical reduction and increasing the strength of internal fixation is the key to success. The purpose of this study was to investigate the short‐term clinical effect of dual plate fixation in the treatment of proximal humeral fractures with calcar comminution.MethodsThe data of 37 patients with proximal humeral fractures with calcar comminution, treated in our departments from July 2018 to April 2020, were retrospectively analyzed. These patients were treated with anterior plate and lateral PHILOS plate, and followed up for more than 12 months, including 25 cases in Tianjin Hospital and 12 cases in Shanghai General Hospital. The patients included 12 males and 25 females, their age was 54.89 ± 13.59 years (range from 32–79 years), and 21 patients had dominant hand injury. According to the Neer classification, there were 11 two‐part fractures, 22 three‐part fractures, and four four‐part fractures. The range of motion of the shoulder joint, visual analog scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant–Murley shoulder score, neck‐shaft angle, anterior–posterior angle, and other complication scores were recorded at the last follow‐up.ResultsAll 37 patients were followed up after operation, and the follow‐up time was 21.81 ± 7.35 months (range from 12–36 months). The fractures of all 37 patients had healed at the last follow‐up visit. The neck‐shaft angle measured immediately after operation was 132.59° ± 8.34°, and the neck‐shaft angle measured at the last follow‐up visit was 132.38 ± 8.53°. The anterior–posterior angle measured immediately after surgery was 3.45° ± 0.81°, and the anterior–posterior angle at the last follow‐up visit was 3.66° ± 0.77°. The range of motion of the shoulder joint was as follows: the shoulder joint could be forward elevated by 158.11° ± 13.09° (range: 140°–180°), rotated externally by 38.38° ± 7.55° (range: 20°–45°), and internally rotated to T4‐L4 level. The VAS score was 0.46 ± 0.87 (range: 0–3), the ASES was 86.58 ± 8.79 (range: 56.7–100), and the Constant–Murley score was 88.76 ± 8.25 (range: 60–100). Thirty‐three cases were excellent, and four cases were good. No obvious complications occurred.ConclusionThe combination of anterior plate and lateral PHILOS plate in the treatment of proximal humeral fractures with calcar comminution can achieve stable fixation, and the postoperative clinical and imaging outcome was satisfactory. Firstly, the anterior plate can provide temporary stability when the Kirschner wires are removed, which can provide space for lateral plate placement during fracture reduction and fixation. Secondly, additional support by the anterior plate can provide higher stability in complex fractures with calcar comminution.

ObjectiveAnterolateral coronal fractures are so rare that the mechanism of injury, the type of combined fracture and ligament injury, and the optimal treatment are unknown. To study the outcome of surgical treatments for anterolateral (AL) fracture of the ulna coronoid process (Adams Type IV) and summarize the characteristics of this type of fracture and to guide clinical applications.MethodsFrom February 2015 to April 2021, 32 patients were included in the study. All patients had standard radiography with anteroposterior and lateral views, computed tomography, and intraoperative fluoroscopy. All patients were treated surgically. Surgery‐related information, including surgical approach, operation duration, blood loss, and repairing the lateral collateral ligament and the medial collateral ligament integrity, were recorded. The patient's clinical details, such as the final range of motion (ROM), the Broberg–Morrey scores and the visual analogue scale (VAS) at the last follow‐up, were described. The chi‐square test or Fisher's exact test was used for statistical analysis.ResultsWe divided patients into two groups according to the anterolateral coronoid fracture morphology. In the intact group, 20 patients with an intact anterolateral coronoid fracture fragment. In the comminuted group, 12 patients with comminuted anterolateral coronoid fracture fragments extended the less sigmoid notch of the ulna. There was no difference in age, sex, total incision length, follow‐up duration, and recovery with rehabilitation among the two groups (all Ps >0.05). The other follow‐up outcomes, such as elbow ROM (Flexion, Extension, Posterior rotation, Anterior rotation), VAS score, or Broberg–Morrey scores, were not different between the two groups (all Ps >0.05). Both groups achieved relatively satisfactory clinical outcomes, and the Broberg–Morrey score and index excellence rate reached 84.38%. There is a statistical difference in the history of elbow dislocation (P = 0.017), radial head fracture type (P = 0.041), operation duration (P = 0.014) and blood loss at operation (P = 0.029) between the two groups. Cannulated screws, anchors, and sutures were used as point fixation in the coronoid process of the ulna. There was a statistical difference between the two groups in the choice of internal fixation (P = 0.020).ConclusionsFor anterolateral ulnar coronoid fractures with different degrees of comminution, effective and reliable surgical treatment can achieve better results and fewer complications.